Column: Care for chronic illness still available during COVID-19 pandemic

Currently we as a health care community are appropriately focused on preparing for the COVID-19 pandemic. Our emergency room physicians, hospitalists and critical care physicians are heroically caring for these patients in our local hospitals.

In my role as a movement disorder neurologist at The Queen’s Medical Center, my practice is mostly office-based and centers around the care of Parkinson’s disease and other chronic neurodegenerative disease. I may never provide acute care for a COVID-19 patient, but the pandemic has dramatically changed how I provide care to my patients.

Many of my patients are elderly and frail, the group at highest risk for poor outcomes if infected with COVID-19, but they still require care for their chronic illness.

How has my practice changed?

I still go to the office every weekday. Our practice is open, but I see very few of my patients in the office. Under the leadership of Dr. Matthew Koenig, 80-90% of our in-person clinic visits have converted to telehealth/virtual visits, where we provide care remotely via video platform. This has helped ensure that patients continue to have access to the care they need but avoid having to come to the office.

For the few patients who need in-person visits, we prescreen for signs of illness before their appointment and the staff performs temperature checks on all people who enter our building. These precautions are both to protect the patients, but also to ensure our providers and staff do not become ill due to occupational exposure to the virus.

What am I recommending for my patients during this time of social distancing?

Patients with chronic neurological illness, such as Parkinson’s disease, multiple sclerosis, stroke and epilepsy still need care during this crisis. We are very concerned about their health and well-being. Anxiety runs very high in this difficult time.

I start with the basics. Hand washing, hygiene and social distancing. I recommend patients focus on what they can control and take an active role in improving their lifestyle. Paying attention to daily routine, exercise, diet, bowel habit and sleep hygiene are extremely important for patients with chronic diseases like Parkinson’s disease.

Patients need to be active to prevent decondition. I recommend taking a walk (if safe, with social distancing) or try an online exercise class. There are many commercially available online programs, and locally, the Hawaii Parkinson’s Association has posted information on online exercise alternatives on its website.

How can you help the vulnerable population?

We are in a difficult time, but I am heartened by the many acts of grace and charity that have occurred during the crisis. We have seen an outpouring donation of PPE (personal protective equipment) to the hospital, witnessed significant volunteerism, and watched our community coming together to flatten the curve.

Social isolation for patients with chronic illness and disabilities is a big concern. We must look out for these vulnerable populations as recommendation for social distancing enters weeks to months. Please help get their supplies and make sure they are taking their medications. Please assist them if they need help with technology, or transportation to a provider.

If you need care for your chronic condition, we are still open and available so please do not hesitate to contact your health care provider. We will continue to provide care, by virtual health, or in person if necessary.

Michiko Kimura Bruno, M.D., is medical director of the Parkinson’s and Movement Disorder Center and Neuroscience Institute Outpatient Clinic at Queen’s Medical Center.