From the Desk of the EMD: COVID-19 and the allergist

March 2, 2020

During a recent haircut, my barber, who knows I’m a physician, wanted to know about the coronavirus and what she should do. She was hoping that the extra vitamin C she took that morning would help prevent infection. She wanted to know what she could do to boost her immune system. Should she be wearing a mask? I bet you have had patients asking you about this probable pandemic, too. There are lots of rumors spreading out there about COVID-19, which raises alarm in the community. Of course, I am not an infectious disease specialist, but as an allergist, I should still be able to answer some basic questions and help patients by giving reasonable, scientific answers.

The best up-to-date source on information related to COVID-19 is the CDC website. Here are some points gleaned from this website and others that I believe will help with what the allergist should know.

How do you get COVID-19 and how contagious is it?

All the data so far suggest that the spread is by respiratory droplets when an infected patient coughs or sneezes, and by touching an object that has the virus on it and then touching your mouth, nose, or eyes. At this time, it is thought that with this virus, for every one person infected, 2.5 people will catch the disease. You can compare this to measles, with 12 to 18 unvaccinated people getting it from one infected person. COVID-19 appears to be about as contagious as what was seen with SARS, though SARS never spread worldwide.

What are the symptoms and death rate?

Severity has ranged from asymptomatic to severe disease and death. Symptoms usually are in the pulmonary category with fever, cough, and shortness of breath. On CT scan, the hallmarks of COVID-19 infection are bilateral and peripheral ground-glass and consolidative pulmonary opacities. GI symptoms such as diarrhea are also reported. The CDC believes at this time that symptoms may appear in as few as two days or as long as 14 days after exposure. The death rate has been estimated at 2.3% of confirmed cases, but with some infected patients showing no symptoms, the true number is probably lower.

What about treatment and prevention?

Presently there is no vaccine for this virus, though work is moving quickly. An NIH clinical trial with Remdesivir, a nucleotide analog with broad-spectrum antiviral activity, is starting in Nebraska. Also, there is some suggestion that chloroquine, an old malaria drug, may be efficacious.

We all know the basic protection methods for all viruses which, of course, apply to COVID-19:

  1. Frequent and thorough washing of hands with soap or an alcohol-based hand sanitizer.
  2. Avoid people who are coughing and sneezing – keep 3 feet away.
  3. Cover your cough with the bend of the elbow.
  4. Avoid touching nose, eyes, and throat.
  5. Fist bump instead of handshake.

Should I wear a face mask?

The WHO states that you should only use a mask if you have respiratory symptoms, have suspected COVID-19, or are caring for someone with COVID-19 infection. At least at this time, it is rare that anyone in the U.S. needs to wear a face mask.

What infection control procedures do I need to implement in my allergy office?

According to the CDC, when scheduling appointments, instruct patients and people who accompany them to call ahead or inform your office upon arrival if they have symptoms of any respiratory infection (e.g., cough, runny nose, fever) and to take appropriate preventive actions (e.g., wear a facemask upon entry to contain cough, follow triage procedures). Take steps to ensure that all persons with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit. If you believe you have a patient with suspected COVID-19, contact your local department of public health.

What if I am supposed to travel out of the country soon?

The CDC frequently updates countries that have precautions for travel related to COVID-19. As of February 29, if your plans include China, Iran, Italy and South Korea, you should avoid all nonessential travel. If you plan to travel to Japan, practice enhanced precautions.

The College has an informational COVID-19 webpage with links to our recent COVID-19 webinar, the WHO and CDC. With the media covering COVID-19 constantly, it can be very frightening for our patients. It’s important that we, as allergists, be a source of clear and valid information as this infection spreads. We can be a calming, reassuring voice to our patients.

Michael Blaiss, MD, FACAAI, Executive Medical Director