Call for older physicians to be protected from COVID-19

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Hospitals and government health departments should give careful consideration to the protection of older physicians and nurses in the face of the COVID-19 pandemic, according to a viewpoint published in the Journal of the American Medical Association (JAMA).

Peter I. Buerhaus, PhD, a nurse and healthcare economist in the Center for Interdisciplinary Health Workforce Studies at Montana State University College of Nursing in Bozeman, Montana, et al asked whether such physicians and nurses should be re-deployed to less risky roles.

“While hospitals and other organizations ramp up their preparations, this is the time to determine whether there may be different roles for older clinicians that will ensure they are able to contribute over the long-term course of the pandemic,” the authors wrote. “This is not to suggest that these older nurses and physicians should necessarily be precluded from providing clinical care or should be isolated, but rather to consider if their direct clinician duties can be shifted to emphasize roles with less risk of exposure.”

Buerhaus and colleagues cited Centers for Disease Control and Prevention (CDC) statistics indicating rates of hospitalizations, intensive care unit (ICU) admissions and mortality among reported COVID-19 cases in the United States as being substantially higher among patients older than 45 years compared with younger patients, “with case-fatality rates exceeding 1.4% among patients aged 55 to 64 years and exceeding 2.7% among those aged 65 to 74 years.”

Furthermore, they report data from the U.S. Census Bureau American Community Survey 2014–2018 that estimate the physician workforce—approximately 1.2 million in the U.S.— as bearing 230,000 (20%) aged 55–64 years and 106,000 (9%) 65 years or older.

“The recent report of two critically-ill emergency physicians infected by the novel coronavirus disease 2019 (COVID-19) is a sobering reminder of the vulnerability of the nation’s healthcare workforce,” the authors argued. “While all members of the healthcare workforce are vital as the healthcare system faces perhaps its greatest challenge in memory, physicians and nurses are the caregivers who typically have the most direct contact with patients, whether through advising, triaging or treating those who require hospitalization.”

Buerhaus et al urged healthcare organizations to have foresight of the coming challenges: “Hospitals and other care delivery organizations, including state and local health departments, should carefully consider how best to protect and preserve their workforce, with careful consideration involving older physicians and nurses. Older clinicians are likely to have an even larger role in the months ahead as more regions address workforce shortages by requesting that retired physicians and nurses consider returning to the workforce during the COVID-19 outbreak, as has recently occurred in New York City, the state of Illinois and Great Britain.”

The issue of vascular surgeon contact with COVID-19 patients—specifically regarding those over the age of 65—was raised during a specially convened Society for Vascular Surgery (SVS) Town Hall on the pandemic response last Friday.

Co-moderator Alan Lumsden, MD, the medical director of Houston Methodist DeBakey Heart & Vascular Center in Houston, put the question to fellow moderator and SVS president Kim Hodgson, MD: Should surgeons in this category be restricted from COVID-19 patients?

“The data we’re hearing is difficult to interpret because we don’t really know what the [number] is, so we don’t really know if the elderly are a more significantly at-risk population,” said Hodgson, also chair of the division of vascular surgery at Southern Illinois University School of Medicine in Springfield, Illinois. “Clearly, I would say that many of my colleagues in a similar age group are probably not up on our intensive care management—certainly not ventilator management, so we can’t provide any value there—but we may be able to provide other supporting roles in the hospital.”

In turn, Hodgson asked Benjamin W. Starnes, MD, professor and chief in the division of vascular surgery at the University of Washington, Seattle, if his hospital had excluded certain surgeon age groups or those in particular disease cohorts. Washington state, of course, became North America’s epicenter as COVID-19 took root stateside, the first in the U.S. to experience the ravages of the developing pandemic.

Starnes said three physicians over the age of 65 at his institution currently were not operating—but posed a corollary. “I would switch that around and say, how do you get a 65-plus-year-old vascular surgeon to stop operating? Say they’re a chief of a division or a chair of a department and they feel as if they have to operate for the betterment of society, and no one is strong enough—or strong-enough-voiced—to keep them from operating. Has anyone had that situation?”

Lumsden, a leadership figure at his institution, concluded the exchange with some context.

“Speaking as being not quite 65—but it’s in the headlights: When you’re in a leadership position, you feel like you’ve got to be here and you’ve got to be part of the team,” he said. “You’re heavily involved in not just taking care of the vascular surgery patients, but in the overall management of the hospital, the strategies and looking at how we’re going to handle this going down the line.”

SOURCE: doi:10.1001/jama.2020.4978

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