*This article first appeared in the Summer 2020 issue of Arizona Physician magazine, a publication of the Maricopa County Medical Society.
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By Brian Powell
August typically marks the return of Arizona students to their classrooms and college campuses for the fall semester, the early promotion of the influenza shot by pharmacies and clinics, and the start of seasonal residents planning their return later in the year.
Amid the COVID-19 pandemic, these annual markers serve as a reminder of an uncertain future as physicians and hospitals prepare for a potential new wave of COVID-19 cases that would coincide with the peak of flu season.
“I think there’s going to be a volume problem,” said Dr. Shane Daley, a urologist with Arizona Urology Specialists. “Flu season taxes the health system, and you will have two major viruses at the same time.”
Dr. Nick Staab, medical director of the bureau of epidemiology and disease control at the Arizona Department of Health Services, said his office is planning for an expanded influenza vaccination program.
“Under routine conditions our health care system is near capacity in a usual fall and winter season, especially given the influx of winter residents to Arizona,” Staab said. “Add to that the ongoing transmission of COVID-19, and careful monitoring of the health of our health care system will be important to maintain function.”
With health experts predicting a second wave of COVID-19 before a new coronavirus vaccine is available to the public, physicians may have to halt elective surgeries if hospitals do not have adequate capacity or staffing, adapt to fewer patient visits and absorb a financial hit that could lead to furloughs or layoffs.
Adapting for today and the future
At Clear Dermatology and Aesthetic Center and Valley of the Sun Dermatology in Scottsdale, Dr. Brenda LaTowsky said her practice responded in the early weeks of the COVID-19 outbreak by treating only the most urgent patients in person and converting as many patients as possible to telemedicine. Patients were asked to submit photos of any concerning spots and lesions. Oncology cases were deemed most urgent and continued, while other outpatient procedures were postponed.
“It really impacted us administratively; we had to figure out the best platforms for us and a new way of seeing patients,” said LaTowsky, who has been following the American Academy of Dermatology guidelines. “We were seeing a decreased number of patients which does affect our bottom line, but patient safety is our primary concern.”
After about six weeks, more patients were being seen in the office but with stricter protocols for employees and patients, including required masks and greater use of personal protective equipment and distancing among patients. If the fall and winter prove to be as or more disruptive, LaTowsky’s practice, like so many others, has policies it can fall back on.
“It’s really about being educated about Arizona numbers and being educated about COVID-19 itself,” LaTowsky said. “Over time we have discovered much more about symptoms, antibodies, the incubation period. By staying on top of new information coming out and the incidents in Arizona, we can be flexible and change as needed in the future.”
Daley, who also serves as assistant professor of urology at University of Arizona College of Medicine-Phoenix and as secretary of the Maricopa County Medical Society board of directors, said the majority of his practice switched to telemedicine during the initial COVID-19 lockdown.
Daley, who receives daily updates from hospitals, expects physicians will be adapting their practices through the fall and winter until a COVID-19 vaccine is available.
“It has dramatically affected us largely because our surgeries are elective,” Daley said. “Kidney stones and prostate- and kidney-cancer surgeries are not considered emergencies, but many are urgent.”
Staab said the state’s primary method of communicating urgent information to physicians is via the Arizona Health Alert Network. He said the state also created the Arizona Surge Line, a centralized bed placement system that enables COVID-19 patients to be transferred to a hospital with the capacity and staffing to treat them.
“No single hospital, practice or provider should feel like they are alone in managing the care of their patients,” Staab said. “While there may be obstacles and crises along the way, ADHS is committed to helping all practices approach this outbreak with the best tools we have available.”
Universities developing new tests to track virus
New methods of testing being developed by Arizona’s universities could become more accessible for physicians in the coming months, playing a critical role in slowing the spread of the new coronavirus.
Staab said he has contacted the Biodesign Institute at Arizona State University to discuss expanding the availability of its newly developed PCR saliva test.
The test requires a person to spit into a screw-top tube through a straw. It is less invasive and costly than the NP swab tests, requires less personal protective equipment, and can be done in the workplace, schools, or even at home. In June, ASU began pilot testing its students and staff in anticipation of the fall semester scheduled to begin in August, with plans to increase availability using a fully automated robotic system and point-and-click IT infrastructure for testing and reporting, said Joseph Caspermeyer, an ASU spokesman.
ASU plans to develop partnerships with hospital practices and health care systems, schools, cities and counties, businesses and nonprofits, and community organizations. Caspermeyer said the potential is there with the saliva test to collect samples from any hospital or private physician’s practice.
Staab said the state health department works closely with all of Arizona’s universities and research institutes and is in regular contact with commercial labs to discuss testing availability.
The Phoenix-based Translational Genomics Research Institute, in collaboration with Northern Arizona University and University of Arizona, is working to genetically sequence as many Arizona positive samples as possible to build a statewide genomic map to track the virus as it appears and moves through different communities.
Staab said the serology test developed by UArizona is being used by the state to test high-risk workers in health care and corrections for the presence of antibodies.
All of which will become even more critical as Arizona physicians prepare for what lies ahead.