July 16, 2020

An update from our Chief Medical Officer:

Given the current rapid pace of change and several important recent reports in the medical literature and the news, I wanted to provide another focused medical update to our QualDerm community.

  • Aerosol Transmission debate
    • JAMA Editorial July 13 from Harvard concludes that “the balance of currently available evidence suggests that long-range aerosol-based transmission is not the dominant mode of SARSCo-V-2 transmission.”
    • Despite the theoretical concern about airborne aerosol spread, the primary modes of viral transmission are large droplet exposure from coughing, sneezing, loud speaking/singing and surface contact spread (hands to mouth, nose, eyes)
  • Universal Masking protects health care personnel and general population
    • JAMA study July 14 from MassGeneral Brigham hospitals, the largest health care system in Massachusetts with 75,000 employees confirmed, “Universal masking was associated with a significantly lower rate of SARSCo-V-2 positivity among health care workers.”
      • Pre-masking infection rate 0% 21%; Post-masking 15% 11%
    • JAMA editorial July 14 by directors of CDC concludes:

“At this critical juncture when COVID-19 is resurging, broad adoption of cloth face coverings is a civic duty, a small sacrifice reliant on a highly effective low-tech solution that can help turn the tide favorably in national and global efforts against COVID-19.”

  • CDC suggests that with universal masking across US, COVID-19 could be highly contained in 2 months, like in Asia.
  • CDC investigation of a Missouri hair salon showed that two asymptomatic C-19 infected hair stylists serviced 139 clients in one week, with NO transmissions due to all persons wearing masks
  • Walmart announced universal mask requirement for all stores
  • JAMA published a Patient Page for COVID-19 to place in waiting areas and exam rooms to provide accurate information to patients
  • COVID-19 Trends and News
    • Cases are rising dramatically in US and most QDP markets, which cannot be attributed to only increased testing and/or infections in young people
    • Unfortunately, hospitalizations and deaths are also rising, even in young
    • CDC study shows asymptomatic infection in 40% cases
    • PPE shortages are becoming more common, esp. in hot spots
      • Conservation measures and re-sterilization efforts important
    • Enanthem (oral mucosal lesions) recognized in upto 29% of COVID-19
    • Remdesivir study shows reduction in death by 62% in severe cases
    • Moderna and Pfizer vaccines: both safe and “robust” immune response
      • Phase 3 trials soon with 30,000 volunteers
      • Goal of >100M doses by end 2020



a close up of a map


  • Anosmia (loss of smell), Hyposmia (reduced smell) and Dysgeusia (diminished taste) more widely recognized as specific symptoms of C-19
    • 1/3 to 2/3 patients develop anosmia; female predominance; often early sign
      • Only 35% patients aware of anosmia without testing
    • ENT literature: effective identification by screening using fragrance recognition
    • QualDerm will be initiating a new screening test for patients and employees
      • Smell test administered along with temperature check and questions
      • Brief 15 seconds
      • Policy update attached and distributed by Directors of Operations
      • Optional enhanced screening measure decided by each market leaders

Method: A nurse or certified medical assistant will educate front desk staff at each facility in proper testing as follows.

  • (3) Automobile air fresheners will be kept in opaque paper bag at screening desk
    • Pine, lemon or lime (citrus), cherry or strawberry (fruit) and negative control (pen, pencil, tongue blade/Q tip)
  • Patient/Employee closes eyes and asked to randomly identify one of 4 fragrance options
    • “Tell me if you smell anything, and if so, what is the fragrance?”
    • Successful screening = proper identification of fragrance or no smell
    • Failed screening = erroneous identification
  • Business development activity has accelerated for QualDerm, despite increasing COVID-19 case counts in our markets; reflects QDP strong reputation in the specialty
    • Physicians with concern about future risks are interested in partnering
    • Management continues to be grateful for all our team members’ efforts to promote our practices, support each other and our providers, and maintain our safety measures and commitment to high quality and patient centric care


Thank you, stay safe and well,


John Albertini, MD