US counties with highest COVID-19 burden have few, no ID physicians
Most of the US counties with the greatest number of COVID-19 cases have few, or no, infectious disease physicians, according to findings in Annals of Internal Medicine.
“The study was prompted when, during our surge of patients in Boston, we thought about where the COVID-19 pandemic was likely to head next,” Daniel P. McQuillen, MD, FIDSA, FACP, Infectious Diseases Society of America vice president and director of the solid organ transplant infectious disease service in the division of infectious diseases at Lahey Hospital & Medical Center in Massachusetts, told Healio. “I was reading the New York Times and saw an interactive piece showing the cases cascading from the coasts inland toward rural areas that we knew were more sparsely populated by ID doctors.”
According to McQuillen, he had previously discussed access to, and the distribution of, cognitive care doctors — “general internists, infectious disease doctors, endocrinologists ... doctors who make their living thinking about patients and their illnesses, but who do not perform invasive procedures” — with colleagues Rochelle P. Walensky, MD, MPH, FIDSA, and John D. Goodson, MD. Walensky is vice chair of IDSA's HIV Medicine Association and chief of the infectious diseases division at Massachusetts General Hospital; Goodson is associate professor of medicine at Massachusetts General Hospital.
“As we struggled to handle the huge surge of patients in our well-staffed, big hospitals in a large urban area, it occurred to us that it would be incredibly difficult to manage an overwhelming number of very sick patients in a smaller rural setting,” McQuillen said.
McQuillen, along with Walensky, Goodson and colleagues, aimed to determine whether the distribution of ID specialists throughout the country matched the demands of the COVID-19 pandemic. The researchers established county-level ID physician densities, described as the number of ID physicians per 100,000 persons, using the 2017 Medicare Provider Utilization and Payment Data. They then used CDC and public health agency data aggregated by USAFacts, a not-for-profit organization that compiles U.S. government data, to plot county-level COVID-19 confirmed case rates per 100,000 people.
According to McQuillen, study results showed that of, all 3,142 U.S. counties, 331 (10.5%) and 312 (9.9%) have above- and below-average ID physician densities, respectively, whereas 2,499 counties (79.5%) do not have a single ID physician, leaving 208 million citizens with no or below-average ID physician coverage.
“The distribution of ID physicians in the United States is geographically skewed,” McQuillen said. “Nearly two-thirds of all Americans live in the 90% of counties with below-average or no ID physician access. These counties encompass vast and largely rural parts of the country.”
When looking at the 785 counties with the largest COVID-19 burden, the researchers found that 147 (18.7%) had above-average and 117 (14.9%) had below-average ID physician density, whereas 521 (66.4%) counties had no ID physician coverage. Additionally, when McQuillen and colleagues looked at counties with the second-highest burden of COVID-19, they found that 88 (11.2%) and 110 (14%) had above- and below-average ID physician densities, respectively, whereas 588 (74.8%) had no ID physicians. Approximately 95% of the counties with the lowest COVID-19 burden did not have a single ID physician.
“Our country's medical system needs a more robust, long-term, strategic infectious disease workforce plan,” McQuillen said. “The current system is not prepared to deal with the pandemic and not even currently ready to scale up telehealth to fill the gaps. Rural America is likely to suffer from the absence of ID physician expertise when the COVID-19 pandemic arrives.”