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We consider a model that distinguishes susceptible; infected, but not yet infectious; pre-symptomatic, symptomatic, asymptomatic, and hospitalized infectious; recovered and dead members of two groups: healthcare workers (HCW) and members of the community that they serve. Because of the frequency or duration of their exposures to SARS-CoV-2, a greater fraction of HCW would experience severe COVID-19 symptoms that require medical care, which reduces mortality rates, absent personal protective equipment (PPE). While N95 masks (and, possibly, other scarce medical resources) are available to members of both groups, they do not use them equally well (i.e. efficacy and compliance differ). We investigated the optimal allocation of potentially scarce medical resources between these groups to control the pandemic and reduce overall infections and mortality via derivation and analysis of expressions for the reproduction numbers and final size. We also simulated prevalence and cumulative incidence, quantities relevant to surge capacity and population immunity, respectively. We found that, under realistic conditions, the optimal allocation is virtually or entirely to HCW, but that allocation of surplus masks and other medical resources to members of the general community also reduces infections and deaths.
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INTRODUCTION: Three pathways are available to students considering a pediatric emergency medicine (PEM) career: pediatric residency followed by PEM fellowship (Peds-PEM); emergency medicine residency followed by PEM fellowship (EM-PEM); and combined EM and pediatrics residency (EM&Peds). Questions regarding differences between the training pathways are common among medical students. We present a comparative analysis of training pathways highlighting major curricular differences to aid in students' understanding of these training options. METHODS: All currently credentialed training programs for each pathway with curricula published on their websites were included. We analyzed dedicated educational units (EU) core to all three pathways: emergency department (ED), pediatric-only ED, critical care, and research. Minimum requirements for primary residencies were assumed for fellowship trainees. RESULTS: Of the 75 Peds-PEM, 34 EM-PEM, and 4 EM&Peds programs screened, 85% of Peds-PEM and EM-PEM and all EM&Peds program curricula were available for analysis. Average Peds-PEM EUs were 20.4 EM, 20.1 pediatric-only EM, 5.8 critical care, and 9.0 research. Average EM-PEM EUs were 33.2 EM, 18.3 pediatric-only EM, 6.5 critical care, and 3.3 research. Average EM&Peds EUs were 26.1 EM, 8.0 pediatric-only EM, 10.0 critical care, and 0.3 research. CONCLUSION: All three pathways exceed pediatric-focused training required for EM or pediatric residency. Peds-PEM has the most research EUs, EM-PEM the most EM EUs, and EM&Peds the most critical care EUs. All prepare graduates for a pediatric emergency medicine career. Understanding the difference in emphasis between pathways can inform students to select the best pathway for their own careers.