An update from our Chief Medical Officer:

It seems like a long time since my last update and I continue to keep all our QDP team members in my thoughts. I am pleased to hear from the management team that practice reopenings are progressing well. One point that we cannot overstate is the importance of creating a safety culture throughout our clinics to ensure the highest standards are maintained, especially now during the COVID-19 pandemic. Providers should be the team leaders and set the example for proper safety behavior. But I want to emphasize that every member is fully empowered to keep the entire team accountable. If anyone sees staff improperly or failing to use proper PPE, please point it out respectfully. If you are the one who forgot to place your mask or goggles, accept the comment gracefully and thank your teammate for helping protect you, our patients and the entire team. It’s very hard to change behaviors so quickly and to be compliant with PPE 100% of the time. So, take care of each other and create an open culture of teamwork and accountability to ensure we present the safest and most reassuring environment to patients, while reducing exposures and transmission risk.

Regarding PPE, a recent study from Singapore showed that even with instruction, only 13% of the lay public could properly wear an N95 mask. Even if you wear PPE 100% of the time, if it is not worn and fitted properly it is not effective protection for you or your contacts. I received a helpful inquiry this week and encourage everyone to keep sending suggestions and ideas. The issue related to patients presenting to clinic with a respirator mask with a valve. These masks are primarily used to protect industrial workers from inspiring particulate matter like asbestos and are not effective at source control. QualDerm is updating patient communications and staff training to specifically discourage patients from wearing these masks because infectious particles can escape through the valve. If a patient comes with one of these, they will be required to either exchange it or cover it with a standard surgical mask, or the valves can be taped over.

This week every state is in some form of reduced restrictions and reopening but many remain on the upslope of infections, including our QDP markets in NC, SC, VA, TN and GA. Of course, there is more testing now and local data is most important for our specific practice sites, but we all need to remain vigilant and cautious as second waves are very possible, like we are seeing in France and South Korea.

Testing in the US is vastly improving with a record number set yesterday. While the quantity is clearly moving in the right direction, the quality of tests remains widely variable. The CDC recently issued a statement that antibody testing has up to a 50% false positive rate and antibodies should not be used for individual patient or policy decisions. I continue to monitor guidance and hope that reliable, accurate point-of-care C-19 antigen test kits will soon become widely available and we can develop a rational testing strategy for patients and staff.  Currently >15M tests report a total of 1.9M positives, a positivity rate nationwide of 12%. The US and entire world remains far from the levels of herd immunity (60-80%) needed for protection. Numerous studies suggest we can expect COVID-19 to persist at some level for years, similar to influenza. This graphic illustrates the point very clearly.

Hopefully, vaccines and other therapeutics will advance quickly and provide other options. This week the list of viable vaccine candidates expanded significantly to include promising drugs from Merck, Pfizer, Sanofi and AstroZenica in addition to Moderna and Novavax. More alarming to me, however, were the results of a survey of Americans on their willingness to be vaccinated against COVID-19. Only 49% would definitely receive a vaccine; 31% were unsure; and 20% would decline. Many health care organizations will likely make vaccination a condition of employment and we will cross that bridge when we are fortunate to have a viable vaccine.

Finally, it was reported this week that 1/3 of US population is experiencing anxiety or depressive symptoms related to this pandemic. I want to encourage all staff members to monitor each other for signs of stress, anxiety and depression and offer them support. Evidence continues to demonstrate that online counseling is very effective and the HealthJoy mobile app provides easy, free, confidential telemedicine mental health services for all employees. Also remember that many of our patients will be stressed as well and an extra dose of patience and compassion will benefit everyone.

Thank you all for your continued efforts to maintain our high standards of excellence. Have a great weekend.

John Albertini, MD