key: cord-0883738-8ksu9pyf
authors: Williams, Paul V; Stukus, David R; Virant, Frank S; Bansal, Priya
title: Have the Rules of Engagement Changed? Clinic Visits in 2022 and Beyond
date: 2021-09-02
journal: Ann Allergy Asthma Immunol
DOI: 10.1016/j.anai.2021.08.414
sha: 002108fea5a6b518c740c991478f3bb6761adfba
doc_id: 883738
cord_uid: 8ksu9pyf

nan

The SARS-CoV-2 pandemic has demanded changes in the asthma/allergy practice including staff administration, office layout, patient interactions, care provision and procedures 1,2 . Control of viral disease and transmission via vaccination may allow for a return to more normal practice, but in reality, with the emergence of new viral variants, it is unlikely that COVID-19 will entirely disappear. (Authors note to reader: This Perspective was written in July 2021, so please forgive any inaccuracies in our predictive capabilities) At the same time, necessary adaptation during the pandemic with telemedicine, in-office infectious disease modifications and vaccination could facilitate not only a return to pre-COVID patient flow or even practice expansion. This pandemic has taught us that identifying the viral etiology for acute exacerbations, particularly for our patients with allergic rhinitis and asthma who often have similar symptoms, is important for therapeutic and prognostic reasons. While offices were forced to adopt rapid mitigation efforts at the start of the pandemic, we now have the benefit of experience and valuable information make better informed decisions. What office changes will remain in 2022 and what can we eliminate? The discussion which follows assumes that vaccination will be available for all ages in 2022, and that COVID-19 will continue to cause seasonal infections, although hopefully less prevalent and severe.

Staff: Liberal sick leave policies that encourage sick employees to remain at home when acutely ill with paid time off should remain a standard part of practice. Adequate personal protective equipment (PPE) for staff should be readily available and policies for use should remain. Effective contact tracing procedures should remain intact. Special attention to address staff burnout should remain a priority. Strong encouragement for staff vaccination will remain important in the future.

Structural Changes: Physical distancing was a major challenge in limiting patient visits and immunotherapy administration. Improvement in ventilation to maximize air exchange, use of high efficiency particulate air (HEPA) filters and perhaps separate waiting areas for vaccinated or unvaccinated, ill or well patients could be considered to enable a return to more normal patient volume and immunotherapy schedules. Immunotherapy scheduling versus walkin may also continue to be used to assist with practice flow and distancing. 

Allergists are equipped to assist patient decision making about a variety of chronic medical conditions. 4 This is even more the case with COVID-19, where the allergist/immunologist is the best specialist to help patients understand key elements essential to viral transmission, personal risk, and risks/benefits of vaccines, and correct dys/misinformation related to the disease and immunization . We can continue to be an important resource for our own patients, the general public, and media moving forward.

Most allergy practices suffered significant financial losses during the pandemic, but the response and adjustments that were made allowed for the introduction of new tools and approaches that will likely improve patient care and physician satisfaction in the future. Table I summarizes key areas of adaptation during the pandemic that will likely continue in some capacity moving forward. Special precautions will need to continue in those who are not vaccinated and in anyone who presents with symptoms consistent with infection. Evolving rapid, sensitive and specific point-of-care antigen tests can help clarify infectious etiology and guide specific therapies and precautions. We have collectively learned how to provide high level care to our patients while also decreasing risk for spread of infection within our facilities. None of us knows how long we will need to contend with SARS-CoV-2 or when the next pandemic may occur. While the rules of engagement may have changed, we're still here to help patients and will continue to do so regardless of what the future holds.  Alterations based upon patient vaccination status  Sensitive point-of-care rapid antigen testing prior to aerosol generating procedures  Alter safety protocols based upon community transmission Shared decision making  Proactive discussion with patients and the general public regarding risks and benefits of vaccination  Ongoing efforts to acknowledge areas of knowledge gaps  Focus on decision making process rather than outcomes

COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic

A Phased Approach to Resuming Suspended Allergy/Immunology Clinical Services

Patient Satisfaction with In-Person, Video, and Telephone Allergy/Immunology Evaluations During the COVID-19 Pandemic

Shared decision making for the allergist