Protection comes at a cost: Doctor's life inside personal protection equipment

Availability of personal protective equipment among dermatologists in the COVID-19 pandemic: Assessment and risk factors in a web-based, global study

Background: The availability of personal protective equipment (PPE) among dermatologists during the Coronavirus Disease 2019 (COVID-19) pandemic has not been studied. Methods: We have assessed PPE availability among dermatologists and relevant aspects of hospital service by surveying 733 dermatologists. Results: Considerable percentages of respondents had to purchase their own PPE (40.2%) and were not provided with it at the hospital (37.7%). Only 27% of respondents provided hospital service, and 18.4% were assigned to nondermatologic duty. A substantial percentage (64.4%) indicated the availability of hospital-issued management guidelines (HIMG) for COVID-19 patients. Nearly half of the survey participants (49.1%) responded that the health care system was not equipped for the pandemic. Purchasing one's own PPE was strongly associated with the private practice setting and continent, with the highest rates in Central and South America and in Europe (P < .001). PPE availability at a hospital was associated with 2 continents, with the highest rates in Europe and in North America (P < .001). In logistic regression, the most important factor reducing the odds ratio (OR) for purchasing their own PPE was HIMG for COVID-19 patients (OR, 0.55; 95% confidence interval [CI], 0.32-0.97). Respondents’ assessment that the health care system was equipped for COVID-19 was the most powerful increaser of OR for PPE availability (OR, 9.43; 95% CI, 5.37-16.56) followed by >1,000 COVID-19 cases in a participant's country. Conclusions: Substantial percentages of respondents had to purchase their own PPE and were not provided with it at the hospital. Strategies to increase PPE availability should be implemented by hospitals, industry, and government authorities.

DERMATOLOGY IN A MULTIDISCIPLINARY APPROACH WITH INFECTIOUS DISEASE AND OBSTETRIC MEDICINE AGAINST COVID-19

The care for patients infected with COVID-19 requires a team approach, and dermatologists may collaborate with other specialties, especially infectious disease (ID) medicine and obstetrics and gynecology (ObGyn), at every stage of the infection process. A broad spectrum of cutaneous manifestations may occur early in COVID-19 infection, making appropriate dermatologic identification critical for an early diagnosis. There is prognostic value in appropriately identifying different types of COVID-19–associated skin manifestations, which have been linked to disease severity. Such observations emanated from dermatology research, especially large series and international registries of cutaneous manifestations relating to COVID-19, and impact COVID-19 care provided by most health care providers. Also, research based on international registries of skin reactions from the COVID-19 vaccines has an impact across disciplines. An increased risk for severe illness from COVID-19 is encountered during pregnancy, and dermatologists’ role is to urge ObGyn and other clinicians to monitor and educate pregnant patients about the potential for eruptions as a manifestation of COVID-19. ID and ObGyn experts indicate that teledermatology enhanced the interaction among health care providers and improved COVID-19 care. More than 40% of all dermatology consultations at a tertiary care hospital were done via teledermatology. Future collaborative research involving dermatology and specialties, such as ID and ObGyn, could help delineate guidelines for dermatology consultations in patients infected with COVID-19 and determine cases appropriate for teledermatology.

Global impact on dermatology practice due to the COVID-19 pandemic

This contribution focuses on the effects of coronavirus disease 2019 (COVID-19) on dermatology practice. We discuss the impact on practice volume and procedures and on the considerable increase in teledermatology use. We also describe the important roles that dermatologists have played in enhancing infection prevention and on the frontline. During the crisis, dermatologists have faced the challenge of a shortage of resources, such as personal protective equipment, in the health care system. In addition, they have been involved in managing cutaneous manifestations related to COVID-19 and occupational disease caused by personal protective equipment. Dermatologists have made a diligent effort to identify melanoma and to ensure the treatment of high-risk skin cancers. Safety guidelines have been suggested to minimize the potential risks associated with the systemic use of immunosuppressant agents and immunomodulators in patients with severe inflammatory skin disease during the pandemic. Finally, social distancing necessitated that dermatology conferences take place virtually and teaching via e-learning increased.

Impact of COVID-19 pandemic on dermatology practices: Results of a web-based, global survey

The spectrum and magnitude of changes in dermatology practice induced by the COVID-19 pandemic have not been adequately studied.

OBJECTIVE

This study aimed to assess the immediate and long-term effects of the pandemic on dermatology practice on a large scale, including the clinical activity of participants, frequency and types of procedures used, and teledermatology (TD) use.

METHODS

This web-based, global survey included 733 dermatologists. The primary outcomes are percentages of respondents providing in-person consultations, hospital service, and TD and performing procedures. Factors in logistic regression models that may influence the odds ratio (OR) for TD use during pandemic and for future use also were analyzed.

RESULTS

The percentages of respondents providing in-person consultations (46.6% vs. 100% before the pandemic) and hospital service (27% vs. 52.8% before the pandemic) as well as performing procedures (25.6% vs. 100% before the pandemic) decreased, whereas practicing TD increased three-fold (75.2% vs. 26.1% before the pandemic) during the pandemic (p < .001 for each). Practice location was associated with TD use during the pandemic and with its expected use in the future (p < .001 for both), with North American respondents indicating the highest use. TD use during the pandemic showed a positive correlation with TD use before the pandemic, performing procedures and, more specifically, with biopsies of suspicious pigmented lesions during the pandemic (p < .001 for each). TD use before the pandemic was the most powerful predictor of TD use during the pandemic (OR: 16.47; 95% confidence interval, 7.12-38.06). More than two third of participants (68.6%) expect to use TD in the future. The factor with the largest increase in OR on the expectation of future TD use was >1000 COVID-19 cases in the country (OR: 3.80; 95% confidence interval, 2.33-6.21).

CONCLUSION

This survey indicates a profound immediate effect of the pandemic on dermatology practice. The pandemic appears to have substantially contributed to an increased use of TD in the long run.