Presented by Alaska Native Tribal Health Consortium

As societies grapple with a worldwide pandemic, routine health care has never been more important. At the same time, data indicates that many people are delaying treatments and even preventive care due to fears and anxiety about the COVID-19 virus.

In Alaska, most medical procedures were put on hold for nearly two months. Now, clinics are opening back up, but not everyone is eager to see their doctors again.

“Some patients are quite nervous about returning to a hospital environment,” said Dr. Anusiyanthan Mariampillai, service chief and oncologist at the Alaska Native Tribal Health Consortium.

Some have canceled appointments. Others aren’t sure how to safely travel to and from Anchorage for care.

“My only worry is that, because of COVID-19, if people are not doing their preventive measures, we’re going to see an increase in cancer rates down the road,” Mariampillai said.

Experts agree that pandemic or not, preventive care is necessary. Clinical staff have adjusted their own practices to keep you safe during visits, and have outlined some steps for everyone to practice preventive care without even stepping foot in a doctor’s office.

Preventive care: The importance of seeing your doctor

Alaska is not alone. Reports of patients delaying procedures -- even in face of potentially catastrophic results -- are cropping up across the nation.

One study out of Northern California showed a nearly 50 percent drop in heart attack admissions. Another found that patients across the U.S. were likely deferring care for acute conditions including epilepsy and seizures.

In May, the Alaska Vaccine Tracking System showed child vaccine rates were down by 50 percent compared to last year. “Low vaccine rates could lead to outbreaks of diseases such as measles and pertussis,” a release said.

Alaskans face unique challenges in access to care. In some communities, travel to and from hospitals can be tough, especially now, when travel is difficult, Mariampillai said.

The Centers for Disease Control & Prevention tracks preventive health care data, including states where residents are most likely to have had a routine checkup within the past year. Alaska ranks in the bottom five. Almost 30 percent of Alaskans report that it has been more than a year since their last checkup, and more than 10 percent say it’s been five or more years -- or that they’ve never been at all.

“We don’t utilize primary care,” said Jessica Quinn, manager of the Comprehensive Cancer Control Program at the State of Alaska. Whether cancer, heart disease, diabetes, routine check-ups or immunizations, preventive care helps to stop a disease before it even begins, Quinn said.

Alaska Native people are diagnosed with colorectal or colon cancer at the highest rates in the world. When you have a primary care provider, you’re more likely to be up-to-date on colorectal cancer screenings, Quinn said.

One way providers can increase access is through telemedicine. ANTHC was already heavily invested in telehealth practices, during which a patient is seen virtually. But since the pandemic, those numbers have increased to up to one quarter of all their visits.

Delayed care comes with a cost

For people at higher risk of disease, preventive care can mean the difference between an easily-treated illness and a life-threatening one, according to Judith Muller, a two-time breast cancer survivor and the cancer plan manager at ANTHC.

Many community events are held across Alaska to promote cancer screenings in March, which is designated as colorectal cancer month. But this year those events were canceled due to the pandemic.

After months of health care facilities delaying non-urgent care, Muller is now focused on getting patients back to their health care provider for screening. She recommends Alaskans call their health care providers to see if it’s time to schedule an appointment.

Each year, there are about 425 Alaska Native people diagnosed with cancer, according to Muller. If 25 percent of those diagnoses are missed, that translates to more than 100 people.

“That means 100 people who may have cancer that might have been found,” Muller said. “We need to make sure people know to get back on schedule with those screenings.”

New policies and practices

While telehealth is on the rise, “sometimes as physicians we need to see the patients and do a physical exam,” Mariampillai said.

Although there is some risk in any interaction with another person, Mariampillai said clinics are taking extra steps to keep patients protected from transmission of the virus.

Each hospital or clinic in Alaska can set its own protocols in alignment with state guidelines,, but many policies are similar: Visitors and companions are limited. Employees work from home when they can. Fewer appointments are scheduled. If possible, your visit may be scheduled using telemedicine, so you don’t even need to leave your home.

If you do go into a clinic, some offices will check your temperature before you even enter. Patients may be moved directly into rooms rather than remaining in the waiting room. Equipment and protective gear is sanitized regularly. Masks are encouraged (and required at some facilities, including ANMC clinics), and plastic barriers have been installed to prevent or slow any potential spreading of illnesses.

“Offices are adapting,” Muller said.

How to practice preventive care at home

Preventive care is more than scheduling an appointment. It also means adapting your lifestyle to stop diseases before they appear.

“An ounce of prevention is worth more than a pound of cure,” Mariampillai said. “We see a lot of preventable cancers that are picked up after a missed screening, or patients not being aware of preventative measures people can take.”

Diet and physical movement are two extremely important preventive measures, medical professionals say.

For instance, colon cancer is almost completely preventable by simply increasing your fiber intake, according to research done by Dr. Stephen O’Keefe, who is now undertaking a long-term study with ANTHC studying fiber and cancer rates among Alaska Native people.

“Exercise can also do wonders,” Mariampillai said. Aim for thirty minutes a day. Alaska, with all its natural beauty, offers an abundance of ways to get outdoor exercise, he added.

Quit using tobacco and you will further help reduce your risk for illness or complications of chronic diseases, Mariampillai said.

HPV vaccines also help prevent certain cancers, and are another useful tool in cancer prevention, Quinn added. And take extra care of your mental health, she said. Not only will you help stave off disease, but your quality of life will increase.

Mariampillai suggests patients who are struggling with anxiety before a doctor’s visit try movement and relaxation methods such as yoga and meditation, which can be soothing.

“Focus on something you enjoy, like painting, reading, and working on puzzles.” Mariampillai said. “Take a break from social media, which can be overwhelming.”

“And lastly, a good night’s sleep will work wonders,” Mariampillai said. “Get plenty of rest.”

A combination of health care checkups and screenings with daily preventive care will give you the greatest chance to stay disease-free over the long term.

“Taking care of oneself is the best way to stay healthy,” Mariampillai said.

This story was sponsored by Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the creative services department of the Anchorage Daily News in collaboration with Alaska Native Tribal Health Consortium. The ADN newsroom was not involved in its production.