Ongoing Role of Primary Care in
Management of Covid-19

By Paul E. Lemanski, MD, MS, FACP

In my first six articles on Covid-19, I have stressed that the lifestyle approach of proven risk mitigation strategies – including masking, social distancing, handwashing and targeting quarantine – were essential to protecting us until natural infection (despite properly executed strategies) or preferably a vaccine had produced antibodies in the blood of a sufficient number of individuals – approximately 80% of the population – to achieve herd immunity and stop transmission of the virus (see Non-Medicated Life, February 2021). 

While a sizable number of individuals have already been vaccinated to add to those recovering from natural infection, the total percentage may still fall short of this important goal. I would suggest that Primary Care Physicians/Providers are uniquely qualified to help those remaining not vaccinated to make an informed decision regarding vaccination.

To be sure, up until the availability of vaccine, PCPs have played a major role in helping manage the pandemic. They have been at the forefront of advocating the lifestyle-based risk mitigation strategies outlined above and helping patients wade through complex, frequent, and evolving changes in CDC and NYSDOH recommendations. They have been the first point of contact and the source of ongoing monitoring when patients were exposed to the virus and/or developed cough, shortness of breath or fever. They helped patients determine when to be tested for the virus, how to manage a positive test for the virus, and when to go to the hospital. 

More recently, when younger individuals with medical problems were approved by NYSDOH for vaccination, PCPs helped identify this group for vaccination and provide letters to bring to vaccination sites. Because of a paucity of tests kits and the complex logistics of testing in an office setting, PCPs were not involved in actual Covid-19 testing; additionally, since the availability of vaccines, larger venues including pharmacies have offered a more streamlined means of vaccinating those willing to be vaccinated.

However, as the numbers of those willing to be vaccinated have been accommodated by increased vaccine production and availability, those individuals who are currently refusing vaccine, or are not sure they wish to be vaccinated need a sounding board for their concerns, and help in finalizing their decision in an informed way – informed both by the best and most recent data available on the vaccines known risks and side effects and by the medical knowledge of those familiar with the risks a particular individual may take in refusing vaccination. This is a role tailor made for the PCP.

PCPs know the medical problems of their patients. They also know which medical problems increase the risk of a bad outcome with Covid-19. Such information is critical to a discussion of vaccination. Moreover, PCPs monitor the side effect profile of the available vaccines as that information becomes evident not only from longer term ongoing data from the thousands of individuals involved in the original clinical trials, but also from the millions of individuals now vaccinated. For individuals at low risk – younger and without medical problems – it may seem prudent or at least not foolhardy to wait while more data is collected. But for those older or at higher risk because of medical problems the risk of a bad outcome increases substantially.

As I wrote previously, “Certainly, the decision to be vaccinated is a personal one. And there are always unknowns. But subjecting the Moderna and Pfizer vaccines to a risk/benefit analysis, in my opinion, argues strongly for vaccination. I have been vaccinated. I encourage my family to be vaccinated. I encourage my patients to be vaccinated. The way I see it, this virus is so transmissible (and with certain mutations the transmission has been shown to actually increase), that eventually everyone not vaccinated, will become naturally infected. Then, it becomes a roll of the dice determining if you are an individual who will have severe disease or even death.”

The Moderna and Pfizer vaccines do employ a new mRNA technology to help the body to produce antibodies to the spike protein of the SARS CoV-2 virus that causes Covid-19. Some have suggested that this may alter an individual’s DNA. While not true, it is a reasonable question to put to your PCP. A full discussion of this concern may allow an individual to separate the “wheat from the chaff” and especially when addressed by your PCP – who you know and trust – a more informed decision regarding vaccination may be made. Moreover, the Johnson & Johnson vaccine has recently been approved by FDA and is NOT made with the new mRNA technology. Again, a discussion of such details with your PCP may allow an appropriate decision on vaccination to be made.

Finally, recent preliminary data suggests that the sooner herd immunity is achieved the lower the risk of a mutation or a so called “variant” arising that would be able to escape vaccine neutralization. Also, preliminary data suggests that the currently available vaccines appear to not only prevent severe disease, but also to decrease the rate of transmission. Such data would suggest that the sooner herd immunity is achieved, the sooner we can put an end to the unchecked spread of Covid-19. 

Time is of the essence and, thus, those who currently do not want a vaccine and those who are unsure if they want a vaccine, should initiate a conversation ASAP with their PCP to discuss their concerns and make a truly informed decision on vaccination. The health of all of us may depend on it!

Paul E. Lemanski, MD, MS, FACP is a board-certified internist practicing internal medicine and lifestyle medicine in Albany (centerforpreventivemedicine.com). Paul has a master’s degree in human nutrition, he’s an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.