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Put me on the front line: doctors who have recovered from coronavirus should treat patients with COVID-19
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  1. Ellery Altshuler
  1. Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Dr Ellery Altshuler, Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32608, USA; ElleryAltshuler{at}gmail.com

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A week ago, I began experiencing fevers, a persistent headache and strange muscle pains in my legs. As a physician working in Florida, I was pretty sure I knew what was going on. Later that day, I tested positive for coronavirus. I was lucky to have a mild course. I began my quarantine and wondered if I would be immune when I returned to the hospital. If recovered providers are unable to be reinfected—or, at least less likely to be than those who have never contracted the virus—what would be the implications?

The evidence on reinfection is mixed.1–3 An initial study the Korean Center for Disease Control was hopeful. Researchers had identified 285 individuals who had recovered from coronavirus and, at a later date, tested positive again. However, of the ‘re-positive’ cases, viral cell cultures were negative in all of them and contact tracing showed that no new cases could be tracked to any of these re-positive individuals.4

Less optimistic news came on 18 June, when Chinese scientists in Wanzhou published a study that followed 37 asymptomatic individuals with RT-PCR-confirmed COVID-19. Alarmingly, 40% of asymptomatic individuals became IgG negative in the early convalescent stage.5 Though the study was small, it suggested that immunity can fade quickly, especially for asymptomatic cases.

Further complicating matters is the evidence from more common forms of coronavirus, which suggests that protective immunity usually lasts as little as 6–12 months.6 7

While government officials have yet to make definitive declarations on the possibility of reinfection, Dr. Fauci announced on 6 July that there had yet to be a single documented case globally in which a recovered patient got coronavirus again.8

Although there is a paucity of conclusive evidence, it appears that at least for the next few months, I am unlikely to become reinfected with coronavirus. At the very least, I am much less likely to become infected than a physician who has not contracted the virus.

When my quarantine period is over, I will join the ranks of an increasing number of providers who have recovered from COVID-19. In a pandemic in which using our limited resources as efficiently as possible is paramount to saving lives, it would behove clinicians to make use of these physicians. At least for their first few months following return from quarantine when there is a high level of certainty about their chance of reinfection, these doctors should be on the front lines treating patients with coronavirus. This set-up would benefit to both doctors and patients.

Assigning recovered doctors to patients with coronavirus would be beneficial to physicians who have not had COVID-19 by reducing their exposure to patients with the virus and thus lowering their risk of infection. With appropriate personal protective equipment, the risk of getting coronavirus from patients is low: recent evidence from the Netherlands suggests that most healthcare workers who contract COVID-19 usually do not do so directly from their patients.9 10 Yet even if pairing coronavirus-negative doctors with coronavirus-negative patients would reduce new infections in just a fraction of providers, we would be remiss not to implement this approach. This paradigm has the potential to alleviate stress for providers who have not contracted the virus by reducing their interactions with patients who could infect them.

Pairing recovered doctors with patients with coronavirus would also benefit patients—both those with and without coronavirus. Patients without coronavirus could benefit from a reduction in nosocomial infections, while patients with COVID-19 would benefit from having doctors who would not be afraid of being infected by them and would likely be willing to spend more time with them. Furthermore, if fewer doctors got coronavirus, there would be fewer shortages of providers, helping all patients.

Of course, there are many uncertainties in assigning patients with coronavirus to recovered providers, but these uncertainties should not be an excuse for inaction. We are not sure that recovered doctors are truly at low risk of reinfection, nor are we certain that separating uninfected providers from patients with coronavirus would truly reduce nosocomial infections. In the absence of better evidence, we must make our best guess as to what will help patients and providers the most. Doctors who have recovered from the virus would should volunteer to be the first line in seeing patients with coronavirus; in doing so, they would be taking on minimal risk while helping both patients and their fellow physicians.

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Footnotes

  • Contributors EA is the only author and is solely responsible for the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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