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A proposal: hospitalist “hotshots”

Recovered clinicians could be a mobile force

May 2020
hospitalists as hotshots

AS HOSPITALISTS, we know we are at risk of contracting this infectious disease. Until an effective vaccine is available, those of us in health care will continue to fear occupational exposure. Some will become infected, and some will even die.

But many more of us will recover—and could potentially become an invaluable resource. As an analogy, forest firefighters called “hotshots” are mobile, highly skilled crews who tackle wildfires. This organization of more than 100 interagency professionals has been an effective strike force limiting the extent of fire damage to people, property and land.

Now may be the time to think of using hospitalist hotshots to help fight the evolving pandemic. A core group could be drawn from those already immune to the virus—assuming that recovered individuals have a robust antibody response and at least short-term immunity, as with exposure to most other respiratory viruses.

Deploying such a force—in their home hospitals or around a region or the country—would have many advantages. For one, team members would be familiar with the disease and with supportive measures and potential therapies. They would know how to work around supply shortages, and they’d free up local nonimmune providers to treat uninfected patients.

They could also mentor local hospital staff, and provide both strategic advice and, perhaps, an important onsite therapeutic benefit: blood plasma for passive immunity for the sickest patients, a technique used in other viral outbreaks including SARS and Ebola. The FDA has already approved such immunotherapy in extreme situations.

We’d field such a voluntary workforce with all their compensation, travel and lodging paid for, as well as hazardous duty and hardship pay. State licensure regulations have already been relaxed, and crews might most effectively be organized by a federal agency such as the CDC or FEMA.

Having providers with known immunity on the front lines could boost morale and reduce other clinicians’ fears about being infected. It would also help put fewer health care workers at risk.

Stephen L. Green, MDStephen L. Green, MD, is a locum hospitalist who maintains a telemedicine infectious diseases consulting practice. He previously practiced for more than 30 years as a primary care internist and infectious diseases specialist. Dr. Green can be reached at sgreen5528@aol.com.


Published in the May 2020 issue of Today’s Hospitalist 

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Dr. Stephen Green
Dr. Stephen Green
June 2020 10:57 am

There is no proof yet that robust immunity occurs and for how long in COVID 19 survivors, which is why I stated in the article “assuming robust immunity.” However, judging from previous SARS and MERS coronavirus epidemics, protective immunity seemed to last for 2 to 3 years. Studies on protective neutralizing antibody response are still ongoing for COVID 19 and we may not know the answer for some time. Early reports seem to indicate that T-cell response may be a key element to immunity. However, the FDA has approved an expanded access program for the use of convalescent plasma for… Read more »

Dr. Dinasarapu MD, MPH -LinkedIn
Dr. Dinasarapu MD, MPH -LinkedIn
June 2020 12:28 pm

Idea is reasonable but I am not sure how robust the immunity is for those who recovered and how long they have that immunity to COVID before getting reinfected. I am not sure how effective this idea is going to be when it comes to implement.

AC Squires - LinkedIn
AC Squires - LinkedIn
June 2020 12:29 pm

Interesting idea. I agree that there are some unknowns in implementation.