COVID-19 Daily: High-Risk Specialties, Flu Comparisons

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MAY 14, 2020 --Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

Which Specialists Are Most at Risk From COVID-19?

New survey data of resident physicians in New York revealed that anesthesiology, emergency medicine, and ophthalmology were the specialties associated with the highest risk of contracting COVID-19. The close proximity between ophthalmologists and their patients, as well as evidence that SARS-CoV-2 can be spread through the eyes, helps explain that specialty's surprising inclusion in the most at-risk group. 

The survey is not considered a definitive account, considering variables such as PPE availability and use, hospital protocols, and physician experience. However, the authors hope that the information could provide some indication of specialties that may require increased protection should a second wave of COVID-19 occur. 

Comparing COVID-19 to Flu "Dangerous"

A direct comparison of COVID-19 and seasonal influenza death tolls is not appropriate, according to a new report. One of the coauthors, Jeremy Samuel Faust, MD, explains that comparing the two numbers is "extremely dangerous" because flu death counts are inherently overestimates, whereas COVID-19 deaths are determined from actual counts. 

"Comparing them ― as so many people in this country have done ― to try to diminish the impact of SARS-CoV2 is not fair," he told Medscape Medical News

The authors argue that the Centers for Disease Control and Prevention (CDC) routinely overestimates flu deaths, describing uncertainty about mortality causes among elderly populations and a desire to increase motivation for vaccination. The CDC's own website acknowledges that it "does not know the exact number of people who have been sick and affected by influenza." 

The researchers conclude that, by virtually any metric proposed, COVID-19 is demonstrably deadlier than the flu.

How Much Income Will Physicians Lose Because of COVID-19?

The first glimpses of just how much COVID-19 will affect physician incomes are coming into view. Private practices are most at risk, according to Travis Singleton, senior vice president at Merritt Hawkins, a physician search firm. 

"They don't have a financial cushion, and will start seeing big drops in revenue at the end of May," he said. Although physicians employed at larger facilities may have been somewhat shielded from the financial impacts of COVID-19, that protection could be ending, as the suspension of elective surgeries finally takes its toll.


The hope for some is that telemedicine can help stop the hemorrhaging. "As much as 20% to 40% of a practice's losses can be recouped through telemedicine," Singleton said. Still, the timeline for the return to "normal business" remains unclear. 

Worse yet, a second COVID-19 wave could represent mass financial disaster for physicians, as well as a public health disaster. 

Medscape's recently released Physician Compensation Report 2020 dives into specific numbers and some projected impacts from the pandemic.

Glucose Control Strongly Linked to COVID-19 Outcome

A retrospective, multicenter study of patients hospitalized with COVID-19 reaffirmed the strong link between COVID-19 outcomes and glucose control. The largest study of its kind to date found that, among patients with preexisting type 2 diabetes, those who had better glycemic control experienced significant reductions in adverse outcomes. They also required lower use of antivirals, antibiotics, antifungals, systemic corticosteroids, immunoglobulin, and vasoactive drugs. 

However, in reviewing the findings, some experts questioned the way in which the "well-controlled" diabetes group was distinguished from the "poorly controlled" group. 

Herd Immunity Has a High Cost

Although herd immunity has been proposed as a solution to the COVID-19 pandemic, that strategy requires illness and death on a magnitude rarely discussed. In a commentary, William P. Hanage, PhD, argues that although herd immunity is an option, "how you get it matters." 

Hanage points to the early 2000s, when mass smallpox vaccination was considered but ruled out because of estimates of potential deaths associated with the vaccine's administration. "Just for context, that estimate of 250 to 1000 people dying throughout the United States was considered too great a cost for herd immunity," he explains. 

Dramatic Plunge in ED Patient Volumes

An expert panel examining the unanticipated consequences of pandemic care pointed to the sudden drop in ED patient volumes as an example of unexpected events. Donald M. Yealy, MD, explained that, in his institution, the amount of patients were "cut in half, if not more" during the peak of COVID-19. Yealy described a decrease in the number of patients with myocardial infarctionstroke, and trauma but an even more staggering decrease in more commonplace, less serious conditions seen in EDs.


The panel explored the potential for a wave of non–COVID-19 patients presenting late to EDs, described as a coming "tsunami of untreated illness." They predicted that this likely indicates a need to educate the public about conditions that require urgent care, even during a pandemic. 

COVID-19: The Road to Recovery Can Be Long

Doctors are scrambling to assess long-term health effects in patients who recover from COVID-19. Although most who recover from the illness are likely to do so without significant lasting health concerns, the list of potential concerns keeps growing

From kidney damage that may require long-term dialysis to harmful effects from treatments such as mechanical ventilators, the scope of complications that may develop has left some physicians feeling as though they are "flying blind." As Viraj Patel, MD, a doctor caring for patients in COVID-19 hotspot New York City, explains, "Each institution is developing their own protocol or policy right now because there is no great data about what we need to monitor for when it comes to long-term effects."

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. More than 1000 throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form

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