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Structure and function of practice in covid world

Discussion in 'United Kingdom' started by wdd, Apr 23, 2020.

  1. wdd

    wdd Well-Known Member

    Members do not see these Ads. Sign Up.
    In the U.K. lockdown seems to be taking effect and talk is turning to re-opening businesses.
    Given all the unknowns, eg. Will it be seasonal? Will/when will we have an effective vaccine? When will we have an effective treatment? Is this just phase one? How long is it going to go on for? When will the next pandemic occur? And on and on.

    what long term sustainable changes need to be made to the structure and function of podiatry practices to minimise risk to patients and staff in the long term?
    I don’t see or hear of this discussion going on (I probably haven’t looked or listened hard enough) but now is certainly the time for it? In fact a month ago might have been a better time to start it!
    I am putting down just a few ideas for starters.

    Automatic doors?
    Take patient and staff temperatures on entry?
    Shoes off and bagged on entry to premises and use of plastic overshoes?
    Masks for patient and staff?
    Disposable gloves for patients as well as staff?
    Plastic screens between patients and reception staff in waiting room?
    Plastic screen between patient and practitioner in surgery?
    What size of plastic screens?
    Hand sanitizer for for each patient as they enter and leave premises?
    Cleaning routine after each patient?
    Mechanics of payment for treatment to minimise risk of cross infection?
    Change from receptionist to automated appointment system?
    What are the cost implications?
    Could the system be ramped up and down dependent upon variation in the long term risk to minimise or significantly delay the risk of future lockdown?

    Best wishes,
  2. Diane7

    Diane7 Welcome New Poster

    We all need to join together in the Podiatry world in all countries to quickly investigate if the Foot skin lesions highlighted in Spain and Canada can be used as an early indicator of the Covid- 19 virus. I have today asked the college of Podiatry for a statement regarding this.
  3. wdd

    wdd Well-Known Member

    What changes would you make to your practice to ensure that when you have a patient sitting in the patient’s chair opposite you demonstrating these potential signs of covid19 that the risk to you is so low that you will not have to self quarantine and close your practice?
  4. wdd

    wdd Well-Known Member

    I am putting the problem again but in a different way as some people may feel more at home thinking about it in this way.
    It seems that the basic reproduction number R0 for covid19 is somewhere between 5 and 6 which means that in a susceptible group an infected individual will on average infect approximately six others. If the basic reproduction number is less than one the number of infected cases reduces.
    Total lockdown eventually (after those initially infected in a household infect the other susceptible members of the household) would produce a basic reproduction number (R0) of 0. Game over infection gone. But of course there is no such thing as 100% lockdown so one way or other there will continue to be new infections. However if the R0 can be kept under one the disease will eventually die out.
    Opening up for business in covid world for me means modifying the business model in such a way as to maximise income and profit while keeping R0 less than one and as near to zero as is reasonably possible.
    Can the effects of each possible intervention on R0 be measured? Have they been measured, ie what effect does maintaining a distance of 2m have on R0? What effect does frequent hand washing have on R0, etc, etc?
    Are the answers out there?
    Do we need this type of information or do we just wait until “those in charge” tell us how and when we can go back to work?
  5. Catfoot

    Catfoot Well-Known Member

  6. Catfoot

    Catfoot Well-Known Member

    I think we need to wait to see what the scientists say about this before we jump to any conclusions about the 'lockdown' ending.

    I believe COP & IC&P have both issued guidance to their Members.

    Regarding Ro - the 'lockdown' has produced a Ro of 0.5, so we are seeing a reduction in transmission rates. But this is a false reduction and if the 'lockdown' is lifted too soon, then there could be a rebound 2nd wave of infections.


  7. wdd

    wdd Well-Known Member

    Thanks for your reply Catfoot.
    Without ‘jumping’ I have concluded that lockdown will end. When and how should of course be science led although I think the economic push to reopen sooner rather than later may become so strong that there is a risk that it might eventually tend to dominate the science especially when the arbitrator is politics.
    Science on its own, safe hands. Science, economics and politics together put your faith in God/science but tie up the camel.

    The bit I am focusing on is “tying up the camel”.
    I see you have managed to find something about the effect of “Lockdown” on R0. Can you give us the source for that information?
    You say that it is a “false reduction”. In what way do you think it is “false”?
    I think that “lockdown” is an unfortunate word as something is either locked or it is unlocked, all or nothing so to speak and it seems to imply a free for all once the lockdown is lifted. Heaven forbid.
    Progressive return to work needs careful consideration by all involved and for podiatrists that consideration filters down through science, economics, politics, professional organisation and eventually to the level of the individual practitioner and it’s at that level I have a concern.
    Is there an arena where practitioners can be involved in the discussion about their future?
  8. Catfoot

    Catfoot Well-Known Member

    The comment I made about 'lockdown' (and I don't like the term either, but I can't think of a better one) creating a false Ro was a quote from one of the government scientific advisors at one of the UK government briefings on the BBC.

    In China when Covid-19 was largley undetected the Ro number was put at 4.5 - 5.6 n other words that's it's natural transmission rate if allowed to spread unchecked.

    Compare this to measles 12- 18 !
    Rubella, smallpox, polio - 5 - 7
    Ebola is only 1.5 - 2 but unfortunately is almost invariably fatal.
    I can't find a Ro number for the Black Death that decimated Europe in the Middle Ages, but one of the reasons for it's virulence was a 30+ day incubation period, which allowed it to spread unchecked.

    This is interesting;


    There are various dicussion areas on Facebook, but as I don't have a FB a/c you'll have to ask others for their relevence.
  9. fishpod

    fishpod Well-Known Member

    Many private pods will go under due to covid19 I've gone 5?weeks not apenny in income I suspect it will be another 6 weeks before we can reopen
  10. wdd

    wdd Well-Known Member

    I think you’re right fishpod and I can see that there are a myriad of reasons why a podiatrist would not want to or be able to work during lockdown. Not least being the evaporation of patients.
    Yet in theory it looks as if podiatrists, as keyworkers, are allowed to Continue to undertake “essential and routine” treatment and undoubtedly many patients are only routine because regular treatment keeps them in that category. As the treatment interval increases so does the proportion of patients in the essential group.
    My feeling is that what is going to attract patients back to you is, as always, how well you look after them. At the moment I would think that, apart from their increasing podiatric need, their predominant concern is how well are you going to manage their and your covid19 risk and it seems to me that this is what you have to sell.
    Redesign your practice around creating a zero risk environment describe the changes and why you’ve made them on your website and hopefully things will pick up again.

    Are you planning to make changes when you reopen? How will you decide when to reopen?

    best wishes,
  11. Catfoot

    Catfoot Well-Known Member

    I've treated 4 patients since 'lockdown' began and all those had co-morbidities or were in danger of tissue b'down.

    Some FHPs around here are going into care homes/private homes as normal
    ( one can only speculate at the reasoning behind this choice ) and some have packed up trading permanently.

    I can see some aspects of the lockdown being relaxed next week but I expect large gatherings cinema/theatre/church/clubs/bingo halls/football matches won't be allowed.
  12. wdd

    wdd Well-Known Member

    I have just seen a photo of a nail bar where the operator and client are separated by a clear plastic screen with a hole in it for the hand to pass through.
    Scaled up that would be top of my list for practice in a Covid world. It’s almost like working in adjacent rooms.
    It’s as near as you’ll get teleworking given the hands on nature of the vast majority of Podiatric work.

    Take all other precautions and get a screen.

  13. 5foot6

    5foot6 Member

    Hello I've read all the comments and I am pleased others have raised concerns that I have thought of too. We have a 2 chair practice and initially were treating urgent patients only. All of us (Pods) have worn isolation suits, masks and visors as well as the usual PPE. We're only operating one clinic room at the moment to minimise patient crossover. Times have been extended an extra 15 minutes to allow clean down and Pods to take payment, which previously our receptionists did. The receptionists now work from home and triage from a dedicated pay as you go mobile, then call back at teatime to pick up messages. We're asking Patients to come to their appointment on time and not to come early as reception is closed. We are losing around 3 patients a day due to the new way of working. To survive I have had to cut the receptionists time down (which in turn reduces their holiday allowance, also making a saving). Prices have gone up by £3 to help compensate for the losses - we could do with it being higher, though we want patients to come back. Prices can gradually be increased every 3 months. The two part time receptionists have taken it in turn to furlough and I am taking full advantage of this until it ends in October. After that, who knows. A second spike is predicted at the end of the year. I doubt the Govt can afford another furlough scheme. Also we now have IR35 to contend with for our Associates, though setting up a limited company under an umbrella company may sort this hurdle out. A difficult time for us all, although our business is something that is needed. If we get through this and still make a living, we're doing alright!
  14. NewsBot

    NewsBot The Admin that posts the news.

    COVID-19 Pandemic and the South African Podiatrist.
    Zipfel, B.; Dembskey, N.
    Preprints 2020, 2020090425

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