Q&A with Paul V. Williams, MD, FAAAAI, and Frank S. Virant, MD, FAAAAI

AAAAI Board Members and Practicing Allergists with Northwest Asthma and Allergy Center in Washington StatePaul V. Williams, MD, FAAAAIFrank S. Virant, MD FAAAAI

What are you telling patients who are contacting your allergy office saying they have symptoms consistent with COVID-19?
This is really an evolving situation. We were referring patients with symptoms consistent with COVID-19 to the local health department hotline, but this has changed as more testing becomes available. It depends on their primary care provider to some extent, and some local hospitals have set up respiratory clinics where they can be tested. We are starting to see drive-through testing sites, but there are restrictions for those. All of these patients are referred for a phone or virtual telemedicine visit. If the symptoms indicate a need for emergency care, they are referred to the ER.

How are you approaching dealing with patients who are simply coming in for scheduled visits, in light of the situation with COVID-19?
For patients that are scheduled to come into the office for shots or biologic injections, they are called ahead of time and told not to come into the office if they have a fever and/or respiratory symptoms. Patients who arrive at the office who haven’t been screened over the phone are asked if they have any respiratory symptoms or been exposed at home to anyone with respiratory symptoms, and all have their temperature taken at the door. If febrile, they are sent home. If they have a cough but no fever, and screening does not suggest COVID-19, they are given a mask to wear.

We are having our patient service representatives call any scheduled patient the day before and they initiate primary screening for cough, fever, chills, shortness of breath, etc. This will continue for another 3 weeks until everything will be caught up with telemedicine screening visits. 

So are you implementing telemedicine under the circumstances?
Beginning Monday, March 16, all visits will be virtual, but offices will remain open for oral food challenges for those who pass screening, and for allergy shots or biologic shots for those who pass screening. Patients, after the initial telemedicine visit, can be scheduled to come in for testing.

Have you implemented any social distancing measures in your waiting room?
We are practicing social distancing in our waiting room, and if the numbers don’t allow that, we may start asking shot patients to schedule a time. We have rearranged our waiting rooms to "force" seating 6 feet apart, and requested that immunotherapy patients try to come alone versus bringing several family members. We have also switched chairs from cloth to plastic, which we normally have in exam rooms as they are more easily cleaned. Switching most visits to telemedicine also further decreases waiting room density.

What should we be telling our patients with asthma? Should we forego spirometry, and for how long?
This is a tough question. Spirometry and use of a nebulizer are considered aerosol-generating procedures and should not be used in any individual who may have symptoms consistent with COVID-19. We will consider performing these tests on a case-to-case basis, understanding that patients without symptoms may be contagious.


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