Last week, I wrote about public health authorities’ failure to unite Americans around adopting preventive measures that reduce the spread of COVID, which is now a constant backdrop to our lives, whether we acknowledge its impact or ignore it. Those communicating about public health issues and emergency measures need to move past the old approach of using one-size-fits-all mass messages and begin to think about targeting people most at risk – and those with the most to lose: their lives.
Among those with the most significant risk are older Americans with chronic conditions. From the earliest stages of the pandemic until now, COVID hospitalizations have been six times higher and deaths 12 times higher for people with underlying medical (i.e., non-communicable diseases – NCDs) conditions such as diabetes, heart disease, or chronic lung disease. Currently, 81% of COVID deaths occur in people over age 65. The number of deaths among people over age 65 is 97 times higher than that among people ages 18-29. It’s a dangerous situation that we can overcome if we prepare before the next pandemic wave.
COVID + Diabetes = Serious Risk
For example, consider the brutal truth about one of the deadliest comorbidities in COVID at-risk communities: diabetes.
- Diabetes disproportionately affects racial/ethnic minority populations. Compared with white adults, the risk of having a diabetes diagnosis is 77% higher among African Americans, 66% higher among Latinos/Hispanics, and 18% higher among Asian Americans
- Diabetes prevalence is approximately 17% higher in rural areas than in urban areas, with studies showing that rural adults were more likely to report a diagnosis of diabetes than urban counterparts
- Some 33% of adults aged 65 or older have pre- or Type 2 diabetes. This age group is more at risk of developing diabetes-related complications like low blood sugar, kidney failure, and heart disease than younger people.
The scale of this patient challenge is immense. Approximately 84 million adults — more than 1 in 3 Americans — have prediabetes. According to the Centers for Disease Control (CDC), 90% of people with prediabetes do not know they have it; neither do they know that if left unchecked, it may lead to Type 2 diabetes.
Though its symptoms are subtle, prediabetes is insidious, and as with elevated blood pressure and high cholesterol, it can quickly become deadly. Add another pandemic into the mix, and we know where our subsequent waves of hospitalizations and deaths will come from: seniors, people of color, and rural Americans. We are not prepared, but if we recognize the risk and mobilize health professionals now, we will save lives later.
Further complicating our ability to address this threat is our disregard for prediabetes. For many people, prediabetes means, “Whew! I don’t have diabetes.” But prediabetes requires critical intervention and requires patients to change their behavior. Public health leaders must organize payers, patient groups, and providers – especially pharmacists and long-term care pharmacists – and that must happen before the next pandemic hits. We must get smarter and faster and not wait until the coffins pile up.
Primary Care Has A Change of Address
While this pressing public health threat becomes more urgent, our front-line defense, primary care, undergoes retreat in some cases and fundamentally changes to a retail pharmacy setting in others. These changes may presage increased access to care for some. Conversely, it could allow older patients to fall through the cracks in the face of the growing threat of non-communicable illnesses such as diabetes.
Historically, primary care providers diagnosed, treated, and engaged these consumers. Can walk-in services alleviate people’s ongoing care burden and be ready for the next pandemic? Corporate and clinical leaders of the mega-chains and community retail pharmacies retail must rally these sites to be front-line communicators regarding non-communicable illnesses, especially prediabetes. Pharmacies are no longer just locations where you can grab a jab – an immunization, vaccine, or booster. Pharmacists will need greater input and support as we go forward and face emerging pandemics.
The ability to walk into a CVS MinuteClinic, Walgreen Health Corner, or Walmart Health for primary care is a win for access to manage pressing health needs. But will ongoing, long-term preventive care — featuring a plan for wellness care instead of sick care — be addressed at these sites? People “shop around” for medical convenience and not necessarily for provider relationships, another reason retail clinics need to be part of the preventive care solution.
Today, fewer and fewer people have a long-term family physician who tracks their needs and feels responsible for their longevity. The single-practitioner office is now being absorbed into larger practice groups and private practices are vanishing. Without the diagnostic oversight a trusted healthcare provider offers, we are missing an essential link between urgent and specialty care, prevention and illness, and prediabetes and diabetes.
Weathering the Storm
It is a perfect storm. Poorer diet, higher sugar intake, and increasingly sedentary lifestyle lead to prediabetes, which isn’t straightforward to diagnose and is often not taken seriously by patients. And, as we have seen, the essential player in defense against the condition — the primary care physician — is beginning to step off the stage.
To meet the challenges posed by diabetes/prediabetes epidemic, the lack of primary care patient support, and the persistent threats posed by COVID and other pandemics which will emerge, we need to consider the following actions:
- Easy-Access Diagnostics Technologies – Retail pharmacies must ally with point-of-care and home-testing companies such as Babson Diagnostics and ixlayer. Consumers at risk must be empowered to take greater responsibility for their well-being. Give people with NCDs easily accessible tools to be full partners in preventive care.
- Find a Digital Connection – Netflix pings us about movies and TV shows that might attract our interest. Political parties use texts and email to rally the faithful. It’s time health insurance companies and the CDC find creative ways to enter the game using AI and digital health to establish closer relationships with consumers, helping people with diabetes to become aware of and purchase products to address their healthy lifestyle needs. Keeping people alive and well is a mutual interest of insurers and the CDC.
- Deputize Pharmacists:Pharmacists were always able to do much more than give shots, and now primary care nurses and assistants have found a home in retail pharmacies. CDC and physician associations need to recognize that seniors and people with diabetes increasingly see pharmacy as a go-to for questions, easily accessible solutions, and vaccinations. The American Pharmacists Association is raising the bar on public health resources.
- Start Talking to People: There is “no one-size fits all” effective way to communicate about COVID-19. The 65+ community faces different risks than the 15-and-under crowd. People with diabetes and heart disease face heightened risks from COVID. People of color are often at particular risk for these illnesses, compounded by COVID. The CDC needs to address people’s specific needs and risks better. People are tired of hearing about COVID. They are less worn out from hearing about what matters to their particular interests.
CDC is the target of many critiques right now. More than 80 years ago, British Wartime Prime Minister Winston Churchill told the New Statesman: “Criticism may not be agreeable, but it is necessary. It fulfills the same function as pain in the human body. It calls attention to an unhealthy state of things.” For people in science, failure does not mean the end – it’s the rocket fuel of future success. The CDC will learn from the COVID chapter and return ready for the next viral confrontation. Our lives depend on its success.