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

close or longer at the patients’ side need to wear an FFP2 mask, especially when the patient cannot wear a mask because of the treatment performed. In addition, the staff wears single-use gowns plus gloves in my clinic, and also plastic full-face shields, if possible. On May 4th, 2020 we were able to start working again for medical indications as well as cosmetic treatments and surgeries in Hessen, Germany. My staff is well educated and highly motivated. With all the precautions in place, we started quite good, trying to keep up with the patient flow and all rules. Limiting the number of patients per day becomes essential and is the most difficult task at this point. Each of our doctors sees 1 patient in 45 minutes–1 hour for a consultation including, eg, cosmetic filler treatment, which is 20-30 minutes longer than scheduled before COVID-19. Every patient only goes into 1 consultation room, everything is performed in this one room consultation – photography, treatment, and payment.

Philippines, Manila – Cristina Puyat
We have been on total lockdown since March 15 until the present time. Our lockdown might be lifted May 15. In our country, there are 2 kinds of quarantine namely Enhanced Community Quarantine (ECQ), which is where we fall now. Stringent measures are observed, public transportation system is suspended, and only essential businesses are allowed to operate. While the ECQ is in effect, telemedicine and teledermatology has been implemented. Consent form is sent to the patient electronically prior online consultation in accordance with the 2012 data privacy act of the Philippines. We assure that everything we discuss, and all pictures sent, are kept confidential. Wearing of mask in public is required. General Community Quarantine (GCQ) might be implemented May 15. This is the only time that our private clinics will be able to operate putting all the safety guidelines into place. The new protocols for re-opening clinics post-COVID-19 quarantine will be discussed with the patient who will be going to the clinic physically as these protocols will be strictly implemented. Public transportation in reduced capacity will be allowed, as well as reopening of selected establishments, subject to health standards enforced by the local government.

Malaysia, Kuala Lumpur – Tingsong Lim
Malaysia started implementing Movement Control Order (MCO) March 18 when localized clusters began to emerge. All businesses were closed except for essential services. The restriction was then eased since early May, allowing certain degree of business as usual. However, aesthetic practice was not one of them. Currently, for those who started off seeing medical patients, teams are divided into 2, with shifts and rotation to avoid possible chances of infections among the work force. We also implemented screening of patients before they come for appointments. One patient, one room, one time, is being implemented as well, with minimal human to human contact. We encouraged our staff to get tested before starting work and also to retest if any possibility of getting infected. Vigilant screening is done, and the workplace is being disinfected very frequently.

Israel, Tel Aviv – Ofir Artzi
We were closed for 5 weeks. Before resuming activity, we undertook many measures and changes in all office spaces to allow physical distancing and to minimize possible virus transmission. A reminder call and a screening to identify potential infection is performed prior to patient arrival. In this call, we exclude any symptoms, exposures, or recent travel. The patient should fill and sign a disclosure form. High-risk patients and procedures are delayed at the moment. In this call, all protective measures taken are conveyed to the patient. We elaborate on the new protocol and the expected behavior – we remind the need to arrive on time and alone. We leave the accompanying person in the car outside unless special circumstances. No one enters the office spontaneously without an appointment. We measure temperature in the entrance and provide gloves and mask upon entry. We limit greetings to a smile, wave, and other non-contact gestures. The patients are taken upon arrival to a single treatment room. All supplies and relevant energy-based devices are prepared before patient entry. If possible, only one provider will be with the patient. We allow no more than one medical assistant in the room. Doors are closed – no going out and in when the patient is in. All pretreatment, treatment, and post treatment actions including payment are performed in this room. Payment (if not done) and scheduling of follow-up visit are made later by telephone. Between patients, we disinfect beds, chairs, surfaces, instruments, tables, doors handle, etc. Up to two weeks post procedure, we follow our patients (videoconference or telephone) both to monitor progress and to verify that no COVID-19 symptoms developed. Before treatment, the patient signs an appendix to the consent form. Whenever possible for all nontreatment interaction, telemedicine is used. We schedule 10–15 minutes per patient for first consultation. All existing data, medical records, pictures taken by the patient, are sent prior to this virtual meeting. A temporary summary of the conversation is documented. It is emphasized to the patient and in writing that the recommendations are based on a virtual appointment and thus are can be amended (including the cost) when meeting the patient in person. We reduced the number of patients by 20% but did not experience decrease in income because consultations are made in different time frame to save time.

South Korea, Seoul – Hosung Choi South Korea
had already experienced MERS five years ago, in 2015. During that crisis, we learned how to do epidemiological investigations of an epidemic, how to treat it, and how to prevent it. After MERS outbreak, South Korean CDC realized that persistent patient tracking and the transparency to the public are very important for a high level of quarantine. These preparations appear to have paid off and we were somewhat prepared for the new virus. The preventative measures being taken in South Korea have so far involved no lockdowns, no roadblocks, and no restriction on movement, only social distancing was recommended by the government. Therefore, I’ve never closed my clinic and only reduced my working hours for two months vol-