Scenes From the COVID Resurgence in Wound Clinics

Physicians weathered the first wave of COVID-19 over a year ago, coping with challenges such as a lack of personal protective equipment, providing care via telehealth, and a lack of vaccines. With the Delta variant, many hospitals may be swamped with patients with the coronavirus. Several physicians spoke to Today’s Wound Clinic about their challenges.

“We are busier than ever,” says Matthew Regulski, DPM, ABMSP, CMET, FAPWH(c), the medical director of the Wound Care Institute of Ocean County, New Jersey. “We have so many wound patients. Our wound centers are jam-packed.”

Amputations are up 11-fold in patients with diabetes, notes Dr. Regulski.

Since she practices in an office setting, Helen B. Gelly, MD, FACCWS, UHM/ABPM, FUHM, notes her facility has considerably more discretion about closing and/or limiting patients. At Hyperbaric Physicians of Georgia, she and her colleagues are limiting entry to family members of patients, and are doing FaceTime with the family as physicians see the patient.

Dr. Gelly’s facility never closed during the first part of the pandemic, and will not close this wave. Hyperbaric oxygen therapy remains the same in her facility. They have reduced visits from 3–4 per hour to 2 per hour.

Similarly, Jayesh B. Shah, MD, MSc, UHM ABPM, CWSP, FAPWCA, FCCWS, FACHM FUHM, FACP, notes in his facility, patients are limited to having one family member with them during treatment. Volumes have decreased in wound clinics and inpatient procedures, notes Dr. Shah, who practices in San Antonio. His hospital has stopped elective surgeries that require admission to the intensive care unit (ICU).

Dr. Shah says employees and patients are very compliant with masks during their clinic visits. He notes that televisits have increased during the recent COVID surge, saying these visits had been down two months ago.

What about vaccination rates among patients or staff? In a recent editorial, Caroline E. Fife, MD, FAAFP, CWS, FUHM, notes of the 75 COVID-19 patients hospitalized at her facility in Texas, 72 are unvaccinated. Dr. Fife notes the number of unvaccinated patients hospitalized contrasts with what she sees among wound center outpatients.

“Although I have only been keeping informal count of the vaccination rate in the wound center outpatients, the vast majority of wound center patients have been vaccinated,” says Dr. Fife. “Also, I now have half a dozen wound center patients who are status post ICU stay for COVID pneumonia. I am treating them for pressure injuries that developed while in the ICU but they have all got long term problems like shortness of breath, loss of smell, supplemental oxygen dependency, the aftermath of a COVID-induced stroke, and many other horrible sequelae.”

Dr. Regulski says vaccines are effective but has concerns about breakthrough cases that occur in the summertime when respiratory viruses are not active and vitamin D levels are at their highest. Dr. Shah’s facility has imposed mandatory vaccination on staff. Dr. Gelly notes although vaccines are not yet mandatory for her staff, about 95 percent have gotten the vaccine. Her state of Georgia has a low vaccination rate but she notes rates are a bit higher in metropolitan areas than rural.

“I cannot express my frustration and frankly anger at the folks who refuse to get vaccinated,” says Dr. Gelly. “I am tired of the politicization of this public health initiative. As I said in my LinkedIn post, blue or red—when you are hypoxic, you turn blue. If you want to stay red, then get vaccinated.”

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