COVID-19 Daily: Financial Aid for Medical Practices

What your doctor is reading on Medscape.com:

APRIL 20, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today: 

Financial Aid for Medical Practices 

For medical practices facing financial hardship from reduced patient volumes, there are four options for federal financial assistance to offset revenue loss and remain financially viable during the economic uncertainty of the COVID-19 pandemic. Medscape explains the options, with perspective from other practices making hard decisions. 

“My hope is that after this is over, our business will pick back up pretty quickly,” said one administrator. “However, until I can get the business back, I needed something to keep us afloat.” 

What Do You Think About the Reported Rates of COVID-19? 

As of April 20, the European Centre for Disease Prevention and Control counted more than 300 cases of COVID-19 per million people worldwide, according to Our World in Data, or about 0.03% of the world population. In the United States, nearly 2300 people per million have been infected, about 0.2% of the population nationwide, but the proportion of people who have had COVID-19 varies by state. 

But the confirmed case count depends on the availability — and the reliability — of diagnostic and antibody testing, which can’t be taken for granted. Medscape wants to know: Based on what you are seeing in your practice, what do you think are the actual proportions of people who have been infected? Tell us here. 

Paths to Resume Elective Procedures

Federal officials and medical groups are outlining plans to allow elective procedures to resume in phases once the threat of COVID-19 appears to subside in an area of the US. The roadmaps laid out criteria for a region to meet before resuming elective procedures, such as declining rates of new COVID-19 cases. 

Hospitals also should have enough beds, personal protective equipment, ventilators, and trained staff to allow such surgeries to take place “without resorting to a crisis standard of care,” the American Hospital Association and partner medical groups said. The governors of Alaska, Oklahoma, and Texas also moved last week to ease restrictions on surgeries in their states.

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In-Hospital Glucose 

In the first published report characterizing glycemic control among more than 1000 patients hospitalized with COVID-19 in the US, those with diabetes and those with hyperglycemia had a fourfold greater inpatient mortality than those without diabetes or hyperglycemia. For patients without evidence of diabetes prior to admission who developed hyperglycemia while hospitalized, mortality was sevenfold greater. The lead author of the study is an advisory board member for insulin management software company Glytec, and other coauthors are company employees. 

Acute Kidney Injury

Clinicians facing shortages of dialysis machines and dialysate solution for patients with COVID-19 are devising creative solutions and workarounds, Medscape Medical News reports, but also cautioning that acute kidney injury is driving up patient deaths and may be a lingering sequela of the novel coronavirus. 

“This is acute kidney injury of a different stripe than we’re typically seeing in really sick people,” said one nephrologist. Clinicians are “doing the best they can,” he said, “but a lot of what we would like to do is curbed by resource utilization.”

More Guillain-Barré–linked Cases

Weeks after the first case report, Italian researchers have described five more cases of Guillain-Barré syndrome (GBS) in association with COVID-19. The onset of GBS in the five patients occurred 5 to 10 days after initial COVID-19 diagnosis. The newly described GBS cases occurred in three hospitals in Italy from February 28 through March 21, during which there were more than 1000 estimated COVID-19 admissions. 

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. Hundreds throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.