Below is my reply to the same discussion group Dr. Anne Steiner’s message (bottom) went to, and in her thread.

Dear friends:

I appreciate Dr. Steiner’s thoughts. [see article at end of post]

I suspect that everyone is getting antsy about when we can get back to work, and I imagine that our private practice colleagues are worrying about when they need to make some tough decisions about whether and when to let some employees go.  In an “eat what you kill” private practice, I imagine that if you don’t work, you don’t eat.  The American Medical Association is actively working on supporting physician practices:  <https://www.ama-assn.org/delivering-care/public-health/covid-19-economic-stimulus-must-aid-struggling-physician-practices>, and I hear that some ophthalmology and dermatology practices are accessing small business loans to help keep themselves afloat.

Importantly, there are also several communities (Manhattan, Brooklyn, Seattle, etc) that are getting overwhelmed right now.  According to my local Department of Health, as of last night, there are 7 states that have issued Stay at Home Orders: CA, IL, NY, NJ, OH, LA, CT.

Many or even most of us will likely get COVID-19 (or COVID-20, or -21) over the coming months and years.  Our goal should not be to stay disease-free forever, but rather to “flatten the curve” of affected and critically ill people.  If other countries are any indication, 80% will likely have mild disease, 14% may have moderate disease requiring oxygen, 4-6% may get severely ill, and perhaps 2% will die.  Over time, we will need those healthcare workers who get sick and recover, to take care of the rest of us when it’s our turn.

If you haven’t already, this is also a great time to connect with your local county or state medical societies, as many of your local physician groups have been hosting webinars with their state and local departments of health to keep everyone up-to-date.  Hopefully, we have instituted social distancing just when it mattered the most.  I encourage everyone to donate blood, comply with good hygiene and social distancing, and stockpile 14 days’ worth of food and sundries (in case you need to self-quarantine) but *not* hoard.  It is also important to go outside and get some fresh air, reconnect with friends and family, and have us all take care of ourselves and each other.

In the meantime, this will be a time of great societal change.  We need to fight fear, panic, social isolation, and #CoronavirusCabinFever, while also remembering to take care of ourselves and each other.  My hope is that this pandemic (and our response) will increase our sense of community and togetherness.  I am reassured that even our dysfunctional Congress can pass emergency legislation in a crisis.  Our state and national leaders are right:  this is a war, and we need to band together, so that we don’t get overwhelmed.

Stay safe and well,
– Albert Hsu, MD  Columbia, Missouri

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Below is a repost from a discussion group written by Anne Steiner, M.D. M.P.H. on March 22, 2020 1:38PM

Thoughts to consider

• Persons may agree with all of the Task Force recommendations, some of them, or none of them. Below I classify a person as pro or con, understanding that this is an oversimplification.
• Someone who is pro shutdown is not self-serving because they don’t want themselves or their staff to be exposed unnecessarily. A person who is con shutdown is not self-serving because they worry about financial implications for themselves and their staff.
• Facts that don’t need to be disputed.
  • Flattening the curve is important.
  • Elective procedures should be put off if possible.
  • Prevalence (or number of cases) of Covid-19 (or one could stay stage in progression of the epidemic) differs tremendously throughout our country.
  • The situation is changing daily.
• What we don’t know right now.
  • How long this is going to last– I have seen predictions from 1 month to 18 months
  • The impact of Covid-19 on pregnancy.
    • Side note: SMFM and ACOG chose to view the evidence/lack of evidence favorably. ASRM negatively.
• What your con shutdown colleague is worried about
  • The potential implications of defining infertility treatment as elective
    • How will this affect our position in large healthcare systems and OB/GYN departments?
    • How will this affect our push to have infertility coverage mandated?
    • The message this conveys to those suffering from infertility
  • The ability to provide services once this pandemic has passed (or the long-term viability of our field)

• My assumption is that where you fall in the “pro” or “con” side is based on
  • Your projections about the “unknowns”
  • The extent to which you view infertility diagnosis and treatment as “elective”
  • The status of coronovirus in your community
  • Your type of practice (Academic, part of a Healthcare system, or Private)
  • The extent to which you feel it is important to “do your part” to slow/mitigate the effects of the pandemic

My thoughts on the future:

• In the coming days, weeks, and months, some of us will be called to “cover” for our OB/GYN colleagues. We as a society should focus on how we will preserve our practices so that we can continue to care for patients with infertility in the future.
• We should think of novel ways to provide care such that we minimize exposure to patients and staff. How can we do SAs, HSGs, SISs, blood draws while minimizing staff and patient exposure?
• Can we work together as a community? Can one practice do the HSGs, the other SAs, etc. and not “steal” each other’s patients?
• Should the decision to reproduce at this time be the patient’s decision?   If so, are there treatments that we can provide such as unmonitored OI and IUI, which minimizes staff and patient exposure?
• If the pandemic becomes as bad as projected, we will not be able to implement these novel practices. However, I think it is a concept worth exploring.

Wishing you, your staff, and patients health and safety,
Anne

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Anne Z. Steiner M.D.,M.P.H
Professor and Chief, Division of Reproductive Endocrinology and Infertility
Department of Obstetrics and Gynecology
Duke University
Durham NC
(919)572-4673