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

untarily. I think that early patient detection with accurate tests followed by isolation can lower the mortality and prevent the virus from spreading. Appointments with allotted timeslot to allow disinfection of consult and treatment rooms in between. We are disinfecting regularly the entire clinic using proper disinfectants three times a day. All doctors and staff wear masks all the time when facing patients. (when consulting patients who are suspected of being infected with the COVID-19, N95 mask must be worn, otherwise wearing a dental mask is enough). We are measuring body temperature of every single patient who visits the clinic in order to protect not only patients, but also medical staff. We are actively informing our patients of our efforts to prevent the infection through text messaging or online media. There are thermal imaging cameras in the entrances to most major buildings in South Korea. Bottles of hand sanitizers have been placed in every lift. Italy, Modena – Elena Rossi In Italy, the lockdown started on March 8. Working both in the national health system and in private practice, I faced two very different scenarios. In our private practice, I continued to do urgent procedures in the first 2 weeks of March (ie, post-surgical follow-up, urgent consultations, no cosmetic). Then we closed until May 4. I managed contact with my patients mainly via WhatsApp, telephone, and emails. It was very important to try to keep a virtual relationship with more sensitive patients, not only to care for them medically but to reassure them about the general situation and help them not feel abandoned (mainly the eldest). Whatsapp was also a very nice tool also to follow up with some COVID-19-positive patients who showed signs of cutaneous rash. Now we resumed operations and we conduct non-urgent procedures (cosmetic included), but we increase time between patients and keep up with all the precautions (PPE, social distancing, disinfection). Within the national healthcare system, we could continue to perform urgent consultations and surgical operations. Since the number of surgical sessions was reduced both for inpatient and outpatient, surgery was highly selective for melanoma, high risk squamous cell carcinoma, and rapidly growing nodular lesions. The situation in the OR has been changing day by day regarding the different protocols and safety measures. At first, there was a lack in PPE. Then depending on the anatomical areas and type of anesthesia (ie, general anesthesia procedures have high risk for contamination) we adopt different safety protocols and PPE: for inpatient going under general anesthesia the protocol the patient is tested in preadmission with blood test, chest-x-ray, and nasal swab before surgery. For outpatients, when the tumor is located on the face and the patient cannot keep the mask during surgery, the surgeon is recommended to keep both the N95 mask and the surgical mask on top of it. I also had the chance to work once a week supporting the coronavirus unit on the territory of my city.

The authors have no conflicts of interest.

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Neil Sadick MD nssderm@sadickdermatology.com