September 8, 2020

Aspects of COVID-19 featured in the Southern Medical Journal

We in the United States have been living—and, unfortunately, dying—with COVID-19 for ¾ of a year, most acutely during the last 6 months, since the pandemic was declared. Almost everything about our lives has changed radically because of a virus we can’t see. But we can see its effects: nearly 200,000 dead (widely acknowledged to be an undercount of the true toll), millions of cases, millions unemployed (and many won’t return to the job they held before COVID because it no longer exists), businesses closed permanently, mandatory mask wearing in many public spaces, social distancing and social fears/suspicion, schools delaying or canceling in-person teaching, families struggling with childcare, people affected by isolation and depression, and on and on. 

Our frontline warriors and heroes—healthcare workers—see and feel these effects up close in long, stressful workdays, and they’re being affected, too. The September issue of the Southern Medical Journal looks at a few aspects.

One aspect is how COVID-19 is affecting medical resident training. This may not seem like it impacts consumers, but think about your last visit to the ER—you or your child were likely treated by a resident. Residents’ health, physical and mental, have an effect on how patients get treated. 

Researchers at the University of Miami did a nationwide survey of dermatology residents, some of whom have been reassigned to treating patients with COVID. Some said they felt uncomfortable about treating patients with the virus, because it’s not their area of expertise. Of those reassigned, less than half were comfortable with their new duties. And they’re very worried about the long-term effects of the virus on the economy and their job prospects after graduation, which is a concern many of us share about our own lives. 

There was a bright spot from the survey, which was that the residents are becoming more comfortable with and good at using telemedicine. (Another article in this issue notes that “telemedicine is a viable way to deliver health care,” a brand of medicine that has been slow to catch on.) This is especially welcome news for people who don’t have easy access to a doctor but do have a cell phone or computer, including people living in more rural and medically underserved areas of the country. And technology is helping residents learn, as more classes move exclusively online, to help prevent the spread of the virus. The jury is still out on whether they learn better from online instruction than from in-person teaching, however.

Those who have tracked the spread of COVID-19 around the world believe that international travel, especially from Europe, is responsible for COVID coming to our shores. Something that may have identified transmission of the virus in the US earlier is physicians and healthcare workers’ asking patients for travel histories—where have you traveled recently and were you or are you now sick?—as part of the examination. The percentage of doctors and medical residents asking for travel histories is quite low; almost 50% of residents have no training at all in obtaining travel histories, and if they do have training, they are more comfortable diagnosing/treating conditions from US domestic travel than from international travel. The situation is even worse in treating children, with children being more susceptible to travel-related illness than their parents and misdiagnosis frequent (eg, a study found that malaria in children was more likely to be misdiagnosed as something more like inflamed intestines/diarrhea). This can have serious implications for public health, as children because of their immature immune systems and undeveloped hygiene practices tend to spread infection among their friends and then to parents and to the public at large. This article by Stacy Gaither and colleagues is an eye-opener and definitely a reminder that we must advocate for our well-being and that of our children with our healthcare providers.

Turning from those on the frontline of treatment, the Journal speaks to COVID-19’s effects on consumers/patients in 2 articles geared toward the future with the virus. Two researchers in psychiatry from Kentucky and Oklahoma report that some of the effects coming directly from the infection itself are psychological. Almost half of the survivors of the 2003 SARS outbreak (SARS is a coronavirus, just like COVID) have been found to have anxiety and/or insomnia long after they recovered from the virus. Other symptoms that persisted were depressed mood, PTSD, OCD, panic disorder, memory impairment, fatigue, and/or irritability. Right now, it is unclear whether COVID-19 will have the same psychological and neurological legacy as the 2003 SARS pandemic, but studies are pointing in that direction.

The other article is extremely timely, as we count down the days to the 2020 election and the many controversies surrounding voting. Can we vote in person? Should we vote in person? What about voting by mail? What precautions are going to be taken by the government to make voting in person safe? This is not just about our individual futures but also about the future of our country, both futures that will be different from what we might have expected because of something we cannot see.

About the Author
Anita McCabe is socially distancing with a small collection of color-coordinated and medically effective face masks in Austin, TX. She has been writing about science and medicine and editing books and journals on those topics since the age of the dinosaurs (well, OK, it was the 1980s). Her areas of interest are pathology and infectious diseases, but COVID was still an unwelcome surprise.

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