April 15, 2020

An update from our Chief Medical Officer:

I hope everyone remains in good health and spirits, despite the very trying times. I know that I will be grateful for the end of social isolation, whenever that time comes, although I admit to enjoying the unexpected time with my college children who are remote learning. Our mental health can always benefit from finding the silver linings. For anyone struggling with stress and anxiety, please take advantage of the mental health resources available in the Employee Assistance Program, HealthJoy app, human resources staff, or other QDP teammates. Good news from the public health experts suggest that all of our social distancing efforts to date are definitely making a difference and we are flattening the curve! I have not yet heard of any QDP team members contracting the infection and pray that our good fortune persists. I continue to monitor the general COVID-19 situation and have a few additional updates based upon evolving and unforeseen scenarios.

A dermatologist notified me that our current screening questions for reception and nursing staff do not specifically inquire about healthcare exposures, as they recently encountered a respiratory therapist whose work requires high risk procedures in suspected and confirmed COVID-19 positive patients. He answered our screening questions honestly, but did not directly disclose this high risk activity until after the visit. Given widespread community transmission nationwide, we all need to consider every patient as potentially infected and utilize universal precautions and appropriate PPE. But, it is also worthwhile amending our screening questions to be as exhaustive and specific as possible. Attached is a screening question update for reception and clinical staff and the EMR sections will also be edited accordingly.

I have also received further inquiries regarding PPE and what is appropriate. Until the nationwide shortage on N95 masks is resolved, we will continue to recommend following WHO and CDC guidance to responsibly preserve critical supplies for frontline healthcare personnel performing high risk procedures in suspected and confirmed COVID-19 patients. CDC guidance does not consider our medical and surgical dermatology visits or procedures ‘high risk’ when performed on patients not suspected or confirmed as COVID-19. OSHA considers them only “Medium Risk” with standard surgical masks appropriate. We are closely monitoring our own PPE stock and sourcing supplies through multiple vendors for the various markets. For those providers with access to properly OSHA fit-tested N95 masks, it is reasonable to wear these with special attention to limiting waste. I attended a webinar last evening sponsored by the American Society for Dermatologic Surgery entitled “COVID-19 Impact on Dermatologic Surgeons, Part 1: Skin Cancer, Mohs, Reconstruction Expert Panel”. Tomorrow evening at 8 pm EDT is “Part 2: Aesthetic Procedures Expert Panel” that any interested ASDS member is encouraged to attend. The skin cancer expert panel was variably using standard and N95 masks for Mohs surgery on the face. All were preserving and reusing their N95 masks by storing in brown paper bags each evening, while one also placed a standard facemask overtop the N95 for further protection from soiling. I polled several Dermatology Department chairs who also disclosed that the only N95s being used by their providers were for Mohs surgery around the mouth/nose.

I was encouraged by the live polling results from the audience and the panelists’ responses which confirmed that QDP’s comprehensive safety and quality measures meet, and often exceed, the experts and participants’ efforts. We know that the crisis continues to evolve and our strategies must keep up so I thank all of you who have shared ideas, concerns and suggestions.  It’s for the good of our whole QDP team, our families and our patients.

Stay well,

John Albertini, MD