key: cord-0964103-kl8a7mg7
authors: Gerami, Pedram; Liszewski, Walter J.
title: Risk assessment of outpatient dermatology practice in the setting of the Covid-19 pandemic
date: 2020-07-16
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.07.035
sha: 410755660d0c3d332bbfbb32405355c54b1d3bcb
doc_id: 964103
cord_uid: kl8a7mg7

nan

surmounting data that the number of infections is far greater than reported. 50

To help dermatologist better grasp the impact of COVID, we created two models: a 51 dermatologist practicing in Chicago (city population 2,700,000) and one practicing in a 52 metropolitan area of 100,000. The model assumes the physician sees 145 patients per week, 53 which is the national average. 2 The model displays a range that assumes the ratio of 54 symptomatic-to-asymptomatic infections are 1:4 or 1:9, which are based on data from Wuhan 55 and New York, respectively. The range also uses current data that the sensitivity of the PCR test 56 may be as low as 70% or as high as 95%. 3 The number of asymptomatic or mildly symptomatic 57 patients in a population, and the number of these patients a dermatologist is likely to encounter in 58

When there are 4,425 average daily new positive cases in Chicago and 165 in the metropolitan 60 area, a conservative estimate would suggest a dermatologist could expect to encounter one 61 mildly symptomatic or asymptomatic COVID patient per week. 62

The virus is transmitted through airborne aerosols, including speaking, which can travel 63 for at least 6 feet. 3 Furthermore, viral loads are similar in both symptomatic and asymptomatic 64 individuals. 4 4 Surgical masks can decrease transmission by 75% 5 , and N95 masks are even more 65 protective. However, depending on the type and fit of PPE, dermatologists and their staff could 66 be exposed to if a COVID patient is seen. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)--has had a mortality 115 rate of 2.2% in China and 7.2% in Italy. Mortality and severity of infection are associated with 116 older age and comorbidities. 1 Infectivity is estimated at 2 to 3.58% of exposures. . Health care 117 workers, representing up to 20% of those infected, are at elevated risk. The high rates of 118 infectivity and mortality raise questions on how outpatient clinics can reduce risk. We created a 119 model to assess the weekly risk of exposure in a dermatology practice. 120

In the United States testing is limited in many places to patients who are highly 121 symptomatic. The largest study to date mainly focused on testing symptomatic individuals from 122

Wuhan reported 81% to have mild disease and 19% to have severe illness. 1 Additionally, many 123 may be completely asymptomatic. In New York on April 27, 2020, the reported number of 124 positive cases was 298,004. The same day a seroprevalence study showed a positivity rate of 125 14.9% in the Sstate of 19.45 million people roughly translating to 2,898,050 infections. These 126 studies suggest current reporting may only be capturing 10 to 20% of all infections. There is 127 surmounting data that the number of infections is far greater than reported. Also RT-PCR testing 128 sensitivities range from 70% to 95% . 2 129

To help dermatologist better grasp the impact of COVID, we created two models: a 130 dermatologist practicing in Chicago (city population 2,700,000) and one practicing in a 131 metropolitan area of 100,000. The model assumes the physician sees 145 patients per week, 132 which is the national average. 2 The model displays a range that assumes the ratio of 133 symptomatic-to-asymptomatic infections are 1:4 or 1:9, which are based on data from Wuhan 134 and New York, respectively. The range also uses current data that the sensitivity of the PCR test 135 may be as low as 70% or as high as 95%. 3 We created two scenarios to model the risk of COVID 136 exposure: a physician in Chicago (city population, 2,700,000) and a physician in a metropolitan 8 area of 100,000 people. Our model assumes 145 patients per week 3 ; the ratio of test-positive, 138 symptomatic to untested, asymptomatic infected patients range from 1:4 to 1:9; the sensitivity of 139 the PCR test ranges from 70-95%. 140

The number of asymptomatic or mildly symptomatic patients in a population, and the 141 number of these patients a dermatologist is likely to encounter in a given week, is shown for 142

Chicago (Table I ) and a metropolitan area of 100,000 (Table II) transmission by 75% 5 , and N95 masks are even more protective. However, depending on the 152 type and fit of PPE, dermatologists and their staff could be exposed to if a COVID patient is 153 seen. Fortunately, surgical masks have been shown to decrease COVID transmission by 75% 5 , 154 and N95 masks are even more protective. However, depending on the type and proper fit of 155 patient and provider PPE, dermatologists and their staff could be exposed to the virus if a 156 

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Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 185 2019 Pneumonia in Wuhan, China

Generational Differences in Practice Patterns of 187 Dermatologists in the United States

Novel coronavirus (COVID-19) 189 infection: What a doctor on the frontline needs to know

SARS-CoV-2 Viral

Upper Respiratory Specimens of Infected Patients

Simulation of the clinical 194 and pathological manifestations of Coronavirus Disease

Syrian hamster model: implications for disease pathogenesis and transmissibility. Clin 196 Infect Dis