Perspectives in Primary Care features writing from practitioners, activists, and community members representing organizations, practices, and institutions across the United States and around the world.

“Some New Kind of Infection or Plague:"  The 1918 Flu Pandemic & COVID-19

A humbling sense of medical uncertainty. Tensions between public health concerns versus economic consequences for shuttered businesses. Public recognition of heroic healthcare workers, especially nurses. Concern over the standards used to gauge therapeutic efficacy. Even homemade masks. Such tensions and tropes of course color our contemporary experience of the COVID-19 pandemic, but they likewise appeared throughout the 1918 influenza pandemic ...

Immigrant Health, COVID-19, and the Duty to Care

Three months ago, the novel coronavirus arrived in the Boston area. It struck first in wealthy communities of international business travelers and exchange students, then spread quickly to the low-income and immigrant neighborhoods of their housekeepers and personal care attendants. Fear in communities of privilege led to early characterizations of COVID-19 as a disease that doesn’t discriminate. But the disease’s case rate in Chelsea, MA (majority Latinx, poor and working-class) is now

In Times of Crisis, Family Medicine Rises to the Challenge

We are all looking forward to the day when COVID-19 no longer dominates the news cycle, nor our lives. The ongoing conversations about treatment, improving preparedness, and how we move forward are vital and must continue. However, I would like to make a quick aside to these discussions and share why I am grateful for my Family Medicine training. A crisis is not a common time for gratitude, and I admit that I have felt plenty of despair during this pandemic. All the same a recurring thought keeps coming to me that provides me with some comfort: “I was trained really, really well.” My ...

Caring for Women Who are Homeless During COVID-19

We doctors don’t like to feel helpless. It’s a real comeuppance when we are faced with an unknown entity so vast, so consuming of resources, and so perplexing even to the giants of medicine. And devastating. Robbing lives too soon. Stealing goodbyes and last hugs. I’ve been here before. The emergence of HIV/AIDS happened during my residency. Thousands of young gay men died from opportunistic infections. It was years before they identified the virus and discovered treatment regimens that contained—and still haven’t cured—that virus. I remember standing in the ...

The Coronavirus Does Discriminate: How Social Conditions are Shaping the COVID-19 Pandemic

Part of this developing crisis is very well known: On December 31, 2019, Chinese officials reported a cluster of pneumonia cases in Wuhan and identified the novel coronavirus as the causative agent on January 7, 2020. This novel coronavirus spread rapidly, and on March 11, 2020, the

Boston MedFlight Playing a Vital Role in New England’s COVID-19 Response

Boston MedFlight is a 501(c)(3) nonprofit organization that for 35 years has provided critical care transport to patients in need by air and ground. We care for more than 4,700 patients annually, including the most critically ill and injured infants, children and adults. As a nonprofit, our organization provides over $4 million in free and unreimbursed care to patients in need with little or no medical insurance. We have always served as the link between community hospitals and larger tertiary care facilities. Now, as our region and our nation face the COVID-19 pandemic, ...

A Second, Silent Pandemic: Sexual Violence in the time of COVID-19

What happens when “safer-at-home” doesn’t apply to everyone? NOTE: The term sexual violence refers to crimes like sexual assault, rape, and sexual abuse, which can be perpetrated by anyone. Domestic violence includes emotional, physical, and/or sexual harm by a current or former intimate partner. Research into the specific types of violence ...

Primary Care and COVID: Our Role in Flattening the Curve

As it became apparent in early March that COVID would become a global and not only local problem, health systems had to transition from a focus on individual patients who might have been exposed to thinking about a population-guided response. Thus, Cambridge Health Alliance (CHA), an academic community healthcare system based in the Boston area, developed a comprehensive plan for COVID guided by the goal of “most lives and life years saved” that spanned both the hospital and the ambulatory space. This transition happened urgently and iteratively: in a few short weeks, we went from ...

The Forgotten Specialty: Primary Care

As the COVID pandemic devastates the United States, comorbidity has been identified as one of the key factors that increases risk for serious complications. Chronic disease burden in the US, including hypertension, heart disease, diabetes, chronic lung disease, and arthritis, is 28%, compared to the Organization for Economic Cooperation and Development (OECD) average of 17.5%. Furthermore,