Table I.

Challenges and solutions in the urban academic allergy and immunology division in response to the COVID-19 pandemic

Domains	Challenges	Solutions
Clinical	•Social distancing (including reducing exposure in outpatient clinic and reducing need to round on inpatient consults with large team of fellows, residents, and students)	•Converted all nonurgent in-person clinic visits to virtual (with video) or telephone visit •All inpatient consults triaged for need for physical examination and risk of exposure to coronavirus; physical examination was not done if unnecessary. Discussion rounds were done virtually. Group rounds at patient rooms were avoided
	•New virtual/telephone visit model	•Rapid training of faculty and fellows on virtual/telephone visits
	•Increased telephone calls from patients concerned about possible COVID-19	•Nurses and fellows created phone call pools through a new triaged algorithm •Faculty volunteered at special COVID-19 virtual visits at hospital level
	•Staffing and nursing shortage due to surge	•Stopped all visits at central clinic •Moved any urgent visit to 1 satellite location
	•Need for coronavirus-specific patient communication (eg, letters, work-from-home excuse, coronavirus symptoms, and risk stratification)	•Standardized letters describing symptoms and when patients should call the COVID-19 hotline •Generated COVID-19–specific letters
	•Biologic medications administration	•Except omalizumab and few cases with disabilities, all other biologics were given at home. Moved all biological injections to 1 satellite location
	•Allergen immunotherapy (IT)	•Halted all IT in accordance with AAAAI guidelines for 4 wk •Created IT restart plans for interested individuals, with lowest possible frequency. Plans were discussed with patients over the phone
Educational	•Minimizing fellow exposure	•Converted all educational meetings to Web-based meetings
	•Staying current on COVID-19 literature	•Expanded journal club and staff meetings •Expanded case conference
	•Added complexity of fellows schedule in response to increased educational activities and redeployment	•Shared calendar
	•Anticipating future COVID-19 challenges	•Frequent discussions with program directors of Allergy/Immunology
Research	•Patient recruitment	•Temporary suspension of all research recruitments •Efforts were focused on completing information and chart reviews •Expedited IRB amendments to switch consenting and follow-up visits to virtual and Web-based questionnaires
	•Basic science research	•Temporary halt of previous experiments •Research lab members who were interested got involved in new studies related to COVID-19 experiments by other labs or volunteered in the clinical laboratory
Hospital and community	•Need for volunteers on the COVID-19 hotline •Increased need for inpatient coverage for COVID-19 surge	•Faculty volunteered to screen concerned patients for COVID-19 •Nurses volunteers in various COVID-19 testing areas •All providers were added to hospital surge lists for COVID-19

AAAAI, American Academy of Allergy, Asthma & Immunology; IRB, institutional review board; lab, laboratory.