March 30, 2020

An update from our Chief Medical Officer:

I hope everyone had a chance to enjoy the Spring weather and take a bit of a break from the news this weekend. I know this past week was especially challenging for our entire QualDerm workforce.  As the pandemic starts to peak in our local regions and cities like New York and New Orleans struggle, the next month will likely become even tougher.  As I try to help QDP navigate this crisis, I admit to being no less concerned or anxious than many of you.  But there is always a dawn after the darkness, and I was personally buoyed on Sunday when reading the following report National Coronavirus Response: A Roadmap to Reopening by Dr. Scott Gottlieb, former Commissioner of the Food and Drug Administration (FDA) and an advisor to the current administration. He and his co-authors outline a strategic master plan for this pandemic and the steps needed to move through different phases that will allow Americans to resume a sense of normalcy in their personal and work lives, and ultimately make the United States more resilient in the future. ‘Fear of the unknown’ exacerbates everyone’s stress so I invite you to review this document and see the roadmap developed by our brightest minds. Phase I involves our current actions to Slow the Spread. Phase II advises how to Reopen, State by State with specific benchmarks that trigger action plans. Phase III Establish Protection Then Lift All Restrictions occurs later (but hopefully sooner) as the nation begins manufacturing vaccines and therapeutics and can perform testing to determine population immunity. Phase IV Rebuild Our Readiness for the Next Pandemic outlines near and long-term strategies to modernize and fortify our health care system and re-establish a national agency to prevent and address future pandemics.

I would also feel encouraged by several weekend reports:

  • FDA authorizes a new 15-minute COVID-19 test with plans for distributing 50,000 tests/day by next week; identifying and tracking cases remains crucial to mitigation
  • Small clinical trial shows promise in treating COVID-19 patients with the plasma/antibodies from recovered patients; manufactured monoclonal antibodies also hold promise as a treatment option; further trials are expanding
  • Effective new antiviral drug(s) could be developed by summer, according to Dr. Gottlieb

An ongoing and critical component of every pandemic plan is reducing exposure risks and limiting community transmission through social distancing and shelter-in-place orders, such as those now enacted in nearly all of our QDP markets. I strongly encourage all our providers to review again the Quality Council (QC) recommendations for triaging medical and surgical dermatology care, as well as any specific state medical board requirements or restrictions. While the QC is purposefully relying upon each physician’s medical judgment, we have heard that triage interpretations are sometimes fairly variable. We expect some minor variation given different populations, practice patterns and local conditions. Please continue to honor the intent and spirit of the guidance, such that we do what is best for our patients, staff and broader communities.

Some recent additional practical recommendations from the field that I have received include:

  • Early adoption of TeleDerm by many providers has already led to iterative improvements; further guidance and support ongoing by Josh Metzger/IT team and Dermatology “super-users”
  • For patients triaged for urgent, necessary care, treat as many dermatology problems and skin cancers as possible each visit to reduce future appts and exposure risks
  • Continue to triage “new, changing or concerning lesions” for TeleDerm and/or in-office visits as necessary for clinical assessment; invasive, high risk skin cancers have been identified this week by both modalities
  • Mohs surgeons are offering ‘same-day evaluation, biopsy, frozen section pathology diagnosis and immediate surgery’ for high-likelihood, high risk lesions referred by QDP or referring providers to expedite care and minimize exposures

Please continue to share ideas and take good care of yourselves, your coworkers, and your loved ones.

John G. Albertini, MD