key: cord-308807-9yggo5yk
authors: Zheng, DavidX.; Jella, Tarun K.; Mitri, Elie J.; Camargo, Carlos A.
title: National analysis of COVID-19 and older emergency physicians
date: 2020-11-04
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.10.074
sha: 
doc_id: 308807
cord_uid: 9yggo5yk

nan

. While public health efforts (e.g., statewide stay-at-home orders) had initially flattened the curve, 1 COVID-19 spread in the U.S. has once again begun to accelerate.

On October 23, 2020, the U.S. reached a new pandemic record of 83,010 daily cases, 1 and all signs point toward an impending "second wave" or "third surge." Given the association between advanced age and COVID-19 severity, 2 our objective was to compare the geographic distribution of U.S. EPs age  60 years to the cumulative distribution of confirmed COVID-19 cases, to highlight the potential risks faced by this vulnerable population of clinicians. 4 We integrated both datasets into QGIS geospatial analysis software (version 3.12.1), superimposing them onto state boundary files published by the U.S. Census Bureau. 5 States were grouped into color-coordinated quintiles based on proportion of EPs age  60, and a logarithmic scale was used to adjust coordinate data points of cumulative COVID-19 cases, resulting in a heatmap depicting the proportion of EPs age  60 and COVID-19 disease burden for each state. This study was deemed IRB exempt due to the use of deidentified and publicly available data.

The AAMC identified a total of 43,311 clinically active EPs in 2018, of whom 10,804 (24.9%) were age  60 years. 3 The 10 states in the highest quintile of older EPs were West Virginia, New Mexico, Vermont, Hawaii, Maine, Oklahoma, Montana, Alabama, Arkansas, and Arizona ( Table 1) consideration, especially as cases continue to surge. Emergency departments could also amend operations to prioritize reduction of nosocomial transmission risk among advanced age EPs (e.g., allocating critically limited PPE to higher-risk physicians, geographically cohorting patients with suspected or confirmed COVID-19 infection within an emergency department). 7 Furthermore, prioritization of routine COVID-19 testing of older EPs, as well as creation of reserve pools of emergency medicine physicians (e.g., EPs from hospital systems relatively less affected by COVID-19), may facilitate the transfer of care duties from older EPs at more heavily affected emergency departments, in the event that they test positive and need to safely self-isolate. 8 Study limitations include not controlling for other individual factors associated with increased COVID-19 severity (e.g., obesity, Black race, Hispanic ethnicity), 9,10 as well as using state-level data, which precludes insights into risk differences by, for example, rural/urban status.

Moreover, we acknowledge that utilizing cumulative case volumes does not account for differences in the present rate of COVID-19 spread between states (e.g., rate of COVID-19 spread and confirmed case count in New York have since stabilized from March/April 2020). 1 Finally, we understand that COVID-19 infection among younger clinicians is a serious problem.

Our hope is that the current findings will raise awareness among EPs and assist implementation of safety guidelines and workforce planning. Collectively, we need to ensure that all front-line EPs, including those at higher risk, are properly protected during the COVID-19 pandemic. States were grouped into color-coordinated quintiles based on relative proportion of older EPs, and cumulative COVID-19 case volumes were adjusted with a logarithmic scale to create proportionally-sized data points. 

Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China

State Physician Workforce Data Report

ESRI. COVID-19 resources

The American College of Emergency Physicians Guide to Coronavirus Disease (COVID-19

Redesigning emergency department operations amidst a viral pandemic

Protecting our healthcare workers during the