Report From the Front Lines, Ambulatory Reform, and Practice Management Opportunities in the COVID-19 Era

We are living in a time of extreme parallel pandemic universes; of literally "normal" life versus COVID-19 fear, illness, or death; COVID-19-related economic privation or, for now, Wall Street results that do not compute for most Americans. At the human/clinical level this week, I negotiated with a patient to get out of quarantine after being symptomatically COVID-19 positive; a young person with a rapidly expanding bald spot that he and I attribute to the stresses of not finding enough work in a COVID-19 economy; and another death caused by complications of Alzheimer disease and exacerbated by her COVID-19. But in a sign of the era we live in-was the COVID-19 gone by the time that she died? If no, the family cannot view the body. That is the question I am researching as I write this From the Editor column. While we are learning a great deal about COVID-19, there is much we do not know about, for example, the impact of COVID-19 on our body systems.

This entire issue is thus appropriately devoted to the greatest health care challenge of my lifetime-the COVID-19 pandemic, which as of this writing is only becoming more widespread and more deadly. We attack this topic from a variety of perspectives.

Lee Rosenthal, Bob Crittenden, Kuhn, Katherine Helfin, and Pierce in separate articles provide an intimate view into what is happening on the ground during this time of the pandemic. We continue our abiding focus on community health workers not just with our frontline reports but also with the article by Johnson on national community health worker response.

In the last issue of the journal, we had several articles highlighting opportunities for fundamental reform of our health care system in this time of the COVID-19 pandemic. We continue that in the current issue with articles by Thiessen and Nesin on the evolving role of pharmacists that need to be considered, especially at this time. Wasson emphasizes the importance of consumer confidence if we are ever to make a serious commitment to population health.

Another critical aspect of health reform is reimbursement of non-face-to-face encounters in ambulatory care practice. This section is led by an important effort by Wharton and colleagues to understand with an in-depth interview on reimbursement issues for this type of visit. O'Malley and Wasson in separate articles comment on this important issue. Mishori addresses important issues of telehealth and rural health care in an era of the COVID-19 pandemic.

Finally, Murphy assesses practical issues of reopening practices in a COVID-19 pandemic era.

Two headlines from today's Washington Post hammers home the parallel universes that we are living through in the United States: Time to Shut Down Again? And Trump Sidelines Health Advisers in Rift Over Coronavirus Response. There needs to be a reset on the dialogue at least at a state level between politicians and health professionals. That reset could lead to a renewed public dialogue that takes into account the many unknowns while highlighting what we do know about COVID-19. This issue of the journal is intended to contribute to that conversation between politicians and health professionals.

-Norbert I. Goldfield, MD

Editor