Public Health NOW: COVID-19 in the U.S.
by Nishu Vora.
Public health has really come into the spotlight recently due to the COVID-19 pandemic. We can see the many aspects of public health at work from the epidemiologic tracking of the disease to the health policies being implemented to keep citizens safe. It has affected all aspects of life for everyone, including the podiatric world from students to practitioners. Students have been pulled from the classroom and clinical rotations. All classes are now online with students feeling frustrated by not being able to work with patients. Many fourth-year students preparing for clerkships are trying to make travel arrangements around weekly changing protocols. Others are, unfortunately, scrambling to find new rotations after some programs have canceled their clerkship positions. It is uncertain when students will be allowed back into hospitals and clinics, but it is an integral part of their education that they are missing. Prometric testing centers have even limited the number of seats available making it difficult for students to take boards.
The residents also find themselves in an unusual situation. Most residents are still continuing to work on their podiatric rotations with a limited amount of patients. Some programs have pulled podiatric residents from off-service rotations. Elective cases are widely canceled at most facilities, but some are slowly starting to trickle back in with the easing of quarantine measures. Academics have gone virtual. One benefit is that conferences and academic meetings are now online making them easily accessible.
It was an eye-opening experience being on the ID team and working with hospital management and the city public health department…
Personally, at our program, we continued with all our rotations cautiously. Our program also has an internal medicine and an orthopedic surgery residency, and a protocol was established that we would be pulled from our rotations to cover the hospital if the internal medicine resident were to come in contact with the virus and have to quarantine. I was on my emergency medicine rotation at the start of the pandemic when we weren’t exactly sure how deadly the virus was but began wearing masks. Then, I found myself on the infectious disease (ID) and rheumatology rotations where half of the month I was practicing from home due to the rheumatology clinic shifting to telemedicine and the other half I was helping take care of COVID-19 positive patients. I was lucky enough that we were in an area that was not hit incredibly hard by the virus. It was an eye-opening experience being on the ID team and working with hospital management and the city public health department combing through a live stream of day to day updates from health care leaders and determining hospital protocol changes. The day-to-day practice changed a little with universal masking and temperature checks daily. Hospitalists found a little silver lining by no longer having to dress in casual wear for rounding and now joined the surgical specialties by wearing scrubs. Luckily, our hospital had plenty of PPE, although we tried to preserve it and update ourselves about the patient from primary teams and nurses. I continued onto orthopedic and then podiatry rotations, where clinics were already cut to just urgent follow-ups and only urgent surgery. This basically consisted of fractures and wounds. At the time of this publication, elective surgeries have returned but with limited OR time to keep hospital census lower. Nationally, there is also a record spike in cases, which will likely correlate to changes within the hospital. The elephant in the room for the residents is getting their number of cases not just for graduating, but to be comfortable and competent surgeons after graduating.
Practicing podiatrists find themselves learning a new tool: telemedicine. Clinics are now triaging their patients and only allowing urgent patient follow-ups to keep a load of emergency rooms, ultimately turning clinics into wound care centers (1). The majority of patients are being checked up on over the phone to limit their exposure to the virus. Some practitioners are taking the extra mile and temporarily closing their practice. Telemedicine will likely become new normalcy in the way we practice. A new way to practice comes with new rules on billing and coding, making it difficult for all podiatrists to transition to telemedicine smoothly. Luckily, Medicare has already increased coverage for telehealth services (2). “COVID toes” have become a concern for some of these patients coming into the clinic. “COVID toes” has been described as an erythematous rash along with multiple toes, as seen in patients with chilblains. Discoloration in the toes has also been seen in COVID-19+ patients that are usually critically ill and have a coagulopathy secondary to the virus causing ischemic changes in the toes (3). This type of change is unlikely to be affecting patients coming to the clinic with no respiratory issues.
COVID-19 has really changed many aspects of healthcare from hospital layouts and universal masking to pressing the limits of emergency rooms and intensive care units around the country. It has put the fragility of our healthcare system in the spotlight and has pointed out many areas of improvement. Many changes in the way we now practice are likely to stay for the near future with many more changes to come. The economic cost of the virus on the healthcare sector is still to be determined, and we may see many hospitals and practices struggle to survive. Thankfully, podiatry will still be around and will continue to play its role caring for all feet!
by Nishu Vora.
- Rogers LC, Lavery LA, Joseph WS, Armstrong DG. All feet on deck – the role of podiatry during the COVID-19 pandemic: preventing hospitalizations in an overburdened system, reducing amputation and death in people with diabetes. J Am Podiatr Med Assoc. 2020 Mar 25 [online ahead of print]. DOI: 10:7547/20-051. Available at: https://www.japmaonline.org/doi/pdf/10.7547/20-051 . Published March 15, 2020. Accessed April 1, 2020.
Podiatry & Public Health
Special Edition, Education
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