How to avoid infection in the office: Prevention and Control
We know that SARS-Cov2 spread mainly from person to person, for interaction below 6 feet (1.8 m) via large droplets, produced when an infected person coughs, sneezes, or talks. Those droplets can land in the mouth, nose, or eyes of people nearby and can be inhaled. Symptomatic and asymptomatic individuals can spread the disease very easily and sustainably between people. The virus can also spread in other ways, from touching surfaces or objects, feces, from animals to people and from people to animals, but these are not thought to be the main ways the virus spreads.5
Information from the ongoing COVID-19 pandemic suggests that this virus is spreading more efficiently than influenza (R0=1-2), but not as efficiently as measles (R0=12-18), which is highly contagious.8 We know that way to reduce person to person spreads are: Maintain good social distance (about 6 feet); wash your hands often with soap and water. If soap and water are not available, use a hand sanitizer with at least 60% alcohol; Routinely clean and disinfect frequently touched surfaces.5While organizing the office space, it is very important that when possible, staff will maintain 6 feet distance from each other, and also health care providers will maintain when possible such distance from patients. This can be achieved by redistributing desks, staggering patient influx in waiting rooms, limit the number of people coming with the patient (an adult should come alone when possible, children should be accompanied by 1 adult, and no siblings should not be allowed), avoid communal lunch or food sharing.9 Universal masking of patients and staff have also shown to reduce transmission.7 Furthermore, while the vaccine is not available, the CDC and ECDC have recommended that healthcare providers use of personal protective equipment (PPE) typical for standard, contact, and airborne precautions and with the use of eye protection. Therefore, to take care of COVID infected or potentially infected patients, gowns, gloves, and either an N95 respirator (in the USA) or FFP3/FFP2 (in Europe) plus face shield and goggles or a powered air-purifying respirator (PAPR) should be used. However, there is a worldwide shortage of N95 and PARP; therefore, allergists may need to use a face mask instead of an N95 respirator if one is not available.
To reduce the risk of exposure, the allergist can decide to visit only asymptomatic patients, by strict screening phone call prior to the visit. Patients should be asked if they have been exposed to COVID-19 infected individuals, if they have traveled to areas of high transmission, and if they have any of the typical symptoms (Figure 1). Telehealth can be used instead of an in-person visit. Furthermore, procedures like spirometry and nebulizers should be avoided.5
To reduce the spread of the virus, policies in the office should be present in the office to self-quarantine of asymptomatic healthcare providers that have been directly exposed to sick patients or in the community.
For certain periods allergist may be asked to reduce the visit to only essential ones, in order to reduce the physical contact among people as well to preserve PPE and resources.
It is important to note that many allergy/immunology services are elective and can be managed without face-to-face interaction or deferred outright for short periods. Prioritizing certain services may be required when countries go in the red zone to prevent disease spread or based on the availability of adequate PPE for health care providers (Table 1).6,7
We will here review how to treat specific conditions in the allergy office.