Recommendations for Dermatology Office Reopening in the Era of COVID-19

July 2020 | Volume 19 | Issue 7 | Original Article | 22 | Copyright © July 2020


Published online June 26, 2020

Suleima Arruda MDa, Doris Hexsel MDb, Tingsong Lim MDc, Heidi A. Waldorf MDd, Ofir Artzi MDe, Whosung Choi MDf, Sahar Ghana MD PhDg, Huang Gaomin MDh, Wilson Ho MDI, Maria Cristina Puyat MDj, Elena Rossi MDk, Ava Shamban MDl, Sonja Sattler MDm, Neil Sadick MDn

aArruda Dermatology, Sao Paulo, Brazil bBrazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil cClique Clinic, Kuala Lumpur, Malaysia dWaldorf Dermatology Aesthetics, Nanuet, NY; Icahn School of Medicine of Mount Sinai, New York, NY eTel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel fPiena Aesthetic Clinic, Seoul, Korea gAlexandria University, Alexandria, Egypt; Sahar Polyclinic, Salmiya, Kuwait hShanghai WanTian Cosmetic Medical Management Consultancy, Shanghai, China iThe Specialists: Lasers, Aesthetic and Plastic Surgery, Central, Hong Kong jRizal Medical Center, Pasig, Philippines kHead and Neck Skin Cancer Service, Modena, Italy; Reggio Emilia University, Modena, Italy lAva MD, Santa Monica, CA; SKIN FIVE, Los Angeles, CA mRosenpark Klinik GmbH, Clinic for Aesthetic Dermatologic Surgery and Plastic Surgery, Darmstadt, Germany, nWeill Cornell College of Medicine, New York, NY

Abstract
The COVID-19 pandemic, originating in Wuhan, China, has become a major public health and economic challenge for countries around the world. As of May 08, 2020, there are over 3 million COVID-19 cases, and 250,000 COVID-19- associated deaths in 215 countries. As more data is collected, updated infection control measures are continuously released and published by government, public health authorities, and physician specialty associations. Across the globe, dermatological practices have had to limit their operations to varying degrees to facilitate disease control, but as the pandemic subsides, they will broaden their operations. In light of the uncertainty surrounding safe and effective practice of medical and aesthetic dermatology in the era of COVID-19, fourteen international experts in the field contributed to recommendations for effective infection control protocols and practice management modifications. While guidance from the World Health Organization and local public health officials comes first, these recommendations are crafted as a starting point for dermatologists worldwide to commence either reopening their doors to patients or expanding available service offerings. This can help ensure that patients receive needed care in the short term and improve long term practice viability.

J Drugs Dermatol. 2020;19(7):e-1-e-9. doi:10.36849/JDD.2020.5293

INTRODUCTION

On March 11, 2020, the coronavirus disease 19 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO).1 The incubation period of the virus varies from a few days up to two weeks until presentation of reported symptoms that include fever, cough, nasal congestion, fatigue, breathing difficulty, sore throat, diarrhea, vomiting, and loss of taste or smell.2 In severe cases, the disease can progress to Acute Respiratory Distress Syndrome (ARDS), septic shock, acidosis resulting in severe metabolic alterations, coagulation deficiency, and multiple organ failure can occur.3 The pandemic has placed significant stress on healthcare providers and their patients, both due to critical resource shortages and delays in care. Because clear dermatological diagnoses can rarely be done from a distance larger than 20 cm, and close face-to-face contact is required for a plethora of dermatologic procedures, both medical and aesthetic, even routine dermatologic care poses a significant risk of viral transmission between patient and providers. In the early stages of the pandemic, response varied by country: from the American Academy of Dermatology recommendation to cease all but the most urgent dermatological care to preserve critical personal protective equipment (PPE) for hospital COVID units to the German Federal Ministry of Health requirement that dermatology practices remain open to keep dermatologic care out of emergency units. These variations were based in part upon population density, availability of PPE, and hospital capacity in different countries. Despite these differences, dermatologists