Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, is a new strain of coronavirus that has not been previously identified in humans and is thought to have originated in chrysanthemum bats in Wuhan City, Hubei province.1,2 Since December 2019, when Chinese public health authorities noticed several cases of acute respiratory syndrome in Wuhan City, SARS-CoV-2 outbreaks and clusters of the disease have since been observed in Asia, Europe, Australia, Africa, and the Americas and WHO declared a pandemic on March 11, 2020.
SARS-CoV-2 is now recognized as a highly contagious respiratory virus SARS-CoV-2 has multiple clinical presentations from asymptomatic to severe lung injury and multiorgan disease, especially in older individuals and those with chronic comorbidities. This polyhedric presentation makes it difficult to predict which health consequence the virus will have on the single individual and make it challenging to contain the spread.3,4
Being a novel disease, everyone is susceptible, there are no vaccine and no treatment. To contain the spread of the disease, while developing treatment, vaccine, and hospital/health care preparedness, health authorities throughout the world have restricted social interactions of individuals in various degrees. Typically, the most restrictive measures are taken in the “red zone” or “Phase 1” when full quarantine measures are recommended for all citizens. In such a phase, only life-sustaining businesses are open, schools are closed, and there are government-imposed social distancing rules. These extreme mitigation strategies are followed by a progressive reopening approach with different phases like “orange zone”, “yellow zone” “green zone” or phase 2, 3 etc. that ease the restrictions as the virus becomes less prevalent in the community and health care systems are more prepared to treat the infected individuals (Figure 1).5
Allergists, like other physicians, face the challenge of providing care for their patients while protecting themselves and patients from getting infected. To achieve this goal, they use tactics that are in continuous evolution, adjusting work practices to State-mandated restriction, without clear guidelines but largely guided by fragmented recommendations given by local, national, and international organizations.6
Allergists provide care for patients with the most common non-communicable disease in the world: asthma, allergic rhinitis, food allergy, venom allergy, drug allergy atopic dermatitis, and urticarial. Some of these diseases are not only considered risk factors for severe reactions but also have symptoms, like cough and sneezing, that are in differential diagnosis with Covid-19. Taking care of the atopic patients is therefore essential not only to reduce severe outcomes if patients get infected with COVID-19, but also to prevent symptoms that may preclude allergy patients from working, go to school or access medical services if they are suspected of having COVID-19. To take care of those patients, allergists use procedures that require close contact with patients and can aerosolize the virus, and many therapeutic approaches that modulate the immune system. Risk and benefit for the single patients and the staff need to be carefully evaluated before doing them.6,7