Dr. Martin Makary: Coronavirus – For everyone's sake, organize into second- and third-string medical teams

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The outpouring of the 100,000+ retired U.S. doctors and other health care professionals who are volunteering to come back to work during the coronavirus pandemic is the ultimate statement that medicine is a calling, not a job.

Embodied in our allegiance to help patients is a self-sacrificial instinct that is being demonstrated today as it has been throughout history.

Our medical ancestors first tested new devices and therapies on themselves before trying them on patients, and for over a century military doctors put themselves at risk to serve others, sometimes from behind enemy lines.

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Our creed has no borders, is agnostic to politicians, and always puts patients first.

The current outpouring of help by health professionals is a testament to our great medical heritage. But as a personal admirer of the volunteerism of older doctors, some of whom have comorbidities and other risk factors for COVID-19, I'm concerned by the data that health care workers are at the highest risk for getting the infection.

Unlike the Spanish flu of 1918, which selectively killed younger people, the current COVID-19 infection is the inverse in its case fatality rate age distribution. Namely, COVID-19 has a punishing case fatality rate in people in their 70s and 80s. That includes doctors.

One estimate published in JAMA indicated that 43 percent of all infections at one point involved hospital transmission.

To best prepare to meet the needs of coronavirus patients and take care of our own, we should organize into first-, second-, and third-string teams.

As reported by the New York Times, the Northwell hospital system in New York has already done some of this pre-planning, assigning dermatologists and orthopedic surgeons to the emergency room and surgeons with ICU skills to work in the ICU.

Kaiser Permanente has made similar staffing re-assignments, asking rheumatologists to staff their COVID-19 hotline phone lines.

While some hospitals have undertaken enormous planning efforts, others have done very little.

Contingency planning is necessary because our workforce is at risk of getting hurt and of transiently shrinking at a time of unprecedented demand.

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Many medical professionals will become infected or have already become infected, requiring temporary quarantine or hospitalization themselves.

Others are showing signs of burnout with months to go, not to mention the backlog of patients that are currently on hold.

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Specifically, hospitals and medical groups should take a detailed inventory of their health care professionals and design first-, second-, and third-string teams to staff ICU beds.

First-string teams should include intensivists who do not have significant risk factors themselves.

Above all, we should be removing high-risk staff, such as those who have had an organ transplant, off the front lines of patient care.

Second-string teams could include staff physicians who are not intensivists but who have formal training in managing ventilators and feel comfortable doing so in partnership with a critical care nurse or respiratory therapist.

Some of us who are not intensivists have had extensive training in critical care during residency and feel comfortable managing ventilated patients. Many anesthesiologists meet these criteria.

As a general surgery resident, I spent approximately 1 year of my 5-year residency working in an ICU managing complex ventilated patients and since then I've rounded in the ICU on my patients almost every week during my career.

While many doctors may not have sufficient critical care training in their residency to provide reliable critical care and others may understandably feel too removed or rusty to manage ventilators safely, taking an inventory of doctors who have needed skills and are ready to help is good contingency planning in these unprecedented times.

Unlike the Spanish flu of 1918, which selectively killed younger people, the current COVID-19 infection is the inverse in its case fatality rate age distribution. Namely, COVID-19 has a punishing case fatality rate in people in their 70s and 80s. That includes doctors.

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For that reason, it is prudent for us to prioritize appropriately older health care professionals or those at high risk of dying if infected. While I applaud the offer of older doctors to come out of retirement to put their lives on the line, some may be going to battle unarmed. While it may be necessary to have these doctors join the fight, we should be thoughtful in our strategy and ensure that we are maximizing the skills of those at lower risk before putting those with a weaker immune system on the front lines.

As we see the tremendous outpouring of health professionals to step up and serve during this time of need, we should remember our responsibility of taking care of our own.

This column was first published on MedPage Today