Abbreviations
- CDC
Center for Disease Control
- PPE
personal protective equipment
Dear Editor,
As of 13 May 2020, The Center for Disease Control (CDC) reported over 1.3 million COVID‐19 cases in the United States. 1 Older adults and those with comorbidities have increased complication risks and higher mortality compared to the general population. 1 Despite appropriate precautions to reduce transmission risk, many dermatology faculty, residents, staff, and their families are at increased risk for COVID‐19 infection while caring for patients. Telemedicine is being well utilized to treat certain routine and less urgent conditions, and dermatologist attendings and residents continue to treat urgent/emergency cases in‐person. As stay at home orders expire, delayed surgeries and in‐person semi‐urgent appointments will be scheduled, with increased patient volume and heightened COVID‐19 infection risk. Our specialty must establish guidelines to protect those most susceptible to complications and mortality due to COVID‐19.
Per the CDC, adults 65‐84 years comprise an estimated 31%‐59% of hospitalized patients and 8 of 10 deaths due to COVID‐19. 1 In 2018, the Association of American Medical Colleges reported that 44.2% of dermatologists were older than 55. 2 Those with comorbidities, including hypertension, diabetes, and obesity, are at even higher risk for hospitalization substantiated by a case series of 5700 individuals hospitalized with confirmed COVID‐19 infection. 3 Special care must be taken to implement precautions for this vulnerable group.
In 2016, the National Graduate Medical Education Census reported that 64.1% of dermatology residents are women, many of whom are of childbearing age. 4 In a 2017 survey of 183 members of the Women’s Dermatologic Society, 51% reported having their first child as residents and 36% as an attending physician. 5 While limited data is available on pregnant women with COVID‐19, early reports and lessons from other severe respiratory infections, including Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome, suggest that pregnant women may be at increased risk for complications. 6 In a case series of nine women with third trimester COVID‐19 diagnoses, intrauterine fetal distress was noted in six pregnancies and six infants were born preterm. 6 An unconfirmed report of a 30‐hour infant with COVID‐19 infection suggested the possibility of in utero transmission; transmission of COVID‐19 through breastmilk is unknown. 6 While further research is needed to quantify pregnancy and breastfeeding risk, female dermatologists and partners of women considering pregnancy deserve special consideration.
To reduce risk of COVID‐19 infection acquired in the workplace, we must maintain an adequate supply of personal protective equipment (PPE) and enforce social distancing. Trainees and faculty should receive fit testing for N95 respirators and education in the proper use of PPE and donning/doffing procedures. Efforts are needed to create workspaces that minimize exposures, including protocols to limit the number of individuals in patient examination rooms to only necessary personnel. Scribes should work remotely; student shadowing should be limited or virtual. Patients should be instructed to attend their appointment alone; for pediatric or disabled patients requiring a caregiver, only one individual should be permitted in the room. Additionally, dermatology departments and private practices must foster an atmosphere where all employees feel comfortable raising concerns about personal safety without negative consequences to their training or employment status.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
REFERENCES
- 1. Centers for Disease Control and Prevention . Coronavirus Disease 2019 (COVID‐19). https://cdc.gov/coronavirus/2019-ncov/index.html. Accessed May 14, 2020.
- 2. Association of American Medical Colleges . Physician Specialty Data Report; 2018. https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-age-and-specialty-2017. Accessed May 13, 2020.
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