COVID-19 Daily: Hazard Pay, Dangerous Mistakes

What your doctor is reading on Medscape.com:

MAY 13, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today.

Hazard Pay in New COVID-19 Relief Bill

Hazard pay for frontline healthcare workers — an idea that has been championed by President Donald J. Trump and Senate Minority Leader Chuck Schumer, among others — is included in a just-released COVID-19 relief package assembled by Democrats in the House of Representatives.

The package could include as much as $200 billion to fund hazard pay for essential workers, including those in the health field. But it is far from a done deal, experts said.

Although various nursing organizations, nurses’ unions, and healthcare unions have advocated for hazard pay, physician groups have been less vocal. The American Medical Association (AMA), for instance, pushed for hazard pay for residents but has not made any further public statements. An AMA spokesman told Medscape Medical News the group was monitoring the situation but declined further comment.

Dangerous Mistakes

With COVID-19 studies appearing at a furious pace, clinicians, researchers, and the public are all trying to figure out what the data mean. But that’s not always easy, and being too cavalier can lead to dangerous misinterpretations, cautions Medscapecontributor F. Perry Wilson, MD, MSCE.

A study of more than 17 million people in England provides insight into who is at highest risk of dying from COVID-19 ― among them, older adults and men. The researchers used multivariable models to assess risk factors associated with death from COVID-19.

But association isn’t causation, as Wilson illustrates. And pushing aside clinical reasoning when considering risk factors can lead to mistakes, such as concluding that smoking is protective. It, of course, isn’t. Smoking is as dangerous as ever in the COVID-19 era.

Focus on ACE and Gender

SARS-CoV-2, the virus that causes COVID-19, co-opts the ACE2 receptor during infection. Now leading experts suggest that effects of the virus on the renin angiotensin system may be the key to understanding why men and individuals with underlying cardiovascular diseases appear to have worse outcomes from COVID-19.

Managing Delirium

COVID-19 patients who undergo treatment in intensive care units are at increased risk for delirium, but a bedside risk management strategy based on modifiable risk factors can help prevent lingering effects on cognition, researchers report.

Several factors can contribute to an increased risk for ICU delirium among COVID-19 patients, including direct nervous system infection, inflammatory processes, and prolonged sedation. But high-quality ICU care with adequate respiratory support, lighter sedation, and an appropriate safety bundle can mitigate the effects.

COVID-19 Fatigue

As the United States moves through multiple weeks, if not months, of social distancing, Brett M. Coldiron, MD, a dermatologist in Ohio, considers when “we may all become fatigued and say, ‘well, let’s just take our chances,’ the isolation being worse than the disease.”

There are clear reminders that the risk is real ― such as the sight of a local funeral director buying more lumber. But the day-to-day changes to Coldiron’s practice and his life are wearing thin: fewer patient appointments, more busy work for his staff, and social engagements missed.

Yet, the changes for medicine, wearing thin or not, are likely to be around for a long while.

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