Rescheduling of clinical activities and teleconsulting for public dermatology. Two prompt answers to COVID‐19 emergency

Dear Editor,

On February 20, 2020, after a dramatic spread across China, the novel coronavirus, recently named SARS‐CoV‐2, determined the first autochthonous case of COVID‐19 in a village in Northern Italy. ¹ At the time of the writing of this letter, 135,586 confirmed cases in Italy have been diagnosed and over 17,000 patients have died. ² To date, the Italian government started a program of progressive restrictions in the whole country up to a complete lockdown from mid‐March. People can access hospitals only with a medical prescription that allows to pass police checkpoints. All Italian hospitals are taking measures to control the nosocomial spread of the novel coronavirus and to maintain all current standard care for patients with clinical conditions other than COVID‐19. In addition, in dermatological departments, the risk of nosocomial transmission from asymptomatic‐infected patients has been highlighted, where the awareness of protective facilities is generally scarce and skin lesions can play a role in the indirect transmission of the virus. ³

On March 20, 2020, the San Gallicano Dermatological Institute of Rome, a historical public dermatological hospital, revised the planning of all care activities to drastically reduce the flow of outpatients across its different facilities, laboratories, and surgery units. Furthermore, in order to assure physical distancing, a considerable number of waiting chairs have been made unavailable in clinical areas.

The walls of the halls, meeting points, wards, and waiting rooms were used to place the point‐by‐point recommendations on COVID‐19 prevention that have been disseminated by the National Health Authorities.

In the meantime, all nonurgent outpatient visits, such as those for cosmetic procedures, non‐acute allergological conditions, acne, and chronic skin disorders, have been postponed or cancelled. All the dermatologists, nurses, and other health operators are now required to wear protective suits, masks, and gloves during current clinical procedures also in accordance with the SIDEMAST (Società Italiana di Dermatologia e Malattie Sessualmente Trasmissibili) recommendations regarding the coronavirus emergency. ⁴

In the STI Centre, the screening activities for sexually transmitted infections (STIs) have been temporarily suspended to limit the stay of attendees in the waiting and consultation rooms. Only scheduled visits for ongoing clinical trials have been guaranteed and conducted according to the strict norms for environmental control of droplet transmission of the Sars‐CoV‐2.

According to the recommendations of Chinese specialists, ⁵ , ⁶ during the last week, two pre‐triage stations have been arranged at the main entrances of the Institute, where all attendees are scanned for signs of fever with thermometer guns and undergo a brief epidemiological interview.

At this moment, serological screening for antibodies against SARS‐CoV‐2 targeted at all healthcare workers and selected groups of patients (i.e.; patients with autoimmune disorders, HIV‐1 infected individuals) has been launched.

Additionally, a WEB platform for teledermatology has been organized to respond to the consultation needs of external patients with mild and nonemergency dermatological conditions. ⁷ , ⁸ The procedures to access this teleconsulting were promptly explained on the Institutional website and radio and TV advertisements. The system is based on an asynchronous contact process between patient and dermatologist. The response by the staff of the Institute is assured within 24 hours of the call.

We hope that in our dermatological Institute, the above‐mentioned strategies can contribute to contrast the nosocomial spread of COVID‐19 in Central Italy, and in the meantime, ensure that patients with dermatological disorders of different severity can receive the appropriate management and treatment that they would have received in the absence of the COVID‐19 epidemic. We are aware that the strategies presented here are far from perfect and that because of the uncertain evolution of the epidemic, they could be modified in real time.