Evaluating the dermatology communities' public health response to COVID-19.

Abstract

Dear Editor, Governmental organizations1 and the American Academy of Dermatology (AAD) recommended that during coronavirus disease (COVID-19), patients with nonessential medical concerns should be rescheduled or offered telemedicine.2 Although most dermatologic visits are nonurgent, some do require urgent evaluation. We, therefore, examined how dermatological practices across the United States have responded and changed their practices. A study population of dermatologic private practices was selected from the AAD's member list.3 A minimum of three private practices were randomly selected for each state and the District of Columbia using a random number generator. To ensure close temporal association between practice changes and COVID-19 case data, we chose to use website information. The use of websites had the advantage over calling in that it allowed us to capture a large sample in a single day (April 22), allowing a truer comparison of the response to the rate of COVID-19 cases at a specific time point. For comparison, we selected the largest academic institution in each state, defined by the institution with the greatest number of dermatology residents. We chose to compare response to the Centers for Disease Control and Prevention reported COVID-19 cases4 to test whether response was related to local disease burden. Differences in groups were tested with Student t-test and correlations with Pearson correlation. A total of 153 private practices' websites and linked-social media accounts were analyzed. Of which, 86.9% of private practices had placed a COVID-19 announcement regarding a change of practice due to COVID-19. For those with an update, 79.7% of practices were open; 73.6% specified restrictions and/or precautions patients should take; 38.3% of private practices indicated they were seeing only urgent cases or limiting nonessential cases; and 36.8% of private practices indicated they were continuing to see all patients or all patients who did not have recent symptoms, exposure, or travel. Importantly, states with a higher COVID-19 rate, >400 cases per 100 000, had a statistically significant higher proportion of closed practices compared with states with <400 cases per 100 000 (P = .0006) (Figure 1). There was a slight correlation between higher rates of cases (R = .25) and the percent of practices closed in individual states, but it was not statistically significant (P = .077). A total of 40 academic dermatology departments were analyzed for comparison. 100% of academic departments had updated their websites or social media accounts with a COVID-19-related message. 62.5% of academic institutions did not clearly indicate whether clinics were open or closed. Only 22.5% of academic clinics indicated they would limit nonessential cases. This study provides an in-depth analysis of how dermatologists responded to COVID-19 case rate. One criticism could be the use of website data, but this allowed more temporally related data, whereas phone calls would have introduced varying delay between COVID-19 rate data extraction and response data. In addition, most surveys are considered accurate if they capture >65% respondents. We have data on 100% of those selected and found that 86.9% provided an update on their website, suggesting that we captured a representative sample. Although academic sites more consistently posted updates, information provided by private dermatology practices were more specific about service changes. Despite being more financially vulnerable, there was a statistically significant higher rate of closure of private practices compared with academic practices (P < .01). In contrast, only 38% of private practices indicated that they would limit nonessential cases despite guideline recommendations. This latter observation could be seen as an inadequate response by providers. However, 87% of private practices were proactive, providing information for patients publicly regarding changes they would implement. Importantly, practices that closed had a significantly higher local rate of COVID-19 cases, suggesting that practice changes were rationally based on local conditions rather than an overall blanket response. The authors declare no conflict of interest.