key: cord-0717749-1i9jfvr6 authors: Kumar, Sheetanshu; Bishnoi, Anuradha; Vinay, Keshavamurthy title: Changing paradigms of dermatology practice in developing nations in the shadow of COVID‐19: Lessons learnt from the pandemic date: 2020-05-28 journal: Dermatol Ther DOI: 10.1111/dth.13472 sha: b97979386a13dd00473ebe5979bfae42b2abe658 doc_id: 717749 cord_uid: 1i9jfvr6 At present, routine dermatology practices stay mostly disrupted worldwide owing to the ongoing COVID‐19 pandemic. However, dermatology services need to be resumed in future and dermatologists especially in developing countries face a mammoth task of devising plans to tackle the upcoming surge of patients while still maintaining the precautions to avoid risk of infection to health care workers and our patients. Teledermatology practice is a viable alternative and there is need of starting functioning teledermatology centers at primary health care centers and training health care workers in telemedicine. Several steps like increasing the working hours of outpatient clinics, posting dermatologists and health staffs in shifts, encouraging online registration and payment, providing time slots to patients should be taken to prevent overcrowding at outpatient departments in hospitals of developing countries like India where the usual patient turnover during summers maybe around 600 to 800 per day. Once diagnosed by the dermatologist, a subsequent meticulous use of teledermatology can limit the number of follow‐up visits. To avoid student gatherings, the undergraduate and postgraduate teaching schedule should be replaced by online or virtual teaching in form of webinars and video conferencing. Above all, intense upgradation of health care infrastructure, recruitment, training of new health care staffs on mass level and huge investment in health care sector is required in all the developing countries. functioning teledermatology centers at primary health care centers and training health care workers in telemedicine. Several steps like increasing the working hours of outpatient clinics, posting dermatologists and health staffs in shifts, encouraging online registration and payment, providing time slots to patients should be taken to prevent overcrowding at outpatient departments in hospitals of developing countries like India where the usual patient turnover during summers maybe around 600 to 800 per day. Once diagnosed by the dermatologist, a subsequent meticulous use of teledermatology can limit the number of follow-up visits. To avoid student gatherings, the undergraduate and postgraduate teaching schedule should be replaced by online or virtual teaching in form of webinars and video conferencing. Above all, intense upgradation of health care infrastructure, recruitment, training of new health care staffs on mass level and huge investment in health care sector is required in all the developing countries. Dermatology practice in shadow of COVID, Changing dermatology practice post COVID. As many of us are still sitting safely in the confines of our homes (thanks to our friends who are fighting the coronavirus disease-2019 (COVID-19) epidemic out there on frontline), the thought of "how things will turn out in future" crosses most of our minds. The present epidemic has halted almost everything around the globe, and we cannot evade the aura of uncertainty that has spread everywhere. Our country is presently under "lockdown." 1 Among all this, as academicians, clinicians, and specialists, we do think intermittently on how are we going to serve our patients and students while maintaining the much coveted "social distancing" till the present pandemic ends forever. Although dermatologists have not been involved in direct care of critically ill and in-patient COVID cases in India, few of us are serving as volunteers at screening and quarantine centers. Amidst an official or virtual lockdown in most of the affected developing countries, routine dermatology services stay mostly disrupted owing to the closure of dermatology outpatient departments in many hospitals (in order to cut down on gathering); turning of dermatology wards into COVID care and quarantine centers; and deploying health care workers for COVID care. Considering the fact that a significant proportion of dermatology patients have ailments which are not life threatening or significantly disabling, these steps are justified seeing the burden and shortages the health care is facing at present. However, if the current pandemic is prolonged which seems quite probable going by the current trends, a majority of our routine dermatology patients will require active intervention eventually. During the quarantine period, there is a risk of exacerbation of various otherwise chronic dermatological disorders, which may cause a rebound increase in outpatient consultation requests to dermatologists after a while. Therefore, we as dermatologists face a mammoth task of devising plans to tackle the upcoming surge of patients while still maintaining the precautions to curtail large outpatient gatherings and social distancing, to avoid risk of infection to health care workers and our patients. To avoid student gatherings, the undergraduate and postgraduate teaching schedule remains suspended or mostly have been replaced by online or virtual teaching in form of webinars and video conferencing. 4 The traditional classroom examination is being substituted by online examinations. The practical examinations are also being conducted on videoconferencing where real patients are being replaced by virtual case scenarios and images. All these steps although may marginally affect the quality of academics, but are quite justified seeing the risks of large student gatherings in terms of transmission of COVID-19 especially to frontline health care workers. Although the above-mentioned measures may sound cumbersome and inconvenient, we should acknowledge the fact that they have to be implemented in the long run and would be the new "normal." Implementing the above-mentioned measures will also require intense upgradation of health care infrastructure, recruitment, and training of new health care staffs on mass level and huge investment in health care throughout the world. In most of the developing countries like India, governments spend a meager 1% to 2 % of GDP on health care despite the WHO recommendation of 5%. 5 As we say crisis is a great teacher, there are several lessons to be learnt from the current COVID pandemic. Questionnaire to screen for COVID-19 cases at dermatology outpatient clinics Have you or your family members been in contact with a known COVID-19 patient in last 14 days? Do you or your family members have a history of foreign travel in last 14 days? Are you a health care worker? Covid-19: India imposes lockdown for 21 days and cases rise Telehealth: helping your patients and practice survive and thrive during the COVID-19 crisis with rapid quality implementation Rational hand hygiene during COVID-19 pandemic Medical education during pandemics: a UKperspective Changing paradigms of dermatology practice in developing nations in the shadow of COVID-19: Lessons learnt from the pandemic The authors declare no conflicts of interest.