Approximately one year ago, I was like many of my fellow colleagues; taking care of routine care patients, performing wound care visits, providing ambulatory surgical services and in general, going out for dinner, seeing friends and family and traveling. January 2020 changed the entire world.
The rampant global pandemic of SARS-CoV-2 and the subsequent sheltering and mandatory government mask mandates became the fear that we all lived. Cases of COVID-19 exploded, and communication, support and resources from guiding agencies were lacking. Patients were dying, including family members and even colleagues. Patient visits became less frequent as people quarantined and sheltered. 2020 was becoming “the year the world stopped.”
Fortunately, medical services stayed open as an “essential” service. The paycheck protection program (PPP) and Small Business Administration (SBA) Loan Guaranty program helped many businesses, but in particular, medical practices. However, in my observation, doctors in private practice were still losing money.
As a wound care specialist, I had access to and had been using DNA swab sampling for wound cultures for years. This was not revolutionary technology, but just becoming more the standard of care versus qualitative wound cultures. The owner of the laboratory to which I sent samples contacted me and asked if I had any thoughts about screening for COVID-19. I asked him why he was asking me, a podiatrist?
His response was simple enough; the lab had the ability to run reverse transcriptase polymerase chain reaction tests (RT-PCR) for the novel coronavirus, and they had Emergency Use Authorization (EUA) to screen for COVID-19. He felt I should start screening my patients immediately.
Of course, I was skeptical after watching the news and seeing the pitfalls of the early federal testing programs. I started not with my patients, but myself and my two staff personnel. When we received our results less than 24 hours later, I decided to send my patients the next day for screening tests. Again, 24 hours later, same type of results, all processed as negative.
Before any ideas of testing started, I reached out to my health care attorney regarding scope of practice and this type of testing. After about a week and after multiple conversations, my health care attorney gave me the green light and told me to move forward.
I started offering the tests to my immediate wound care patient population. I was only seeing wound care patients on Mondays. The rest of the week, my office closed and I spent the time revamping the office policies, procedures and going through the CARES Act SBA loans and PPP program.
As I was able to open more hours, we continued to PCR test. Patients did not come to the office as often as pre-pandemic, but we had to do something. I ran into a patient’s family during a treatment day and they inquired about the COVID-19 testing (as I had tested their parent). I offered them the test at a concierge price (which they paid) and I started thinking to myself, “I can do this.” This particular person worked for a large corporation that manufactured body armor for the federal government (military and law enforcement). I reached out to their Vice President of Operations and their Chief Operating Officer and had a Zoom meeting. As fate would have it, they had over 2000 employees at two locations in my area. We started testing their employees on-site in full PPE level 4 gear twice weekly at 100 tests per day over four hours.
This then progressed to other companies hearing about our services (auto repair, furniture wholesalers, yacht captains/crew, etc.). This soon became a whole secondary business due to the pandemic and the need for testing sites. The concierge effect was a draw to these companies; they didn’t have to send employees to state testing sites that took 10 to 14 days to get results. Because I had been watching the market, and was aware of the need for rapid testing, I procured one of the two FDA-EUA-approved rapid testing devices. This allowed for us to do both rapid and PCR testing.
One of the other advantages our clinic had was the long-standing relationship of buying power from a major distributor of medical supplies. Because of past ordering history, we were able to procure allocation quantities of gloves, masks, gowns and sharps containers. Throughout the entire pandemic, I have not needed to scramble to find a case of gloves or masks.
Because of the lack of efficient data on the rapid tests, I was hesitant to rely on its results. Our policy became standard to do both PCR and rapid testing on each and every person that we tested. This gave our clinic testing services more credibility and our results were more predictable as we learned how to read and manage the testing of client populations.
As luck (from a business standpoint only) would have it, the country got worse. Florida cases skyrocketed in September and October of 2020 and again before the holidays in December. The weekly infusion of a cash business allowed for me to retain employees, continue to purchase supplies (which were increasing in cost) and continue to invest in and grow the clinic.
Our attempts to procure COVID-19 vaccines for administration have not gone well. The governor, state and federal agencies responsible for vaccine distribution decided that using pharmacies (not physician/podiatrist offices) was the best way to do so. While I was fortunate to have both doses from my hospital, this distribution method (at the time of this column was written) has many eligible patients unable to procure appointments, in my observation.
With the advent of increased vaccinations, we have focused less on testing, but have pivoted the clinic to performing travel PCR tests for international travel and continue to serve the companies that have trusted our clinic for pool testing of their employees. We are slowly getting back to a regular schedule (still 20 to 25 percent of normal patient loads) and hope that by the end of the year, we will have geographic herd immunity, both natural and immunological, of 60 to 80 percent of the population.
I hope this column can provide hope for some; as sometimes you have to look outside your comfort zone to really see what needs to be done. In my case, it was testing. What this whole experience has taught me is that you should never just accept what is in front of you. But, you have to push though the difficult times to find your path.
Dr. Lullove is in practice in Coconut Creek, Fla. He is the Chief Medical Officer of the West Boca Center for Wound Healing. He discloses that he is the Managing Owner of Clear Results, which provides COVID-19-related testing and services.