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