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| Many Dermatology Practices Stay Open, Ignoring Public Health Pleas | Many Dermatology Practices Stay Open, Ignoring Public Health Pleas |
| (7 days later) | |
| Though public health officials are urging medical practices to use virtual patient visits to help slow the spread of the coronavirus, a surprising number of dermatology offices, many of them owned by private equity investment firms, remain open for in-person skin checks and other nonurgent services. | Though public health officials are urging medical practices to use virtual patient visits to help slow the spread of the coronavirus, a surprising number of dermatology offices, many of them owned by private equity investment firms, remain open for in-person skin checks and other nonurgent services. |
| Many dermatologists have closed their offices, instead examining rashes and skin growths via Zoom, FaceTime and photos. But in a study to be published by the Journal of Dermatological Treatment, a group of researchers at the University of Cincinnati called 60 dermatology practices on March 23, when California, Illinois, New Jersey and New York already had stay-at-home restrictions in place, to see if they were open. Of the 55 dermatology practices they reached in six states, 29 said they were open to all patients. Seventeen said they were open only to urgent visits, and nine said they were closed to all patients. | Many dermatologists have closed their offices, instead examining rashes and skin growths via Zoom, FaceTime and photos. But in a study to be published by the Journal of Dermatological Treatment, a group of researchers at the University of Cincinnati called 60 dermatology practices on March 23, when California, Illinois, New Jersey and New York already had stay-at-home restrictions in place, to see if they were open. Of the 55 dermatology practices they reached in six states, 29 said they were open to all patients. Seventeen said they were open only to urgent visits, and nine said they were closed to all patients. |
| This week, with most of the country under shelter-in-place orders, The New York Times found practices large and small still scheduling in-person visits. | This week, with most of the country under shelter-in-place orders, The New York Times found practices large and small still scheduling in-person visits. |
| Decisions to keep dermatology offices open for all but the most urgent visits ignore guidelines issued last month by the American Academy of Dermatology, which recommended rescheduling visits for all nonessential medical or surgical visits or, alternatively, offering telemedicine services. | Decisions to keep dermatology offices open for all but the most urgent visits ignore guidelines issued last month by the American Academy of Dermatology, which recommended rescheduling visits for all nonessential medical or surgical visits or, alternatively, offering telemedicine services. |
| Pinnacle Dermatology, based in Lombard, Ill., with 52 locations in five states, states on its website that it is an “essential business’ and its “offices remain open.” | Pinnacle Dermatology, based in Lombard, Ill., with 52 locations in five states, states on its website that it is an “essential business’ and its “offices remain open.” |
| Chicago Pacific Founders, a private investment firm, holds a substantial stake in Pinnacle, which is offering telemedicine visits and, for in-person appointments, gives patients the option of waiting in their car. The site says that Pinnacle will continue to do full-body skin checks, and to see patients for rashes, eczema and psoriasis. | Chicago Pacific Founders, a private investment firm, holds a substantial stake in Pinnacle, which is offering telemedicine visits and, for in-person appointments, gives patients the option of waiting in their car. The site says that Pinnacle will continue to do full-body skin checks, and to see patients for rashes, eczema and psoriasis. |
| Pinnacle is also offering senior hours at 15 of its locations, for patients over age 60. | Pinnacle is also offering senior hours at 15 of its locations, for patients over age 60. |
| The multibillion-dollar dermatology services market thrives on large volumes of small procedures like skin biopsies, patch tests, freezing of precancerous lesions, excisions and layered “Mohs” surgery to treat skin cancer, many of them performed on Medicare patients. | The multibillion-dollar dermatology services market thrives on large volumes of small procedures like skin biopsies, patch tests, freezing of precancerous lesions, excisions and layered “Mohs” surgery to treat skin cancer, many of them performed on Medicare patients. |
| A Facebook group of dermatologists has been debating the ethics of keeping practices open. One member of the group reported that her older relatives had received an unsolicited text from Pinnacle, alerting them to the senior hours. | A Facebook group of dermatologists has been debating the ethics of keeping practices open. One member of the group reported that her older relatives had received an unsolicited text from Pinnacle, alerting them to the senior hours. |
| “How unethical to try to get patients let alone seniors out of their homes for an appointment at this time,” the dermatologist wrote to the group. | “How unethical to try to get patients let alone seniors out of their homes for an appointment at this time,” the dermatologist wrote to the group. |
| Multiple attempts to reach Pinnacle’s chief executive, Chad A. Eckes, were unsuccessful. | Multiple attempts to reach Pinnacle’s chief executive, Chad A. Eckes, were unsuccessful. |
| “The Covid crisis is bringing out a real tension between what’s good for practices versus what’s best for our patients, staff and community at large,” said Dr. Justin Ko, chief of medical dermatology at Stanford University. | “The Covid crisis is bringing out a real tension between what’s good for practices versus what’s best for our patients, staff and community at large,” said Dr. Justin Ko, chief of medical dermatology at Stanford University. |
| A spate of private-equity acquisitions of dermatology practices in recent years has prompted concern from within the specialty that many of those practices are under increased pressure to generate revenue. | A spate of private-equity acquisitions of dermatology practices in recent years has prompted concern from within the specialty that many of those practices are under increased pressure to generate revenue. |
| California Skin Institute, a practice with 44 locations throughout California, is not owned by a private equity firm, but Goldman Sachs has a minority investment in it. The practice says on its website that it “is considered an essential business.” Callers to the practice get a recorded message stating that it “remains open and fully operational, providing a full range of services.” | California Skin Institute, a practice with 44 locations throughout California, is not owned by a private equity firm, but Goldman Sachs has a minority investment in it. The practice says on its website that it “is considered an essential business.” Callers to the practice get a recorded message stating that it “remains open and fully operational, providing a full range of services.” |
| Dr. Greg S. Morganroth, California Skin Institute’s founder and chief executive officer, did not respond to requests for comment, but Jonathan Lindeke, general counsel for the practice, said the company has stopped all cosmetic dermatology, and has furloughed all its aestheticians, laser nurses and cosmetic consultants. | Dr. Greg S. Morganroth, California Skin Institute’s founder and chief executive officer, did not respond to requests for comment, but Jonathan Lindeke, general counsel for the practice, said the company has stopped all cosmetic dermatology, and has furloughed all its aestheticians, laser nurses and cosmetic consultants. |
| Mr. Lindeke added that the company’s “overall business is down substantially.” Several office locations have closed, he said, and the majority of offices that remain open are on a reduced schedule. | Mr. Lindeke added that the company’s “overall business is down substantially.” Several office locations have closed, he said, and the majority of offices that remain open are on a reduced schedule. |
| California Skin Institute is keeping as many offices as possible open, Mr. Lindeke said, for patients who need medical dermatology. This, he said, “keeps the patients out of urgent care centers or the emergency room, reducing the burden on those facilities.” | California Skin Institute is keeping as many offices as possible open, Mr. Lindeke said, for patients who need medical dermatology. This, he said, “keeps the patients out of urgent care centers or the emergency room, reducing the burden on those facilities.” |
| Dr. Carrie Kovarik, a dermatologist at the University of Pennsylvania who is on the American Academy of Dermatology’s ad hoc task force on Covid-19, said the decision to remain open is up to individual practices. “The best we can do is offer our guidance and advice,” she said. | Dr. Carrie Kovarik, a dermatologist at the University of Pennsylvania who is on the American Academy of Dermatology’s ad hoc task force on Covid-19, said the decision to remain open is up to individual practices. “The best we can do is offer our guidance and advice,” she said. |
| Dr. Kovarik said her university’s dermatology clinics have closed to all but the most urgent cases and is offering virtual visits. Similarly, Stanford Health Care in Northern California, which set up virtual dermatology appointments in early March for patients at its 13 clinics throughout the San Francisco Bay Area, now conducts 98 percent of its patient visits digitally. | Dr. Kovarik said her university’s dermatology clinics have closed to all but the most urgent cases and is offering virtual visits. Similarly, Stanford Health Care in Northern California, which set up virtual dermatology appointments in early March for patients at its 13 clinics throughout the San Francisco Bay Area, now conducts 98 percent of its patient visits digitally. |
| Updated June 22, 2020 | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| Dr. Ko said the only people seen in person at the Stanford clinics are the most urgent cases, such as patients with a suspected melanoma — the most dangerous form of skin cancer — who need a biopsy. | Dr. Ko said the only people seen in person at the Stanford clinics are the most urgent cases, such as patients with a suspected melanoma — the most dangerous form of skin cancer — who need a biopsy. |
| “Unfortunately, we can’t do a biopsy digitally,” he said. | “Unfortunately, we can’t do a biopsy digitally,” he said. |
| Adults over 65 are at highest risk of severe illness from the coronavirus. At the same time, most people in need of medical dermatology are older adults. | Adults over 65 are at highest risk of severe illness from the coronavirus. At the same time, most people in need of medical dermatology are older adults. |
| They are more likely to develop nonurgent, slow-growing basal and squamous cell skin cancers than melanoma. Basal and squamous cell skin cancers, which often develop after years of unprotected skin exposure, are 18 to 20 times more common than melanoma. Such cancers are rarely life-threatening, but accurate diagnosis requires a biopsy. | They are more likely to develop nonurgent, slow-growing basal and squamous cell skin cancers than melanoma. Basal and squamous cell skin cancers, which often develop after years of unprotected skin exposure, are 18 to 20 times more common than melanoma. Such cancers are rarely life-threatening, but accurate diagnosis requires a biopsy. |
| In a 2017 article, The New York Times found a pattern of unnecessary biopsies and other procedures for older adults among dermatologists in the U.S. | In a 2017 article, The New York Times found a pattern of unnecessary biopsies and other procedures for older adults among dermatologists in the U.S. |
| Dr. Ko at Stanford said that office visits for slow-growing cancers and other nonurgent problems can pose a danger not only to older patients, but also to office staff and clinicians. | Dr. Ko at Stanford said that office visits for slow-growing cancers and other nonurgent problems can pose a danger not only to older patients, but also to office staff and clinicians. |
| “They’re stuck in the middle,” he said. “And that’s a really stressful, really difficult place to be.” | “They’re stuck in the middle,” he said. “And that’s a really stressful, really difficult place to be.” |