COVID-19 Daily: Office Visits Decimated,
No US 'Vaccine Nationalism'

Sharon Worcester

April 26, 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: 

Outpatient Visits Decimated

A massive decline in outpatient office visits — 60% in mid-March and at least 50% since early February — suggests patients are deferring needed care, according to data compiled by Harvard University and healthcare technology company Phreesia. The analysis was reported online April 23 by The Commonwealth Fund.

New England and Mid-Atlantic states saw the steepest drops with declines as high as 66%, whereas visits by patients living in mountain states were down by 45% as of April 16. Not surprisingly, the declines have had the most impact on procedure-oriented specialties, and the youngest and oldest age groups were most likely to skip visits.

Despite a major push to reach patients via telemedicine, which accounted for about 30% of visits as of mid-April vs zero in February, virtual visits have made up for only a tiny portion of the decline in office visits.

Vaccine Access and Equity

Equitable access to a successful vaccine will be the key to tackling the COVID-19 pandemic, especially as the disease spreads in less developed countries, according to an expert panel convened by the National Academies of Sciences, Engineering, and Medicine (NAS).

"Vaccine is really going to be the answer," said Susan R. Weiss, professor of microbiology, University of Pennsylvania School of Medicine, Philadelphia. She, along with other NAS panelists, including Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAID), agreed there is no room for what Richard J. Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations, called "vaccine nationalism."

The agency's first obligation is to the US, Fauci said, adding, however, that NAS is "very sensitive to the fact that, as a country that has a big research and development operation, we do have a global responsibility," and that it will be crucial to ensure that any successful vaccine be distributed equitably around the world.


"Hospital at home" is not a new concept, but it is getting more attention as hospitals seek ways to manage COVID-19 surges while continuing to provide quality care to other patients in need.

At Tufts Medical Center in Boston, a partnership with Boston-based home health company Medically Home is freeing up beds for the most critically ill patients while providing hospital-level care at home — using telemedicine and remote monitoring, among other approaches — for those with less critical conditions. Medscape Medical News looked at how the program works, who can benefit, and what the future might hold for this approach beyond the COVID-19 pandemic.

"Long before the COVID-19 pandemic disrupted our way of life, we began researching innovative ways to provide care for the subset of patients who could receive hospital-level medical services in the comfort of their own homes," Tufts Medical Center President and CEO Michael Apkon, MD, PhD, said in a news release. "Our partnership with Medically Home is allowing us to optimize our space and resources at a critical moment, but even after this crisis has passed, we believe Medically Home will remain an important part of our overall strategy to meet the unique needs of each patient we serve."

New CVD Guidance

Patients with cardiovascular disease or risk factors are particularly vulnerable to severe illness from COVID-19. The European Society of Cardiology has developed a comprehensive guidance document on all aspects of cardiovascular care during the pandemic.

Stephan Windecker, MD, PhD, of the Swiss Cardiovascular Center, Bern, Switzerland, told Medscape Medical News that the document is not a guideline, but a guidance document that neither replaces any existing guidelines nor supersedes recommendations from local or national healthcare authorities. He further described it as a "living document" that may change and mature over time with increasing knowledge.

So, You're Brad Pitt…

That may not impress country-pop superstar Shania Twain much, but when it came to having a bit of fun at the expense of longtime National Institute of Allergy and Infectious Diseases director — and now-famous COVID-19 expert — Anthony Fauci, MD, on SNL at Home yesterday, Pitt definitely had "the touch." His moving tribute to Fauci and frontline medical workers, first responders, and their families should impress even Shania Twain.

Famotidine Study

It wouldn't come as a surprise if COVID-19 had brought on some serious cases of heartburn, but it may come as a surprise that famotidine, the active compound in the over-the-counter heartburn drug Pepcid, is among the candidates for COVID-19 treatment. The journal Science reports online today about in vivo testing of famotidine at an intravenous dose nine times that of the heartburn dose at Northwell Health, a 23-hospital system in New York City.

To protect the drug supply and prevent premature speculation about efficacy, investigators kept quiet about their study, which was launched based on early evidence from China and promising models showing that famotidine might be associated with reduced mortality in patients with COVID-19.

"If it does work, we'll know in a few weeks," Northwell Health's Kevin Tracey, MD, who leads the famotidine study, told Science.

Newborn Guidance

As babies born to mothers with confirmed or suspected COVID-19 may require newborn resuscitation, airborne, droplet and contact precautions should be used when attending deliveries in such cases, according to new clinical practice guidance from the American Academy of Pediatrics (AAP).

The guidance further calls for separating newborns from mothers with COVID-19 when possible. In addition, the AAP urges educating mothers who refuse separation about the potential risk to the newborn, stressing that mothers can express breast milk to be fed to the newborn by a noninfected caretaker (the virus has not been found in breast milk). The guidance also recommends testing of the newborn at 24 and 48 hours when possible. Post-discharge protective measures and follow-up are also outlined.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. More than 500 throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form

Sharon Worcester is a reporter for MDedge, part of the Medscape Professional Network. She has more than two decades of experience reporting on healthcare.

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