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MAY 14, 2020 — The doctor in China who risked his job to warn the world about COVID-19 was not a frontline emergency medicine or ICU doctor. Li Wenliang, MD, was an ophthalmologist, a glaucoma specialist who died after contracting the virus from an asymptomatic patient.

Now a new preprint suggests that that may not have been a coincidence: The survey data show that of all resident physicians who worked within the greater New York City area between March and April, anesthesiology, emergency medicine, and ophthalmology residents were at greatest risk of contracting COVID-19.

Study author Royce Chen, MD, spearheaded the survey soon after COVID-19 struck. Chen directs the ophthalmology residency program at Columbia University Irving Medical Center in New York City. He along with other New-York based residency directors make up the New York City Residency Program Directors COVID-19 Research Group. The group had few resources to help them decide how to protect their trainees.

“There was very little information we had to work with,” Chen said. “Simultaneously, as the government was starting to provide directives about social distancing, there were reports from China that it was highly contagious, and we didn’t know how to protect [medical] residents.”

Early efforts in Chen’s program involved separating residents into smaller groups to lessen the number of coworkers they were exposed to and performing daily symptom checks. Anyone with fever, cough, or other symptoms immediately isolated themselves until the symptoms resolved. (This included Chen, who had mild symptoms).

But not every program had similar protocols in place, and no one knew whether residents in certain specialties were safer than others. So Chen and his coauthors sent surveys to about 340 residency directors ― all the programs within 30 miles of New York City’s Central Park ― to investigate risk levels for each specialty. Ninety-one of those directors responded, representing 24 specialties and more than 2300 residents.

Risk levels for three specialties in particular stood head and shoulders above the rest. Two of the three, anesthesiology and emergency medicine, were expected. Ophthalmology, however, was surprising — at least at first glance.

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“People think of it as outpatient, low-acuity, but the patient and doctor are less than 2 feet apart,” Chen said. “And neither patients nor physicians were wearing masks at the beginning of March.”

The nose and mouth are obvious exposure paths, but recent research shows that infection can also spread through the eyes. In mid-March, the American Academy of Ophthalmology recommended ceasing most nonurgent care but has since issued guidance on resuming elective surgeries.

The survey is far from definitive: A. Elisabeth Abramowicz, MD, director of the Westchester Medical Center Anesthesiology Residency Training Program, in Valhalla, New York, says it’s difficult to interpret the data in the preprint without a comparison with attending physicians. The researchers only included the seven subspecialties that received over 100 responses, and usage of personal protective equipment has improved since the survey period. Thus, the results could be different were the survey repeated today. But, she says, it does raise important questions, such as, Should hospitals be thinking ahead to better protect high-risk specialties during a second wave?

“Certainly, for higher-risk specialties, you want to pay attention to really good donning and doffing and strict protocols,” Chen said.

During the first wave of COVID-19 in New York City, resident directors worried that their charges could fall ill or die, Chen said. Knowing that there may be a second wave — and that some areas are still waiting for the first wave to peak — the study authors are using the information they gleaned from this first survey to think about how future, follow-up surveys might be helpful in preparing for what comes next.

Sheila Eldred is a freelance health journalist in Minneapolis. Find her on Twitter  @MilepostMedia.

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