COVID Exposure Risk Outside of Work Increasing for Clinicians

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One third of COVID-19 exposures among health care providers (HCPs) in Minnesota are due to family or community exposure, not patient care, according to a study conducted by the Minnesota Department of Health (MDH) and published online October 30 in Morbidity and Mortality Weekly Report. And nonwork exposures were more likely to lead to COVID-19 infections.

Between March 6 and July 11, 2020, researchers with the MDH evaluated 21,406 incidences of HCP exposure to confirmed COVID-19 cases. Of those, 5374 (25%) were classified as higher-risk exposures, meaning the provider had close contact for 15 minutes or more, or during an aerosol-generating procedure.

Two thirds (66%) of the higher-risk exposures occurred during direct patient care and 34% were related to nonpatient care interactions (eg, coworkers, social and household contacts). Overall, 6.9% (373) of the HCPs with a higher-risk exposure received a positive SARS-CoV-2 test result within 14 days of the exposure. Notably, HCPs with household or social exposure had the highest positivity rate across all exposure types at 13%.

“Since the time period covered in this report, we’ve seen a significant increase in the proportion of HCPs who have had higher-risk exposures outside of work due to household or social contacts,” said lead author Ashley Fell, MPH, from the Minnesota Department of Health.

“HCPs with household or social exposures are also more likely to test positive than HCPs with higher risk exposures within the healthcare setting, which is an important message for both HCPs and the community at large that more COVID-19 spreading in our communities poses a greater risk to our HCPs and health care system,” Fell told Medscape Medical News.

When evaluating personal protective equipment (PPE) use among exposed HCPs, researchers found that 90% of providers in acute or ambulatory care were wearing a respirator or medical-grade face mask at time of exposure, compared with just 68% of HCPs working in congregate living or long-term care facilities.

Further, investigators found that an HCP with a positive SARS-CoV-2 test working in a congregate living or long-term care facility resulted in exposure of a median of three additional HCPs (interquartile range [IQR], 1-6) compared with a median of one additional HCP exposure in acute or ambulatory care (IQR, 1-3).

The researchers also found that, compared with HCPs in acute or ambulatory settings, HCPs working in long-term care or congregate living settings were more likely to return to work following a high-risk exposure (57% vs 37%) and work while symptomatic (4.8% vs 1.3%).

When asked whether these findings apply to HCPs in other states, Andrew T. Chan, MD, from Massachusetts General Hospital, Boston, noted: “These data are not surprising and confirm what many of us have been seeing in our own areas.

“Clearly, the risk of contracting COVID-19 is particularly high for front-line health care workers in long-term care facilities and nursing homes,” Chan said.

“Furthermore, the infection control practices in these care settings are often

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UK Diabetes Clinicians Urged to Embrace ‘Time in Range’

A new ‘best practice guide’ urges UK healthcare professionals to embrace the ‘time in range’ metric for patients with diabetes who use continuous glucose monitoring (CGM), particularly in light of the COVID-19 pandemic.

Time in range: a best practice guide for UK diabetes healthcare professionals in the context of the COVID-19 global pandemic, was published October 19 2020 in Diabetic Medicine by Dr Emma Wilmot of the diabetes department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, and colleagues. The document is a publication of the Diabetes Technology Network (DTN) UK, part of the Association of British Clinical Diabetologists (ABCD). 

Real-time CGM

In June 2019, an international consensus report established the ‘time in range’ concept – the proportion of time a person’s blood glucose falls within a prescribed range – as a clinical metric for patients with type 1 or type 2 diabetes who use either real-time CGM (rtCGM) or intermittently scanned CGM (isCGM), also called ‘flash glucose monitoring’. The latter, the Abbott FreeStyle Libre, is the one most commonly used in the UK, although the NHS in England has recently authorised the Dexcom G6 rtCGM for use during pregnancy.  

The new guidance aims to clarify the intent and purpose of the international consensus recommendations and provide practical clinical and technical advice for use of time in range in UK diabetes care, particularly in the context of the COVID-19 pandemic, co-author Pratik Choudhary, professor of diabetes at the University of Leicester, told Medscape Medical News.

“Even though FreeStyle Libre has been widely rolled out and people are seeing the reports, we felt that a locally-published paper by local leaders of the DTN was needed to get people to start thinking about time in range. People are still fixated on haemoglobin A1c (HbA1c) and glucose of 5 [mmol/L],” Prof Choudhary said.

International Guidelines

The paper reviews and provides rationale for the international guidelines, which recommend generally that more than 70% of glucose readings should fall within a blood glucose range of 3.9-10.0 mmol/L, with modifications for children, older adults, and pregnant women.  

“It’s a huge mindset [change] from saying your target is 5 [mmol/l] to saying you’ve got a target range. It’s saying you’ve got an allowance of 30%, so if you screw up a little bit it’s not a disaster. It will balance out. That’s the narrative we want to put out there,” Prof Choudhary explained.

A UK-based audit on the use of FreeStyle Libre conducted by ABCD showed significant improvements in HbA1c, reduced hospital admissions, and lower levels of diabetes-related distress in patients with type 1 diabetes. Updated data from that study were published in the September 2020 issue of Diabetes Care.

Remote Monitoring

The new document emphasises that time in range is meant as an adjunct to HbA1c rather than a surrogate, and discusses the correlations between the two values and their respective association with diabetes-related outcomes. However, because the COVID-19 pandemic has reduced the capacity for in-person visits including blood tests,

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Clinicians Incensed by Trump’s Claim They’re Inflating COVID Numbers

Medical groups and the clinicians they represent are criticizing President Donald Trump for his claim that their drive for reimbursement for COVID treatment may have raised reported United States fatality rates compared with those of other nations.

Speaking at a campaign event Saturday in Waukesha, Wisconsin, Trump said he thought US doctors were attributing deaths to COVID that their counterparts in other nations would not.

“If somebody is terminally ill with cancer and they have COVID, we report ’em and you know doctors get more money and hospitals get more money. Think of this incentive. So some countries do it differently. If someone is very sick with a bad heart and they die of COVID, they don’t get reported as COVID,” Trump said. “So then you wonder, ‘Why are their cases so low?’ “

Trump did not immediately in this speech cite any specific nations to which he was comparing the US, nor did he refer to any published reports on potential differences in COVID counting. He touched on this theme of testing differences briefly during his campaign appearance, mentioning it in between criticisms of Democratic lawmakers.

“Reprehensible Attack”

Trump’s remarks angered many medical groups and the clinicians they represent, healthcare workers who have endured increased personal risk and, in many cases, notable drops in income because of the pandemic — not to mention the high death rates of frontline healthcare workers. They also challenged Trump’s assertion about how COVID deaths are counted in the United States.

Eva Chalas, MD, president of the American College of Obstetricians and Gynecologists (ACOG), and Maureen G. Phipps, MD, MPH, chief executive officer of ACOG, issued a joint statement accentuating the deaths of those in harm’s way.

“Science is science and data are data. Doctors have no reason to make up or to inflate COVID-19 case numbers,” they said. “In fact, many physicians and other healthcare workers have died from the virus. It is irresponsible and dangerous to suggest that doctors, including obstetrician-gynecologists, have done anything other than bravely battle this pandemic on behalf of their patients and their communities.”

In a tweet, the American Medical Association (AMA) highlighted an October 12 research letter that appeared in JAMA regarding the toll of excess deaths in the US, as reported by Medscape Medical News.

The AMA also put out a tweet with the following statement condemning the “misinformation about how patients are counted”:


The American College of Physicians (ACP) made the same point in a statement Sunday, calling Trump’s comments “a reprehensible attack on physicians’ ethics and professionalism.”

“ACP notes that several recent studies suggest that the actual number of people who have died from COVID-19 is much higher than the terrible toll of 220,000 deaths officially attributed to the virus,” said Jacqueline W. Fincher, MD, president of ACP, in the statement.

Undermining Clinicians

Trump’s statements also may hinder efforts to control the pandemic, said

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Clinicians, Med Students Help Patients Register to Vote

With less than 2 weeks until election day, clinicians around the United States have been helping patients who land in their hospitals find voter information or register on the spot — an extension, they say, of treating the whole person.



Dr Alister Martin

The VoteER initiative was started a year ago by emergency medicine physician Alister Martin, MD, at Massachusetts General Hospital in Boston, but it has taken off in the COVID-19 era because of the challenges posed by voting at a physical location.

Now physicians, nurses, and other healthcare professionals in a wide range of disciplines at 300 hospitals and students at 80 medical schools are spreading the word. So far, Martin told Medscape Medical News, the program has signed up more than 40,000 people who have either registered to vote or have requested vote-by-mail ballots.

Participating clinicians wear buttons, lanyards, or badge stickers with information patients can text to learn details on how to vote in their area. Healthcare professionals can also upload a QR code as a background on their phones’ home screens or print them out in poster form. Patients can scan the code and within minutes register to vote or request a mail-in ballot.

The tools are available free by ordering a physical kit or by downloading the toolbox. Martin said that so far, 25,000 physical kits, funded by foundations, have been sent out and “hundreds of thousands” of the digital version have been downloaded.



Dr Aliza Narva

Because the message promotes voting and not a particular candidate, no ethical lines are being crossed, said Aliza Narva, MSN, RN, JD, director of ethics for the University of Pennsylvania Hospital in the Penn Medicine health system. Clinicians answer questions about how to vote if patients ask.

“If anything, there’s an obligation to help people participate,” she told Medscape Medical News. “As a nurse, I have an ethical obligation to care for my whole patient. Nursing is a civic profession, which means we have an obligation outside of a 12-hour shift to engage in civic duty and help our patients navigate their lives. We’re certainly not telling them who to vote for.”

Martin said health systems are competing to sign up the most patients and staff. Penn Medicine is leading by a wide margin, having signed up 3500 voters since August 1, largely because the CEO, Kevin Mahoney, made the project a system-wide priority.

“Healthcare Is Political”

In 2016, Martin brought voting kiosks, with the blessing of hospital leaders, to Mass General’s Emergency Department (ED) with the hope of giving a voice to people who would be most affected by policies.

Martin said he learned from experience — growing up with a single mom in a low-income home in New Jersey — that struggling families like his were using EDs for primary care.

In his years studying for a master’s degree in public policy, he realized that young people, those with low income, and people of color made up a large percentage of the population

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