Virginia Research Day 2021

The Impact of COVID-19 on Otolaryngology Practice Patterns Henry Carnes, MS IV 1 , Benjamin Gillette, MS IV 2 ,Travis Smith, MS IV 2 , Jacob Greenberg, MS IV 1 , Lindsay Tjiattas-Saleski, D.O. 2 , Ning Cheng, PhD 2

1Edward Via College of Osteopathic Medicine- Virginia Campus (VCOM-VA), 2265 Kraft Dr SW, Blacksburg, VA 24060 2Edward Via College of Osteopathic Medicine- Carolinas Campus (VCOM-CC), 350 Howard St, Spartanburg, SC 29303

Background

Results

Methods

Management Continued

• First Discovered - first reported to WHO from Wuhan, China December 31, 2019 • Spectrum of diseases – Asymptomatic infections and anosmia to flu-like symptoms and fatal pneumonia • Pandemic declared March 11, 2020 • Over two million deaths worldwide (At its deadliest, HIV/AIDS claimed roughly 2 million lives in 2005) • More deadly in US than World War II • Majority of deaths occur from acute respiratory failure SARS-CoV2 (COVID-19) Risk to Otolaryngologist • Nasal mucosa contains high density of viral COVID-19 particles • The otolaryngologist frequently has close contact with nasal mucosa and is often involved in performing aerosolizing procedures Survey • A survey of otolaryngologists in the South Atlantic region provides valuable information on the specific impact COVID-19 has had on practice patterns

• 21 question Cross-sectional Survey examining: practice demographics, staffing and financial changes, and changes of medical management

Use of Telemedicine

Creation

Used more frequently than before the pandemic

• June 2020 : Participants in South Atlantic US Enrolled through each states Otolaryngology Listserve and social media accounts (Facebook, Instagram, Twitter) • An estimate of 1539 Otolaryngologists were targeted in this cohort

Distribution

Used just as much as before the pandemic

• After 3 weeks , responses were collected • Last response collected September 2020

Collection

Did not use

QR code to a PDF of the survey distributed to participants

• Responses were analyzed with Fisher’s exact test for categorical responses and ANOVA tests were utilized for numerical responses. P-value = 0.05

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10 20 30 40 50

Analysis

Figure 7: Many different forms of telemedicine turned out to be valuable tools to Otolaryngology practices during the COVID-19 Pandemic.

Figure 2 : South Atlantic states included - Maryland, Delaware, West Virginia, Virginia, North Carolina, South Carolina, Georgia, Florida, District of Columbia.

Length of Time Rescheduling Elective Procedures From Originally Scheduled Date

Results

<1 month 1-2 months 2-3 months >3 months Have not rescheduled yet

Demographics

Staffing and Financial

Demographic data included the following: state distribution of survey, percentage of “at risk” patient population, practice affiliations, number of providers, level of providers, offering of additional services, and which subspecialities each practice caters to.

Staffing and financial data included the following: adjustments to staffing, benefits received by CARES act and whether these benefits would sustain practice.

30

0.25

U.S. Daily Testing Trends

25

0.2

Adjustments to Staffing

0

5

10

15

20

Response Collection

Total Positive Tests

Figure 8 : In order to accommodate an increasing number of COVID-19 cases, many Otolaryngologists were delaying elective procedures.

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Distribution of responses in the South Atlantic region

No adjustments made Other (please specify)

0.15

Positive Test Rate

PPE Use

15

Temporary reduction of pay Temporary suspension of pay

Our practice is disinfecting PPE after each use and resusing We have found other source of supplies (eg. Through donatinos or… Other (please explain) PPE is in good supply and we have no issues

0.1

Millions

10

Positive test rate

Lay off employees Furlough Reduce work hours

0.05

5

0 5 10 15 20 25 30

0

0

Figure 5 : 64.4% were considered private practice and 35.4% affiliated with a hospital. Subgroup analysis was not performed.

Our practice is resusing PPE

Form of Benefits Received

Figure 1 : Daily testing trends in the United States from May 2020 to January 2021. The survey was distributed and responses were collected between July 2020 and September 2020. During this period there was a second spike of cases during the summer. Graphic generated from data provided by The COVID Tracking Project https://covidtracking.com/data

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5 10 15 20 25

Small business loans via the payment protection program Medical supplies Public Health and Social Services Emergency Fund Not expecting to receive any benefits Other (please specify)

Figure 9 : Otolaryngology practices were asked if they had adequate supply of PPE as well as how they may be sustaining their PPE use.

Conclusions

Objective

• Most practices relied on financial assistance to sustain their practice • An increase in the use of telemedicine during pandemic response has significantly impacted the landscape of medicine • Limitations : Designed as a small scale study, aggressive follow up with each state during response collection was not feasible thus contributing to the low response rate . Because the survey was distributed during a small portion of the pandemic, it does not capture issues encountered at the beginning and during the winter 2021 resurgence • Future studies : long term effects of pandemic on practice patterns, specific focus on telemedicine, specific focus on financial stability, comparison to previous pandemic responses in history, comparison of results with state mandates over time

Figure 3 : Of the 1539 estimated Otolaryngologists within the South Atlantic region 48 responses were collected, totaling a response rate just over 3%. 9-Maryland, 1-Virginia, 22-North Carolina, 9-South Carolina, 6-Florida, 0-Georgia, 0-West Virginia, 0-Delaware, and 0- Washington D.C.

• Question : What impact has the COVID-19 pandemic had on Otolaryngology practice patterns? • Null hypothesis : COVID-19 did not alter Otolaryngology practice patterns • Objective: This study will determine how the COVID-19 pandemic affected staffing, financial management, and medical management of Otolaryngology practices • Goals: Identify areas of deficiency in pandemic response to help optimize response in potential future pandemics

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Figure 6 : 65.12% believed that the CARES Act (which included the payment protection plan) would provide sufficient funding to sustain their practice. Management Data included in the management section of the survey includes: the use of telemedicine (before pandemic, during, and potential for future use), forms of telemedicine, the rescheduling of elective procedures (length of time from originally scheduled date), status of PPE, patient load per day (before pandemic, during, elective surgeries, and telemedicine visits), number of employees tested for COVID-19 (with number of employees testing positive), and which entity determined adjustments made to rescheduling of procedures (hospital, surgery center, personal, patient, other).

Percentage of Patients Falling into "High Risk"

Less than 25% 25-49% 50-74% 75-100%

Acknowledgments

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Figure 4 : According to the American Academy of Otolaryngology anosmia reporting tool questionnaire, “High Risk” patients have: a smoking history, history of head trauma, cardiovascular disease, neurological disease, pulmonary disease.

• Funding provided by Dr. Harold ‘Skip’ Gardner • Special thanks to: Dr. Butehorn and the MD, VA, WV, DC, FL, DE, NC, SC, and GA Otolaryngology societies

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