As further evidence of the spreading coronavirus pandemic, a survey of more than 2,600 U.S. physicians finds that half of them report treating at least one patient with possible COVID-19 symptoms but have not been able to test for the virus.
Despite assurances from government officials that the country’s testing capabilities have gotten better, 73% of the doctors say they are not able to test patients quickly and easily, according to the survey (PDF) by Doximity, the online professional network.
Doximity conducted the survey between March 21-24 in partnership with Harvard Medical School and RAND Corporation.
Just over 10% of the doctors reported having seen at least 10 patients with possible coronavirus symptoms that could not be tested, the survey found.
One emergency room doctor said he was surprised how many doctors have encountered patients with symptoms of coronavirus. “As surprised as I was that that number was high, I think it’s going to get higher over time,” said Amit Phull, M.D., a board-certified emergency medicine physician and vice president of strategy and insights at Doximity, who is self-quarantined right now.
Phull, who worked a shift in the ER last weekend at a Chicago hospital, said he self-quarantined after he was exposed to vomit from a patient who possibly had COVID-19. Phull said he feels fine but did not want to take the risk of exposing his older parents and young child to the virus. He has not been tested as he has not shown symptoms.
At the Chicago hospital where he works, Phull said staff are seeing patients in severe distress.
“Chicago benefitted from being a few weeks behind New York,” he said. “But we’re beginning to see an uptick where patients are beginning to show up at hospitals.” The city is rapidly converting an open convention center into a field hospital, expecting a surge of patients, he said.
The survey was taken on Doximity’s network of U.S. physicians, and the company said it was the largest national poll to date on U.S. physicians’ viewpoints and represented all major medical specialties. Survey respondents including physicians from 53 specialties and 50 states, along with Puerto Rico and the District of Columbia.
As an ER physician, Phull said he expects to see patients with the virus, but based on the survey, COVID-19 is touching "every facet of the healthcare system.
"All kinds of doctors are now being exposed to this in their patient population,” he said.
Based on the projections from the White House Coronavirus Task Force earlier this week predicting between 100,000 and 240,000 people in the U.S. will die from the coronavirus, Phull said there will likely be 10 million or so people eventually infected with the virus calculated on a 1% mortality rate.
“As we learn more, that number is probably the low end if not the baseline. This will touch all aspects of the healthcare system,” he predicted.
Some 70% of respondents believe government agencies are not doing enough about the pandemic and had not taken appropriate measures to support the medical supply chain.
“The bottom line is that the issues flagged in this study, both at the clinical and system level, need to be addressed quickly for us to get and stay ahead of this," said Phull.
A lead researcher agreed. "For the first time, we have aggregated opinion data that reflects what [physicians] are experiencing on the front lines of this pandemic. These voices are highlighting clinical, medical safety and supply issues that must be addressed quickly," said Anupam Bapu Jena, M.D., an associate professor of healthcare policy and medicine at Harvard Medical School.
The survey revealed that many doctors are turning to telemedicine to care for patients. More than 80% of physicians have moved to, or are planning to adopt, telemedicine virtual visits with patients. Telemedicine can be beneficial in treating patients remotely, saving in-person visits for high-priority coronavirus patients.
Nearly 50% also reported concerns about patients likely avoiding testing or treatment because of financial barriers.
Doctors said significant safety and medical supply challenges persist in the healthcare industry. Findings from the survey include:
- Medical supplies and COVID-19 testing are inadequate: 77% of respondents did not believe that their hospital or clinic had adequate medical supplies or equipment to manage the crisis. At his Chicago hospital, Phull said the protocol was once to change N95 masks with every patient. “That went out the window several weeks ago,” he said. Now, doctors wear a single N95 mask for their entire shift. He hopes the hospital will be able to continue to meet the demand with a resupply of equipment as the number of patients increases.
- There are not enough precautions in place: Nearly 60% did not think there were enough coronavirus precautions in their clinical setting that they feel protected while treating suspected COVID-19 patients.
- Social distancing is potentially an underreaction: While social distancing is inconvenient and has large economic impacts, most—but not all—physicians agree that it is necessary to successfully fight the pandemic. Overall, 59% reported that shelter-in-place or stay-home orders would help “flatten the curve” to stop the spread of the virus.
“The findings highlight the difficult road ahead for healthcare providers confronting the coronavirus pandemic,” said Chris Whaley, Ph.D., lead author and policy researcher at the RAND Corporation.
Insight on physician experiences and concerns surrounding the pandemic should be used to design appropriate and immediate policy response, Whaley said.