The Five Phases of Pandemic Care for Primary Care

Abstract

During a pandemic, many more patients than usual are likely to have symptoms, and many of them will seek care. Nearly all will need primary care, and primary care will need to be there to help them. In 2014, the CDC issued a framework to address the influenza pandemia, describing six intervals, from investigation of cases of novel influenza through preparation for future pandemic waves. This is a great public health framework, but it does not address the specific needs of primary care practices. We propose a framework, in waves, that parallels the CDC's. All communities in the US will go through all waves, but to different degrees and at different times. There may be others that we do not anticipate, some will happen simultaneously, some will repeat themselves, and the cycle will happen again as COVID-19 changes and re-infects our communities. With each wave, primary care will need to continuously reinvent and transform itself. And throughout, primary care will need to provide usual care, including managing chronic conditions, addressing new acute problems, and promoting prevention. One thing is clear: if primary care does not do well in this crisis, the system will be completely overwhelmed. If primary care does everything perfectly, the system will just be overwhelmed. Either way, there is a tough road ahead, and there are thousands of natural experiments occurring across the nation. It is critical to learn from these experiences and to be prepared for next time. The transformations present an opportunity for our health system to evolve, build informatics infrastructure, expand digital health, support diverse multidisciplinary teams to care for patients across settings, fix payment to enable comprehensive, continuous care, and convert to a true community-based focus for patient-centered and population-focused care that helps all in need.