Patients and providers alike were caught by surprise with the sudden change required for social distancing with the onset of the COVID-19 pandemic, says Matthew Greenhawt, MD, MBA, MSc. “There was no clear guidance or rationale in the early weeks of the pandemic, so my colleagues and I wrote a paper for allergists and immunologists to outline a rationale for how to provide safe and effective care,” he notes. “For a subsequent paper, published in The Journal of Allergy and Clinical Immunology: In Practice, we have similarly outlined a safe and logical approach to resuming allergy services, and establish rationales for a flexible and contextual approach to clinical services during the pandemic.

A Consensus of Allergy & Immunology Thought Leaders

The team sought to outline a broad approach, using consensus of allergy and immunology thought leaders, many of whom were on hospital committees and already working on best practices planning approaches to prioritizing services during the reopening of practices. “Our goal was to provide a rationale for why and when to phase more routine services back into practice, keeping in mind the high degree of uncertainty in the process, both with COVID-19 and with demand for services that were possibly deferred during the initial phase of the spring pandemic wave,” explains Dr. Greenhawt.

A recurring need has been for flexibility for both physicians and patients during the pandemic, Dr. Greenhawt explains. Uncertainty and changing regulations have been a constant, with no single approach working across the country. “There are often no easy answers, and although many may not have needed this document, for others, it provides a useful roadmap,” says Dr. Greenhawt. “Around the world, clinicians can now realize that we are not alone and the challenges we face are no longer unique.” While flexibility is needed, the team developed a list of 10 constraints to consider when reopening clinics and offices:

  1. Accurate ongoing assessment of the current level of local community transmission of COVID-19.
  2. A sustainable supply of PPE and ongoing reassessments of best practices regarding PPE as new evidence emerges.
  3. An effective patient and staff screening process.
  4. Adequate availability of rapid, accurate COVID-19 testing.
  5. Accurate understanding of the degree to which a patient (or staff member) may be at risk for severe or life-threatening COVID-19.
  6. Implementation of recommendations for reducing patient density and achieving distancing requirements with respect to waiting rooms and patient care rooms, as well as minimizing close contact time.
  7. Determining the patient isolation capabilities within an office space.
  8. Developing office protocols for how to effectively and efficiently clean and disinfect a room after each visit.
  9. Calculating the allowable number of staff who are permitted to work in a fixed space.
  10. Determining staff availability for scheduling.

We’re in this Together

The team suggested that while the COVID-19 pandemic continues, patients and physicians need to work together, providing the right care, at the right time, in the right context. To help fellow physicians, they developed a list of recommendations for phased reopening (Table) that “provides information that was lacking at the beginning of the response to the pandemic,” says Dr. Greenhawt. “It represents a comprehensive reference for logistical concerns, as well as guidance to protect staff so that practices can stay open and safe. Every practice is going to make individual decisions about treatment during COVID-19, and few circumstances will be identical in every practice. But, I hope physicians can find some nugget of information in this article to be of use and that this guidance can help facilitate optimal care in a suboptimal circumstance to allow for better decisions that help ensure patients in need can be seen, in the smartest and safest manner we can provide.”

References

A Phased Approach to Resuming Suspended Allergy/Immunology Clinical Services

https://www.jaci-inpractice.org/article/S2213-2198(20)30486-4/abstract