COVID-19 Daily: 1.4% Case Fatality Rate, Clinician Pay Cuts

Ellie Kincaid

March 31, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Here are the coronavirus stories Medscape's editors around the globe think you need to know about today: 

New Stats 

The case fatality rate of patients with COVID-19 is about 1.4% overall but increases with age, according to new estimates published in the Lancet Infectious Diseases . "Even though the fatality rate is low for younger people, it is very clear that any suggestion of COVID-19 being just like influenza is false," one expert writes in an accompanying editorial. "Even for those aged 20–29 years, once infected with SARS-CoV-2, the mortality rate is 33 times higher than that from seasonal influenza." 

Furloughs and Pay Cuts

Hospitals across the United States are preparing for a surge of COVID-19 patients while facing a shortage of cash from postponed elective procedures. Some are responding by furloughing nonclinical staff and cutting doctors' pay, Medscape Medical News reports, despite $200 billion earmarked for healthcare systems in federal stimulus money. One hospital CEO says he finds it offensive that the federal government is "bailing out airlines and cruise lines before our frontline men and women caring for patients." 

Critical Care Guidelines

A panel of 39 experts developed 50 recommendations on caring for critically ill patients with COVID-19, based on decades of research on acute respiratory infection applied to the current pandemic. The lead author of the guidelines picked out his top 10 for Medscape Medical News, including prone ventilation. 

Death Predictions

Predicting the number of deaths that may be caused by COVID-19 is a powerful way to spur public health interventions. Medscape contributor F. Perry Wilson, MD, MSCE, took a look at the assumptions and uncertainties of death prediction models and pointed out a huge unknown: the total number of coronavirus infections. Not having this number from broad testing makes it hard to pin down the true death rate.

Tough Choices for Physicians 

Physicians at practices across the United States are facing hard choices about how — and whether — to keep their offices open as hospitals cancel elective procedures and patients avoid nonurgent care. Some are trying telemedicine, modifying their office schedule and policies, or advising older patients not to come in. "Financially speaking, we are shooting ourselves in the foot," a California geriatrician said. Others may find it necessary to cut staff or close altogether. 

French Healthcare Workers Stretched Thin

Despite containment measures and attempts to prepare, healthcare workers in France are close to facing the disaster scenario of critically ill patients with COVID-19 that models predicted, an infectious disease specialist at the Hôpital Universitaire Raymond-Poincaré, in Garches, France, a suburb of Paris, told Medscape's French language edition. A month ago, no one would have believed that this situation could happen in France, he said. Around 2500 confirmed cases have been linked to a single prayer meeting that drew worshippers from around the world to a city in eastern France in February. 

Dispatch from Madrid

Watching the COVID-19 pandemic reach Italy, Spaniards "certainly made the mistake of thinking that this was not going to happen to us," said Dr Sabina Herrera, a specialist in internal medicine and transplant infectiology at the Ramón y Cajal University Hospital in Madrid, Spain. She joined Medscape's Spanish-language podcast to speak of her experiences with the pandemic. "For weeks I have been having nightmares about coronavirus," she said. "This is than a flu, and it seems that errors in Europe are being repeated in America."

Ellie Kincaid is Medscape's associate managing editor. She has previously written about healthcare for Forbes, the Wall Street Journal, and Nature Medicine.

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