Dermatology practices as vectors for COVID-19 transmission: A call for immediate cessation of nonemergent dermatology visits
Authors: Shawn G. Kwatra, Ronald J. Sweren, Anna L. Grossberg
Journal: Journal of the American Academy of Dermatology (2020)

From the Editors: As the COVID-19 pandemic continues to evolve, recommendations to healthcare providers will change based on availability of testing and personal protective equipment. For many patients, virtual visits can take the place of in-person visits, and we should do what we can to protect our older patients who are at greatest risk for adverse outcomes of infection. As tests become more widely available, there may be a role for testing prior to the visit for those who require a procedure that cannot be delayed. This must be done carefully so that we don't adversely affect testing capacity. We should all work with our hospitals and communities to help ensure that available supplies go where they are needed most. Dirk Elston, MD Jane Grant-Kels, MD To the Editor: In late 2019, a novel coronavirus (2019-nCoV) emerged that triggered a devastating disease (COVID-19) that has spread throughout the world. In this issue of the JAAD, Lan et al1Lan J. Song Z. Miao X. et al.Skin damage among healthcare workers managing coronavirus disease-2019.J Am Acad Dermatol. 2020; 82: 1215-1216Abstract Full Text Full Text PDF PubMed Scopus (381) Google Scholar report on occupational dermatitis in health care workers managing patients with COVID-19. Although the authors make an important point, our specialty should be collectively addressing the urgent issues facing health care delivery in this rapidly changing environment. Recent reports demonstrate that the COVID-19 pandemic is set for exponential growth in the United States. While COVID-19 has spread globally, the outbreak has been controlled in some countries (eg, South Korea and Japan) vs rapidly escalated in other areas (eg, Italy and Spain), largely based on public health measures that have blunted the peak number of cases.2Remuzzi A. Remuzzi G. COVID-19 and Italy: what next?.Lancet. 2020; Abstract Full Text Full Text PDF PubMed Scopus (2156) Google Scholar As dermatologists, most of our outpatient visits are nonemergent. Given our exposure to many individuals through high-volume clinics and that asymptomatic carriers can shed viral particles for weeks before (or even without) symptoms, we believe it is prudent to immediately cancel all nonurgent visits indefinitely. Screening patients and canceling appointments only for those with fevers is not sufficient because there is known asymptomatic viral transmission and a prolonged incubation period.3Hoehl S. Berger A. Kortenbusch M. et al.Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China.N Engl J Med. 2020; 382: 1278-1280Crossref PubMed Scopus (431) Google Scholar Indeed, fever was only present in 43.9% of 7736 patients at the time of hospital admission with COVID-19 in a study of 552 hospitals in mainland China.4Guan W. Ni Z. Hu Y. et al.Clinical characteristics of 2019 novel coronavirus infection in China.N Engl J Med. 2020; https://doi.org/10.1101/2020.02.06.20020974Crossref Scopus (0) Google Scholar Emerging research also suggests that COVID-19 viral particles remain viable in aerosol for several hours and can survive several days on multiple surfaces.5Doremalen N.V. Bushmaker T. Morris D.H. et al.Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1.MedRxiv. 2020; https://doi.org/10.1101/2020.03.09.20033217Crossref Scopus (0) Google Scholar In summary, we believe the following measures should be immediately implemented:1.All elective outpatient visits cancelled with deferment for a teledermatology or face-to-face visit.2.Only urgent outpatient visits should be conducted (including surgical procedures for invasive malignancies) or emergent inpatient consultations with proper personal protective equipment and an emphasis on social distancing.3.Practitioners who fit high risk criteria of being age 60 years or older, immunocompromised, or pregnant should be prohibited from evaluating patients.4.Trainee exposure (residents/fellows) should be minimized and staggered to protect the health care workforce. The last point is especially important given that there is minimal supply of intensive care unit beds and ventilators and that practitioners at the front lines are at high risk for infection. With a limited supply of health care providers, dermatology residents and attendings may be called on to treat patients with COVID-19, similar to what is currently taking place in Italy. These measures also apply to the broader medical community and other specialties. We call on the American Medical Association to take measures to promote guidance for wider implementation of telemedicine platforms and to help smaller solo and group practices with loans and other forms of financial relief to keep practices afloat during this crisis. Dermatology is a part of the broader medical community, and it is time for our specialty to make important decisions that can save lives. By taking the above proactive measures we also spread a message to our communities about the seriousness of the crisis. Instead of being reactive, we urge dermatology departments and practices to show leadership. If not now, when? Skin damage among health care workers managing coronavirus disease-2019Journal of the American Academy of DermatologyVol. 82Issue 5PreviewTo the Editor: Since the outbreak of coronavirus disease-2019 (COVID-19) in December 2019, more than 200,000 health care workers from all over China have been participating in the fight against this highly contagious disease in Hubei province, which is the center of infection in China. Skin damage caused by enhanced infection-prevention measures among health care workers, which could reduce their enthusiasm for overloaded work and make them anxious, has been reported frequently. Full-Text PDF Optimizing teledermatology visits for dermatology resident education during the COVID-19 pandemicJournal of the American Academy of DermatologyVol. 82Issue 6PreviewTo the Editor: After an outbreak of unexplained pneumonia cases in Wuhan, China, in December 2019, the World Health Organization officially named the disease caused by the culprit virus as coronavirus disease 2019 (COVID-19).1 Faced with a global public health emergency, dermatology practices are now using telemedicine to limit in-person appointments to reduce transmission of COVID-19 per interim guidance from the Centers for Disease Control and Prevention and the American Academy of Dermatology. Full-Text PDF