Protect older and vulnerable health care workers from Covid-19 - STAT

Since the Covid-19 pandemic caused by the SARS-CoV-2 coronavirus emerged late in 2019, health care workers have been at particularly high risk of infection.

In China, more than 3,300 health care workers have been infected, including Dr. Li Wenliang, who died after being the first to sound the alarm. More than 4,800 health care workers have been infected in Italy, where harrowing stories from Italian physicians and nurses are being posted on social media.

As the pandemic now takes hospitals the U.S. by storm, two emergency physicians in the states of Washington and New Jersey were recently reported to be in critical condition due to Covid-19.

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Social distancing policies are being put in place to protect the oldest and most vulnerable members of society. But they aren’t permeating into the health system where many of these same members of society work, making them as susceptible to severe infection from Covid-19 as the patients they take care of.

Based on available data from Italy, we know that older adults and those with chronic medical conditions have a much greater risk of severe illness or death from Covid-19. In Italy, death rates from Covid-19 were three times higher for those between the ages of 50 and 59, and 10 times higher for those between the ages of 60 and 69, compared to those between the ages of 30 and 50.

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Among individuals over age 70, the risk of dying from Covid-19 are anywhere from 13% to 25%. For those with preexisting heart disease, mortality is 13.2% and between 8% and 9% for individuals with hypertension or diabetes.

In 2018, the last year for which there are complete data, there were 512,000 physicians over the age of 50 in the U.S., representing just over half of the entire U.S. physician workforce. The average age of nurses in the U.S. is 51 years. Knowing the probabilities of severe disease and death increase with age, what risk does the American health care system take on in the coming weeks by not taking overt action today to keep older and medically vulnerable providers safe at home?

In the absence of clear answers, some health care institutions have taken the lead. At some institutions, providers who feel that they may be at high risk for severe illness from Covid-19 have been allowed to request early vacation. Other institutions have taken half-measures, like not having pregnant or immunocompromised providers work in Covid-19 wards. But most institutions do not have set policies yet, and providers at high risk levels of severe illness from Covid-19 continue to report to work.

For health care organization that have not yet started having these discussions, the time is now. Even if efforts to flatten the curve are successful, we expect the battle with SARS-CoV-2 to continue for many months. Now is the time to reorganize health care to maximize efficiency and minimize risk for its workers. This means shifting physicians, nurses, and other health care providers who are over age 60 and those with comorbidities like diabetes, coronary artery disease, COPD, cancer, and other conditions from direct care for patients with Covid-19.

Older and vulnerable health care workers can help fight Covid-19 from a safer distance than they do today. Clinics across the U.S. have shifted to phone or virtual encounters; vulnerable health care workers could absorb some of this load to free younger ones with more robust immune systems to transition to clinical work in hospitals. In 2019 alone, medical schools hired close to 20,000 new faculty, most of them young professionals and most of whom do clinical work at affiliated hospitals.

In critical care wards, virtual rounds with senior physicians could allow social distancing while ensuring their continued guidance of younger colleagues. Similarly, in medicine wards, vulnerable clinicians could do “virtual rounds” by checking electronic medical records and receiving information directly from residents and interns. Senior physicians in emergency departments and critical care units could also leverage their skills to train others on procedures such as intubation and management of severe respiratory failure for those working in hospitals.

This isn’t a problem for which we’ve been given time to work out the details: Covid-19 has arrived and is steadily mushrooming. And it may not be possible in every hospital, clinic, or other health care setting in the country. But we have a sizable health care work force of young and robust individuals who are willing to step up to the challenge and protect their older colleagues in this time of danger.

Older and vulnerable health care providers are a bedrock of the U.S. health care system, and their risk grows measurably by the day. We hope that we won’t look back on this pandemic and ask if we could have done more to protect the lives of those in the medical work force at highest risk of complications from Covid-19.

As young physicians, we understand that our risk is much lower than our mentors, teachers, and older or vulnerable colleagues. We are willing to absorb their risk. We could not forgive ourselves if we do not act now and down the road stand mute at the burials of physicians, nurses, physician assistants, and countless others who have turned us into the providers we are today.

Aaron Kofman, M.D., and Alfonso Hernandez-Romieu, M.D., are infectious disease fellows in the Department of Medicine at Emory University in Atlanta.

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Protect older and vulnerable health care workers from Covid-19 - STAT
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