Preparation key for second wave of COVID-19
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This is my third commentary on the COVID-19 pandemic and its impact on the practice of ophthalmology in the United States.
In all three I have touched on how we are doing as a nation and as ophthalmologists and a little on the economic implications. While I always try to be fact based, my commentaries do include my personal interpretation of the currently available facts, and those facts are likely to change before this commentary is published. My goal is to do my best to be useful to my colleagues in the arena seeing patients and practicing ophthalmology.
First, the U.S. situation as I see it. On March 10, we reported 105 new COVID-19 cases in the United States, according to Worldometers/USA. This rose rapidly to about 32,000 cases per day by April 10, only 1 month later. We had all observed the frightening European experience with this virulent RNA virus, and in response to this rapid rise in U.S. COVID-19 cases, elective eye care was shut down, in both the hospital outpatient department and the private clinic/ASC environment. By treating emergencies only in April, ophthalmology plummeted in both volume and revenue more than any other specialty in medicine, bottoming out 81% down vs. projected for the month of April, with elective cataract surgery down 96%.
The U.S. goal was to flatten the curve of case growth with stay-at-home orders, social distancing, mask wearing and hand washing to avoid overwhelming our hospital systems. We were successful. On May 10, new COVID-19 cases in the United States fell to 25,000 per day from 32,000 1 month earlier, and by June 10, 21,000 new cases per day were reported.
Most U.S. ophthalmologists went back to seeing routine patients and performing elective eye surgery in May. By June, collectively we were at more than 70% of our normal pre-COVID-19 volumes, and in July, many of us were back near 100%, with a few lagging and a few more than 100% as they caught up with patient backlogs.
Led by state and federal government mandates, America started to dial back the social distancing restrictions and opened up the economy more widely, including access to restaurants, bars, beaches and parks. People with COVID-19 and winter-induced cabin fever raced outside and filled their favorite restaurants, bars, beaches and parks with minimal use of masks and no social distancing. One month later, as of this writing, we have surged from 21,000 new cases a day on June 10 to 62,000 new COVID-19 cases a day on July 10. The hospitals and ICUs in some cities and counties are filling up again, and there is concern that in some locations we will not have enough inpatient beds to treat the very sick.
At first, I thought this was the dreaded second wave of COVID-19 coming early, but cases per day are still rising globally, confirming to me that we are still in the first wave of COVID-19. Anthony Fauci, MD, agrees and is concerned that if nothing is done, we could hit 100,000 new cases a day in the United States alone before we peak. This would be, in my opinion, very damaging.
Efforts are underway to control this new surge in cases, and the same principles apply. It seems harder after 3 months of painful social isolation to enforce social distancing, so mask wearing and perhaps testing have become critically important as we manage this surge in infections. Our doctors, our employees and our patients are all wearing a mask continuously inside the clinic and OR and also more frequently when they are away from home and outside the clinic.
As I have said before, the United States, with this surge, will likely lead the world as an advanced nation in COVID-19 cases per million and deaths per million. The five leading European nations are at less than 4,000 cases per million, and we are approaching 10,000 cases per million, or 2.5 times as many. With our advanced health care system, we have done better than many in reducing deaths, and treatments have improved. I will not go into details, and they can be reviewed by those interested, but my favorite Nordic country of Sweden, with a more laissez-faire approach, has done less well than its neighbors with more stringent social distancing and masking regulations, and the countries with tight lockdowns exemplified by those in Asia have done the best to date.
If this U.S. COVID-19 case volume surge continues, we may see hospital outpatient departments canceling elective surgery again. Fortunately, I do not see this happening in our private clinics and ASCs, which will be reluctant to shut down again and are unlikely to be forced to do so. Patient anxiety about venturing out of their homes and traveling to a doctor’s office may increase, but I think we ophthalmologists are past the worst of the economic damage to our practices.
At Minnesota Eye Consultants, we have adopted most of the methods mentioned in the accompanying cover story. We screen, clean, socially distance, and compulsively use personal protective equipment and hand washing. We have learned to see the same number of patients per hour in the clinic and in our ASCs, but it has required additional full-time employees. We now require dedicated “screeners” and “cleaners,” and that has increased our overhead. So, even though revenues are recovering, overhead is higher, and I think this may be a permanent change. If so, our take-home pay will be permanently affected unless we work longer hours to see more patients or add lucrative new procedures in the office and ASC that can increase revenue per doctor per hour worked. We plan to do both. This will be a critical part of the ophthalmologist’s education (mostly virtual) in the months to come.
We have survived, but we will need to adapt and adjust to learn how to thrive again. Nationwide, according to FactSet, U.S. company corporate earnings fell 37% in the second quarter. A 25% reduction in corporate earnings is predicted for the third quarter and a 13% reduction for the fourth quarter. Positive earnings growth is currently projected to resume in the first quarter of 2021, but that presumes no second wave of COVID-19 occurs later this year or early next year. Meanwhile, unemployment has fallen from 13.3% to 11.1% as we added 5 million jobs, mostly in the restaurant and service sector. The stock market is booming, fed by significant federal stimulus, but I for one do not believe this will last. Many believe this stock market surge represents a bear market rally or so-called “dead cat bounce.” Each of us should review our financial planning and be sure to maintain access to enough capital to survive another 2- to 3-month contraction in the next year if a second wave of COVID-19 infection hits us.
It is unlikely that a COVID-19 pandemic like that being experienced today will be an annual experience, but those much wiser than I have suggested we may well get that dreaded second wave in the next 12 months. So, back to work we go, and the number of patients in need of our services has not diminished nor has their desire to preserve, restore and enhance their vision. I believe it is important for each of us to be prudent in protecting our own health and well-being as well as that of our families, colleagues, employees and patients as we traverse the current COVID-19 surge. As a worst-case scenario, our business and personal planning should prepare for a second wave of COVID-19 and a possible extended bear market in the next year.
As always, stay educated because as famously said by Louis Pasteur, “fortune favors the prepared mind,” and it is critical today to look to the future and plan wisely.
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