Here are the stories our MDedge editors across specialties think you need to know about today:
Racism, COVID-19 lead to sky-high stress levels
Primary care clinicians, already experiencing all-time high stress levels related to COVID-19, are now struggling to cope with the fallout from racism and the death of George Floyd, according to a survey conducted June 5-8.
When asked how the situation has affected their practices, 12% of the survey’s 586 respondents “drew clear connections between the current racial unrest and the health of their patients,” the Larry A. Green Center said in a recent statement. One-third of the clinicians also said that recent racism-related events have had a negative effect on their own well-being.
In a related survey of 1,111 patients conducted June 8 about 65% of patients said that racism affected emotional, psychological, and behavioral health.
“The fact that so many patients and clinicians agree that racism is a driver of health points to the incredible role primary care plays in creating safe spaces to process deep societal and personal issues,” said Christine Bechtel, cofounder of 3rd Conversation, a community of patients and providers. Read more.
Medical teams take to the streets
They stanched bleeding wounds and plucked disoriented teenagers from clouds of gas, entering dangerous corners where on-duty emergency health responders may fear to go. Many are medical professionals who see parallels between the front lines of COVID-19, where they confront stark racial imbalances among those stricken by the coronavirus, and what they see as racialized police brutality.
Iris Butler, a 21-year-old certified nursing assistant who works in a nursing home, decided to offer her skills after seeing a man injured by a rubber bullet on her first night at the Denver protests. She showed up as a medic every night thereafter. “I am working full time and basically being at the protest after getting straight off of work,” said Ms. Butler, who is black. That’s tiring, she added, but so is being a black woman in America. Read more.
At-home management of type 1 diabetes, COVID-19
Although hyperglycemia and diabetic ketoacidosis are common in people with type 1 diabetes who develop COVID-19, many are still able to manage the illness at home and overall mortality is relatively low.
These new findings are still preliminary and were published online June 5 in Diabetes Care by Osagie A. Ebekozien, MD, vice president, quality improvement and population health at the T1D Exchange, and colleagues.
The published study includes data as of May 5 on 64 individuals from a total of 64 US sites. Since the paper was submitted, there are now 220 patients from 68 sites. There were two deaths in the preliminary report, Dr. Ebekozien said. There have been a few more deaths in the larger dataset, but the mortality rate remains relatively low.
Overall, 34.9% of patients were able to manage COVID-19 entirely at home. At the other extreme, 22.2% of patients overall were admitted to the intensive care unit. Including the small proportion of patients sent home after being seen in emergency or urgent care, overall roughly half were not admitted to the hospital. “Even in this preliminary study, half were managed at home via telemedicine with an endocrinologist and infectious disease specialist ... I think it continues to be a case-by-case clinical decision between the patient and their provider,” Dr. Ebekozien said. Read more.