key: cord-334075-ruqd2c1j
authors: Der Sarkissian, Samuel; Tjokrowidjaja, Angelica; Sebaratnam, Deshan F; Gupta, Monisha
title: Response of a tertiary dermatology department to COVID‐19
date: 2020-04-21
journal: Australas J Dermatol
DOI: 10.1111/ajd.13298
sha: 
doc_id: 334075
cord_uid: ruqd2c1j

nan

A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported in December 2019 causing the disease known as COVID-19. As of March 24th, 2020 there have been 195 countries affected with 387 354 cases and 16 758 deaths. In Australia every state has been affected and as of March 24th there were 2136 cases with 8 deaths. 1 A significant rise in case numbers is expected in the coming weeks.

China's lockdown measures are considered the main factor in a decline in transmission from a median daily reproduction rate of 2.35 to 1.05 within a week. 2 The Dermatology department of West China Hospital implemented several changes. Clinics were reduced to emergency cases, teledermatology was implemented, only one support person was allowed to accompany patients, upon entry to the department patients had their temperatures measured as well as wearing masks and having travel histories recorded. Doctors were mandated to wear full PPE. 3 Due to the unprecedented nature of this pandemic there has been uncertainty regarding what changes should be implemented to Australian dermatology services.

Given the reported efficacy of China's response in reducing COVID-19 transmission, we are employing similar protocols (Table 1) . At the Department of Dermatology, Liverpool Hospital, we have deferred non-urgent cases from surgical and medical clinics. We have defined urgent surgical cases as melanoma, and squamous cell carcinoma and other cutaneous tumours in high-risk areas or immunosuppressed patients. Medical cases are reviewed on an individual basis. With the Government implementation of teledermatology, we are utilising this where possible. 4 We are staggering patient appointment times to minimise the number in our waiting rooms, limiting patients to bringing one support person, and spacing seating by 1.5 m. For inpatient consultations we have limited the number of doctors seeing a patient to two. Patients are being proactively contacted to discuss the need for continuation of immunosupressive therapy. The British Association of Dermatologists have released a statement suggesting there is insufficient evidence to advocate stopping biologic therapy at this time. 5 Given the nationwide shortage of PPE, supplies are being numbered to identify missing units. The use of masks and other PPE has been dynamic, directed by hospital guidelines. Should a complete community lockdown be initiated, we plan to continue to work via telehealth with physical attendance only for the most acute presentations.

We hope that our experience serves as a nidus to stimulate discussion among departments. An avenue for this Conflict of interest statement: No conflicts of interest. Australasian Journal of Dermatology (2020) ,doi: 10.1111/ajd.13298 may be teleconference between departmental heads with the aim of providing a wider consensus. This being said, we recognise that many of the changes to clinical services are made beyond the departmental level. Hopefully, it can guide those in private practice also, recognising the differences in caseloads between the settings. While COVID-19's impact on the Australian health-care system and economy is uncertain, our departments and hospitals to which they belong play an important role in mitigating the burden by implementing initiatives to reduce the spread and severity of disease.

Samuel Der Sarkissian 1,2 | Angelica Tjokrowidjaja 1 | Deshan F Sebaratnam 1,3 | Monisha Gupta 1,3

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