Family Medicine Doctors ‘Forgotten on the Front Lines’ of the Pandemic

When you think of frontline health care workers, doctors and nurses in hospitals might come to mind, but independent family doctors are in that category, too.



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“Forgotten on the front lines is what we are,” said. Dr. Guy Culpepper, founder of Bent Tree Family Physicians.

Culpepper says the front lines of the pandemic aren’t in emergency rooms, they’re at his front door.

“When you talk about flattening the curve, that curve flattening happened in my office,” he said.

From the parking lot of his Frisco office, Culpepper says more than 7,000 people have been tested for COVID-19. Nearly 1,200 have tested positive.

“We’ve kept 1,100 of them away from hospitals and emergency rooms,” Culpepper said.

Culpepper says he has about 250 active COVID-19 patients. Those recovering from home are checked on by phone every day. “We get about 1,500 telephone calls a day,” he said.

His numbers tell a story. They also speak to his heart.

“Part of the passion I have in managing my COVID patients and managing all my patients is the feeling of I’m only here because of them,” Culpepper said, emotionally.

Like many independent doctors, Culpepper closed his doors in the spring and furloughed all 75 employees.

On the verge of going out of business, it was a GoFundMe page set up by patients that helped him get through.

“We’re only kept up by those handful who know us and appreciate us because we know all too well that most of the country doesn’t know the work we’re doing,” Culpepper said.

Culpepper, who’s been in family medicine for 33 years, says no federal programs exist to sustain private physicians, like him. Nationwide, he says his profession is in crisis because private practices, “can’t handle the economics of a pandemic.”

He says nearly 10% of primary care practices that temporarily closed this year have yet to reopen.

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Are More Women Physicians Leaving Medicine as Pandemic Surges?

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

For mid-career oncologist Tanya Wildes, MD, the pandemic was the last straw. In late September, she tweeted: “I have done the academically unfathomable: I am resigning my faculty position without another job lined up.”

She wasn’t burned out, she insisted. She loved her patients and her research. But she was also “100% confident” in her decision and “also 100% sad. This did not have to happen,” she lamented, asking not to disclose her workplace for fear of retribution.



Dr Tanya Wildes and family

Being a woman in medicine “is a hard life to start with,” Wildes told Medscape Medical News. “We all have that tenuous balance going on and the pandemic made everything just a little bit harder.”

She describes her pre-pandemic work-life balance as a “Jenga tower, with everything only just in place.” But she realized that the balance had tipped, when after a difficult clinic she felt emotionally wrung-out. Her 11-year-old son had asked her to help him fly his model airplane. “I told him, ‘Honey, I can’t do it because if it crashes or gets stuck in a tree…you’re going to be devastated and I have nothing left for you.’ “

This was a eureka moment, as “I realized, this is not who I want to be,” she says, holding back tears. “Seventy years from now my son is going to tell his grandchildren about the pandemic and I don’t want his memory of his mom to be that she couldn’t be there for him because she was too spent.”

When Wildes shared her story on Twitter, other women oncologists and physicians responded that they too have felt they’re under increased pressure this year, with the extra stress of the pandemic leading others to quit as well.

The trend of doctors leaving medicine has been noticeable. A July survey from the Physicians Foundation found that roughly 16,000 medical practices had already closed during the pandemic, with another 8000 predicted to close within the next year.

“Similar patterns” were evident in another analysis by the Larry A. Green Center and the Primary Care Collaborative, as reported by The New York Times. In that survey, nearly one fifth of primary care clinicians said “someone in their practice plans to retire early or has already retired because of COVID-19,” and 15% say “someone has left or plans to leave the practice.” About half said their mental exhaustion was at an all-time high, the survey found.



Dr Monica Bertagnolli

“COVID-19 is a burden, and that added burden has tipped people over the edge of many things,” acknowledges Monica Bertagnolli, MD, chief of the Division of Surgical Oncology at Brigham and Women’s Hospital in Boston and former president of the American Society of Clinical Oncology (ASCO).

“It has illustrated that we do have a lot of people who are working kind of on the edge of not being able to handle everything,” she says.

While many

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Recover, Restore and Re-open: A Stanford Medicine framework for bouncing back from pandemic | News Center

Last spring, as office buildings emptied and local governments ordered residents to shelter in place, Stanford Medicine faculty members and executives sprang into action to understand more about the mysterious new coronavirus.

Even in the early months of the pandemic, it was clear that a return to normal — bringing students back to classrooms, workers back to offices and travelers back to airlines — would take complex and scientifically grounded policies and guidance.

Now, Stanford Medicine has launched a website to advise various segments of society on getting back to healthy functioning. The effort is called Recover, Restore and Re-open, or R3.

“Our experts’ immediate and steadfast response to the pandemic has built a valuable resource that we feel is imperative to share with the broader community,” said Priya Singh, chief strategy officer and senior associate dean for strategy and communications at Stanford Medicine. “We see the R3 framework as a collection of resources that community members — whether you’re from academia, industry or government, or you’re an individual — can use to inform and guide how they adapt to the uncertainties wrought by COVID-19.”

At the onset of the pandemic, experts from the School of Medicine, Stanford Health Care, Stanford Children’s Health, University HealthCare Alliance and Stanford University began building a framework for broad-based recovery. The group considered the needs of the community, such as developing a strategy for expanded coronavirus testing and building a public health surveillance system to track new cases, and used lessons learned from Stanford’s hospitals to inform preparedness for future inevitabilities, such as a surge in cases and a lack of personal protective equipment.

The R3 framework, which was commissioned by Lloyd Minor, MD, dean of the School of Medicine; David Entwistle, president and CEO of Stanford Health Care; and Paul King, president and CEO of Stanford Children’s Health, is powered by more than a dozen Stanford Medicine faculty and leaders. Along with Singh, Bob Harrington, MD, professor and chair of medicine; Mary Leonard, MD, MSCE, professor and chair of pediatrics; and Catherine Krna, MBA, president and CEO of the University HealthCare Alliance, led the R3 committee. Based on the committee’s expertise, the framework is a culmination of the lessons learned while delivering patient care, conducting research and forming policy recommendations as the pandemic evolved.

“Our success in responding so quickly at the beginning of the pandemic was, in part, due to the alignment between the School of Medicine and the clinical enterprises, Stanford Health Care and Stanford Children’s Health,” Krna said. “We would not have been as successful if it weren’t for the joint accountability of our faculty and clinicians and the staff who work with them to care for our patients.”

Guiding current and future response

The R3 framework is a guide to making policy, conducting research and developing treatments, among other things. It’s both a resource for helping communities deal with the pandemic and recover from it. For example, it offers recommendations for protecting vulnerable populations from the virus and safely

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Exercise is medicine, even in the middle of a pandemic

Maimonides (Rambam), the great 12th century Torah scholar and physician, sums up the Jewish attitude toward exercise: “As long as a person exercises and exerts himself…sickness does not befall him and his strength increases…. But one who is idle and does not exercise…even if he eats healthy foods and maintains healthy habits, all his days will be of ailment and his strength will diminish.” The Rambam defined exercise as “vigorous or gentle movement, or a combination of the two, which increases one’s breathing rate.” Interestingly, this is exactly the type of cardiovascular exercise advised by modern medicine – like walking, jogging, dancing, biking, or swimming for 30 minutes at least three times a week.However, social distancing, self-quarantining, and the closure of many gyms have made it harder to exercise. In desperation, many people have turned to walking or jogging outdoors – not permitted in Israel during the first lockdown — while others have found benefit in turning to online workouts. During the first wave, my wife and I did in fact discover a very good online exercise program.Certainly, the physical benefits of exercise are many: increased strength and stamina, fitness, speed and power as well as aesthetic appeal. In addition, over the past 20 years, hundreds of studies have shown that exercise provides numerous emotional benefits such as lowering depression and anxiety and improving overall self-esteem and confidence. In fact, I would argue that regular exercise is a vital coping tool in dealing with the multitude of problems, challenges and stressors that are part of everyday life.Below I list a few of the emotional and physical benefits of exercise.1. When you exercise, your brain produces endorphins (endogenous morphine) that block the feelings of pain and create feelings of euphoria by attaching to receptors on the outer surfaces of brain cells.2. Exercise also increases the production of serotonin and norepinephrine (adrenaline), which is the neurotransmitter in the brain that is associated with all kinds of psychological disorders. Researchers have established that individuals experiencing depression tend to have lower levels of serotonin and adrenaline in their blood. Through exercise, these neurotransmitters are increased and help people to feel less depressed, more optimistic, less worried and more confident.

3. During the COVID-19 pandemic: Exercise boosts the immune system. Research shows that regular, moderate-intensity exercise has immune-boosting benefits that may reduce symptoms of illnesses and disease, ranging from cancer to the common cold. Even arthritis and gastrointestinal disorders are relieved through exercise.4. Exercise allows you to express your frustrations, disappointments, anger, and negative energy in a positive way. Psychologically and physically, exercise gives you more energy and confidence to improve your relationships with family and friends and problem-solve more effectively.5. Exercise increases self-confidence, which positively affects your professional, personal and social lives.6. Exercise shows your kids the importance of being healthy and fit. You’ll be a positive role model. The emotional benefits of exercise can reach your children and beyond.7.

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Dentist offices remain ‘extremely safe’ during coronavirus pandemic

Cesareo Contreras
 
| MetroWest Daily News

ASHLAND –  More than nine months into the coronavirus pandemic, many local businesses are still struggling to get by. But for Dr. Sandra Cove, who owns a dental office at 37 Main St., business has been great.  

“People are knocking the door down,” she said. 

The anxiety of the pandemic is weighing down on many. And that is often reflected on oral health, Cove said.

It’s not uncommon for Cove to see people around the holidays come in with problems, given the stress during this time of year. She is seeing patients with major dental issues at a rate she has never seen in her career. 

From cavities and inflamed gums to chipped and infected teeth, the issues are various.  

“We have this phenomenon in dentistry. Whenever people are under a lot of stress, a lot crazy things happen – a lot of root canals and broken teeth,” she said. “A lot of this stuff happens around Christmas time and Thanksgiving and it only lasts for a week or two, but this going on for six months, where every day, I must have two or three broken teeth due to stress or people gums are completely on fire because they are overreacting to the bacteria because their defenses are down.” 

Dr. MaryJane Hanlon, president of the Massachusetts Dental Society, said she isn’t surprised by number of patients Cove has seen with new and serious dental problems.  

“Sandra, I know, is very busy, and many practices are busy,” she said. “Some practices never slowed down. They saw a lot of emergency care. … The bottom line is that we are seeing a breakdown because people were very concerned about going to the dentist. ” 

While some dental offices are doing well, others have been hit hard.  

Hanlon is the dean of operations at Tufts University and manages all of the school’s clinical operations. Unlike Cove, she said she has seen a decline in the number of people visiting the clinic. Before the pandemic, the college would see around 600 people a day. Now they are seeing half of that. 

In June, the association conducted a survey to better understand how dental offices in the state were faring during the pandemic. The survey was taken by more than 400 dental practice owners. 

More than half of responders said they expect it to take between seven months to over a year to get the number of patients they had before the pandemic hit. 

Nearly 90% of dental practices are spending between $8 – $29 or greater per patient on personal protective equipment, according to survey. 

Moreover, more than half or respondents said the pandemic has cost their practice $225,000 in office upgrades and loss in patients. 

Cove said she thinks a big reason why people are coming to her office is because they feel reassured that the appropriate measures are in place to keep them safe from the coronavirus. 

After the start of pandemic in March, Cove

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Pandemic has taken a bite out of seafood trade, consumption

PORTLAND, Maine (AP) — The coronavirus pandemic has hurt the U.S. seafood industry due to a precipitous fall in imports and exports and a drop in catch of some species.

Those are the findings of a group of scientists who sought to quantify the damage of the pandemic on America’s seafood business, which has also suffered in part because of its reliance on restaurant sales. Consumer demand for seafood at restaurants dropped by more than 70% during the early months of the pandemic, according to the scientists, who published their findings recently in the scientific journal Fish and Fisheries.

Imports fell about 37% and exports about 43% over the first nine months of the year compared to 2019, the study said. The economic impact has been felt most severely in states that rely heavily on the seafood sector, such as Maine, Alaska and Louisiana, said Easton White, a University of Vermont biologist and the study’s lead author.

It hasn’t all been doom and gloom for the industry, as seafood delivery and home cooking have helped businesses weather the pandemic, White said. The industry will be in a better position to rebound after the pandemic if domestic consumers take more of an interest in fresh seafood, he said.

“Shifting to these local markets is something that could be really helpful for recovery purposes,” White said. “The way forward is to focus on shortening the supply chain a little bit.”


The study found that Alaska’s catch of halibut, a high-value fish, declined by 40% compared to the previous year through June. Statistics for many U.S. fisheries won’t be available until next year, but those findings dovetail with what many fishermen are seeing on the water.

Maine’s catch of monkfish has dried up because of the lack of access to foreign markets such as Korea, said Ben Martens, executive director of the Maine Coast Fishermen’s Association.

“The prices just went so low, they couldn’t build a business doing that this year,” Martens said.

The study confirms what members of the seafood industry have been hearing for months, said Kyle Foley, senior program manager for the seafood program at Gulf of Maine Research Institute. Foley, who was not involved in the study, said the findings make clear that the seafood industry needs more help from the federal government.

The federal government allocated $300 million in CARES Act dollars to the seafood industry in May. The government announced $16 billion for farmers and ranchers that same month.

“It helps to make the case for why there’s a need for more relief, which I think is our industry’s biggest concern across the supply chain in seafood,” Foley said.

The study concludes that “only time will tell the full extent of COVID-19 on US fishing and seafood industries.” Gavin Gibbons, a spokesman for the National Fisheries Institute in McLean, Virginia, said the short-term findings reflect the difficulties the industry has experienced this year.

“The closure of restaurant dinning has had a disproportionate effect on seafood and a

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Philadelphia Fitness Coalition protesting restrictions on city gyms amid coronavirus pandemic

More than two dozen gyms in Philadelphia are joining forces, demanding that the city allows them to reopen.

Philly Fitness Coalition is fighing the restrictions for gyms in the city

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They have created the Philadelphia Fitness Coalition and have gathered more than 1,500 signatures in opposition to the new restrictions.

As the number of covid-19 cases rises, the city required gyms to shut down indoor activities at the end of last week.

But gym owners say it is unfair because of the safety precautions they have put in place.

They plan to protest outside of City Hall on Tuesday.

Last week, the city’s top health official, Dr. Thomas Farley, defended the city’s decision to tighten restrictions, saying now is the riskiest time for the transmission of the virus.

“What was now safe is now dangerous with the change in the weather. Many businesses feel they put safety measures in place, sure they have, and I’m sure there’s no spread there and that’s true in many places. Remember, there are more people than ever with the virus,” said Farley.

City officials said dramatic action is needed to respond to an exponential growth in cases and hospitalizations.

On Thursday, health officials announced 765 additional confirmed cases of COVID-19 in Philadelphia. That brings the number of confirmed cases to 57,237.

The number of residents who have died from the virus in Philadelphia is 1,945.

How is 2nd wave of COVID-19 impacting local hospitals?

As the second wave of COVID-19 hits the Philadelphia region, doctors and medical professionals discuss how the virus is impacting hospitals.

Grey Lodge Pub in Mayfair closing

The new round of COVID-19 regulations was the final straw for one Philadelphia restaurant. The Grey Lodge Pub in Mayfair is closing its doors for good after 70 years in business. The Lucky Cat Brewing Company, which is a standalone business inside the pub, will remain open.

Philadelphia museums knocked back down by new COVID-19 restrictions

The new restrictions put in place to tackle the surge of COVID-19 cases in Philadelphia are hitting museums in the area hard. After going through a five-month shutdown during the first wave, they are being shut down again, which in some cases, will cause hard economic pain and uncertainty for employees.

National Constitution Center temporarily closes to the public through January 1, 2021

In accordance with health guidelines from the City of Philadelphia in response to COVID-19, the National Constitution Center is temporarily closed to the public through January 1, 2021. The Center offers a range of free online programs and resources for learners of all ages. CLICK HERE to learn more.

Houses of worship in Philly vow to persevere amid new COVID restrictions

The new COVID-19 restrictions in Philadelphia will have a major impact on houses of worship, which for the time being can operate at only 5% capacity. While the Archdiocese of Philadelphia revises its guidance, some churches and synagogues in the city have a variety of innovative plans

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Despite officials’ warnings and pleas, travel over Thanksgiving is expected to hit a pandemic peak.

The nation’s health experts on Sunday pleaded with Americans to stay home over the Thanksgiving holiday and forgo any plans to travel or celebrate at large family gatherings, even as airports have recorded a significant rise in passengers.

Dr. Anthony S. Fauci, the country’s top infectious disease specialist, and other health experts relayed a clear message on Sunday morning news shows: with coronavirus cases surging to record levels across the country, turning nearly every state into a hot zone of transmission, the risk of getting infected, whether in transit or in even small indoor gatherings, is high.

Up to 50 million people could be traveling on roads and through airports in the United States over Thanksgiving this year, according to AAA, the biggest travel surge since the pandemic began, despite strong cautions from the Centers for Disease Control and Prevention and other health authorities. A video of a packed airport in Phoenix has been circulating widely on social media. As of Sunday, 47 states — all but Hawaii, Maine and Vermont — were considered high-risk zones for viral transmission, and nationwide hospitalizations were at a record 83,227.

“Please seriously consider decisions that you make,” Dr. Fauci said on the CBS show “Face the Nation.” Encountering large numbers of people in airports and on planes is particularly dangerous, he said. Although airlines have invested in air circulation and ventilation systems to minimize viral transmission, Dr. Fauci said, “sometimes when you get a crowded plane, or you’re in a crowded airport, you’re lining up, not everybody’s wearing masks — that puts yourself at risk.”

And gathering indoors, whether you travel or not, carries risk. “When you’re eating and drinking, obviously, you have to take your mask off,” Dr. Fauci said. “We know now that those are the kinds of situations that are leading to outbreaks.”

Dr. Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health, said on Fox News on Sunday that because about half of infections are spread by people who don’t have any symptoms, “you can’t assume that you don’t have the virus, and you can’t assume that the people whose home you’re about to enter don’t have the virus, at this point in our pandemic.”

He recommended celebrating Thanksgiving only with the people you live with. People who choose to visit others’ homes should spend as much time as possible outdoors and “should be wearing masks indoors when they’re together, and only removing them when they’re eating.”

In Tulsa, Okla., Victory, a megachurch, canceled a “Friendsgiving” service on Sunday that had called on members to bring a friend after it prompted an outcry, instead opting to give away boxed meals, NBC News reported. The church did not respond to a request for comment regarding its planned “Thanksgiving Day Brunch,” which, according to its website, is set to be held on Thursday in the church’s cafeteria.

Dr. Fauci and others warned that Americans’ behavior over Thanksgiving would have critical implications for

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How we celebrated during 1918 flu pandemic

More than 200,000 dead since March. Cities in lockdown. Vaccine trials underway.

And a holiday message, of sorts: “See that Thanksgiving celebrations are restricted as much as possible so as to prevent another flare-up.”

It isn’t the message of Thanksgiving 2020. It’s the Thanksgiving Day notice that ran in the Omaha World Herald on Nov. 28, 1918, when Americans found themselves in a similar predicament to the millions now grappling with how to celebrate the holiday season amid the coronavirus pandemic.

“Every time I hear someone say these are unprecedented times, I say no, no, they’re not,” said Brittany Hutchinson, assistant curator at the Chicago History Museum. “They did this in 1918.”

On Thanksgiving more than a century ago, many Americans, like today, lived under various phases of quarantines and face mask orders. Millions mourned loved ones. And health officials in many cities issued the same holiday warning: Stay home and stay safe.

Giving thanks for WWI victory, beating pandemic

By late November 1918, the USA – in the midst of the suffrage movement, Jim Crow and the tail end of WWI – battled the ebbing second wave of the H1N1 influenza epidemic, also known as the Spanish flu.

The first cases were detected in the USA in March of that year, growing exponentially by the fall. In October, the virus burned through the nation. Dozens of cities implemented face mask orders and curfews and locked down for two to three weeks, temporarily closing schools, libraries, theaters, movie houses, dance halls, churches, ice cream parlors and soda shops. The virus killed about 195,000 Americans during October alone.

Red Cross Women sit at long tables making influenza masks in Chicago, Illinois in 1918.

Red Cross Women sit at long tables making influenza masks in Chicago, Illinois in 1918.
Image provided by the Chicago History Museum. Graphic by Karl Gelles, USA TODAY.

As Thanksgiving rolled around, some cities celebrated the relaxation of flu-related restrictions – partly due to opposition campaigns by retailers, theater owners, unions, mass transportation companies and other economically stressed stakeholders. Washington, Indianapolis and Oakland, California, had lifted restrictions days before, and San Francisco was on the brink of lifting its mask mandate.

San Francisco had one of the nation’s largest anti-masking campaigns, spearheaded by the Anti-Mask League of San Francisco, according to Howard Markel, a professor of the history of medicine at the University of Michigan and co-editor-in chief of The American Influenza Epidemic of 1918-1919. Many people refused to wear masks and were arrested, and when the “line into the courtroom was so long, they laid off arresting people because the system couldn’t enforce it,” Markel said.

On Nov. 13, the San Francisco Examiner reported that “Thanksgiving Day will be celebrated in San Francisco by the discarding of gauze masks, if the present rate of decrease in influenza continues.”

A week later, San Franciscans ceremoniously removed their masks as a whistle sounded across the city at noon. “San Francisco Joyously Discards Masks In Twinkling; Faces Beam As Gauze Covers Come Off At Time Fixed,” the San Francisco Chronicle wrote on its front page

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Philadelphia COVID-19 today: Philadelphia Fitness Coalition protesting gym closures in city amid coronavirus pandemic

PHILADELPHIA (WPVI) — More than two dozen gyms in Philadelphia are joining forces, demanding that the city allows them to reopen.

They have created the Philadelphia Fitness Coalition and have gathered more than 1,500 signatures in opposition to the new restrictions.

As the number of covid-19 cases rises, the city required gyms to shut down indoor activities at the end of last week.

But gym owners say it is unfair because of the safety precautions they have put in place.

They plan to protest outside of City Hall on Tuesday.

Last week, the city’s top health official, Dr. Thomas Farley, defended the city’s decision to tighten restrictions, saying now is the riskiest time for the transmission of the virus.

“What was now safe is now dangerous with the change in the weather. Many businesses feel they put safety measures in place, sure they have, and I’m sure there’s no spread there and that’s true in many places. Remember, there are more people than ever with the virus,” said Farley.

City officials said dramatic action is needed to respond to an exponential growth in cases and hospitalizations.

On Thursday, health officials announced 765 additional confirmed cases of COVID-19 in Philadelphia. That brings the number of confirmed cases to 57,237.

The number of residents who have died from the virus in Philadelphia is 1,945.

How is 2nd wave of COVID-19 impacting local hospitals?

As the second wave of COVID-19 hits the Philadelphia region, doctors and medical professionals discuss how the virus is impacting hospitals.

Grey Lodge Pub in Mayfair closing

The new round of COVID-19 regulations was the final straw for one Philadelphia restaurant. The Grey Lodge Pub in Mayfair is closing its doors for good after 70 years in business. The Lucky Cat Brewing Company, which is a standalone business inside the pub, will remain open.

Philadelphia museums knocked back down by new COVID-19 restrictions


The new restrictions put in place to tackle the surge of COVID-19 cases in Philadelphia are hitting museums in the area hard. After going through a five-month shutdown during the first wave, they are being shut down again, which in some cases, will cause hard economic pain and uncertainty for employees.

National Constitution Center temporarily closes to the public through January 1, 2021

In accordance with health guidelines from the City of Philadelphia in response to COVID-19, the National Constitution Center is temporarily closed to the public through January 1, 2021. The Center offers a range of free online programs and resources for learners of all ages. CLICK HERE to learn more.

Houses of worship in Philly vow to persevere amid new COVID restrictions


The new COVID-19 restrictions in Philadelphia will have a major impact on houses of worship, which for the time being can operate at only 5% capacity. While the Archdiocese of Philadelphia revises its guidance, some churches and synagogues in the city have a variety of innovative plans to carry on through the holidays.

Philadelphia-area stores stock up as new COVID restrictions set

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