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These past months of the coronavirus disease-2019 (COVID-2019) pandemic have given us ample opportunity to reflect on the US health-care system. Despite overwhelming tragedy, it is an opportunity for us to learn and to change. As we postpone routine visits because of the pandemic, we worry about risks for patients who delay cancer screening. We use cervical cancer screening and prevention as an example of how we can use some “lessons learned” from the pandemic to prevent “collateral losses,” such as an increase in cancers. COVID-2019–related health-system changes, like the more rapid evaluation of diagnostic tests and vaccines, the transition to compensated virtual care for most counseling and education visits, and broadened access to home services, offer potential benefits to the delivery of cervical cancer screening and prevention. While we detail the case for cervical cancer prevention, many of the issues discussed are generalizable to other preventative measures. It would be a tragedy if the morbidity and mortality of COVID-2019 are multiplied because of additional suffering caused by delayed or deferred cancer screening and diagnostic evaluation—but maybe with creativity and reflection, we can use this pandemic to improve care.

The Acute Community Care Program (ACCP), otherwise known as mobile integrated health, which is based at Commonwealth Care Alliance (CCA) in Massachusetts uses specially trained paramedics to respond to urgent care calls to evaluate and treat patients, as appropriate, within their home or institutional residences (e.g., nursing homes) with the goal of avoiding unnecessary emergency department visits and potential hospital admissions. The population served by ACCP at CCA are clinically complex, socio-economically disadvantaged patients with heavy burdens of multimorbidity and physical and mental health disability. Funded by PCORI, we used in-depth, open-ended interviews to examine the training and skills, workplace experiences, and satisfaction of paramedics. We interviewed 23 people who are either ACCP paramedics or non-ACCP paramedics. Using a thematic analysis approach for qualitative analysis, we found important themes around Interpersonal skills and attributes of paramedics along with challenges of the profession. In particular, we found that paramedics: (1) report frequently working with patients with psychiatric needs; (2) report having inadequate behavioral health training; and (3) have many challenges in managing patients with psychiatric needs where they rely heavily on their experience and/or strong interpersonal skills, not training to address the needs of this population. This data indicates that there is a gap in paramedic training related to behavioral health. It is important to build the competencies of paramedics working in mobile integrated health so this workforce can appropriately respond to patients with psychiatric needs in order to better serve this population.

Growing numbers of reproductive-age US women with chronic physical disabilities (CPD) raise questions about their pregnancy experiences. Little is known about the health risks of women with versus without CPD by current pregnancy status. We analyzed cross-sectional, nationally-representative National Health Interview Survey data from 2006 to 2011, which includes 47,629 civilian, noninstitutionalized women ages 18–49. NHIS asks about specified movement difficulties, current pregnancy, and various health and health risk indicators, including tobacco use and body mass index (BMI). We used responses from eight movement difficulty and other questions to identify women with mobility difficulties caused by chronic physical health conditions. Across all women regardless of CPD, women reporting current pregnancy are significantly less likely to currently smoke tobacco and report certain mental health problems. Among currently pregnant women only, women with CPD are more likely to smoke cigarettes every day (12.2 %) versus 6.3 % for pregnant women without CPD (p ≤ 0.001). Among currently pregnant women, 17.7 % of women with CPD have BMIs in the non-overweight range, compared with 40.1 % of women without CPD (p ≤ 0.0001). Currently pregnant women with CPD are significantly more likely to report having any mental health problems, 66.6 % compared with 29.7 % among women without CPD (p ≤ 0.0001). For all women, currently pregnant women appear to have fewer health risks and mental health concerns than nonpregnant women. Among pregnant women, women with CPD have higher rates than other women of health risk factors that could affect maternal and infant outcomes.