Clinical Dermatology Review

DERMATOLOGY PRACTICE DURING COVID-19 PANDEMIC - EDITORIAL
Year
: 2021  |  Volume : 5  |  Issue : 1  |  Page : 1--2

Preparedness of dermatologists in disaster management: Learning from present for the future


Ragunatha Shivanna 
 Department of Dermatology, Venereology and Leprosy, ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India

Correspondence Address:
Ragunatha Shivanna
Department of Dermatology, Venereology and Leprosy, ESIC Medical College and PGIMSR, Rajajinagar, Bengaluru - 560 010, Karnataka
India




How to cite this article:
Shivanna R. Preparedness of dermatologists in disaster management: Learning from present for the future.Clin Dermatol Rev 2021;5:1-2


How to cite this URL:
Shivanna R. Preparedness of dermatologists in disaster management: Learning from present for the future. Clin Dermatol Rev [serial online] 2021 [cited 2021 May 11 ];5:1-2
Available from: https://www.cdriadvlkn.org/text.asp?2021/5/1/1/309758


Full Text



Unexpected occurrence of pandemics and natural disasters brings along with them both short-term and long-term health consequences, in a way, testing the efficiency of healthcare system. Successful management of pandemic requires meticulous planning and perfect execution. Availability of authentic scientific data on the pandemic is crucial for designing, preparing, and implementing remedial measures. The window of opportunity in such situations is very short and quick action is required to control the damage. In normal circumstances, our healthcare system is capable of managing health-related needs of the country, with the availability of competent healthcare professionals and state-of-the-art facilities. However, the sheer number of unexpected casualties requiring critical care during COVID-19 pandemic can overwhelm any healthcare system in terms of workforce, infrastructure, and equipment. The main objectives of healthcare system in the setting of pandemics such as COVID-19 are decreasing the acute burden on the health services, protection of population at risk of severe diseases, and reduction of excess mortality. Reinforcing capacity of healthcare systems for diagnosis and management of patients should be the primary priority.[1] Hence, it is the survival of well prepared that counts rather than the survival of the fittest.

 Challenges



Dermatology healthcare services

As the health services are categorized under essential services, the dermatologists are expected to continue the consultation of patients with dermatological diseases. In such situation where strict adherence to social distancing is recommended, the management of patient appointment is very challenging in terms of human resource, infrastructure, and equipment.

Managing dermatological diseases

Treatment of primary dermatological disorders requiring long-term immunosuppressant therapy is challenging as the immunosuppression increases the risk of severe COVID-19 infection, resulting in significant morbidity and mortality. Sufficient scientific evidence is also required to make decisions about initiation and continuation of immunosuppressant drugs for the treatment of skin diseases.

COVID-19–related skin lesions

Like any other viral infections, the patients with COVID-19 infection may present with various types of skin lesions.[2] Not only identifying but also recognizing their significance in the diagnosis and prognosis of the disease is very important.

Role in COVID-19 pandemic

In normal circumstances, the dermatologists are involved in taking care of patients with skin diseases attending any healthcare facility. However, during the situations like COVID-19 pandemic, the healthcare facilities require reinforcement of doctors for the management of increased number of patients. The dermatologists may be asked to join hands with other specialists in taking care of nondermatological cases. Sometimes, the dermatologists may be assigned to supervise the screening area, triage area, or wards which are set up as a part of COVID-19 management protocols.

Teaching and learning

The best way of teaching and learning is hand-on training with teachers and patients. However, in the current situation of COVID-19 pandemic, it is not possible to follow conventional teaching methods. The rapid dissemination of knowledge related to COVID-19 infection and management of primary skin diseases as and they are gained is more crucial than ever before for evidence-based patient care. Continuing medical education and assessment of undergraduate (UG) and postgraduate (PG) students through conventional methods are not possible in the current scenario. Any new methods recommended for the purpose need to be validated and approved by the governing authorities.

 Preparedness



Dermatology healthcare services

The primary objective in any pandemic is the prevention of transmission of infection. It can be achieved by strict implementation of infection prevention protocols. The necessary infrastructure, equipment, and resources should be made available, and the necessary protocols should be followed routinely in the dermatology clinics, irrespective of presence or absence of pandemic. The telemedicine technology can be used for consultation. Being a visual specialty, the dermatology practice is best suited for telemedicine. Various challenges related to managing dermatology clinic during the COVID-19 pandemic can be overcome by following the guidelines provided by concerned government authorities. Restoring the dermatology services once the pandemic is over is another big challenge for dermatologists.

Managing dermatological diseases

The management of skin diseases during pandemic like COVID-19 requires careful analysis of the situation with regard to nature of skin disease, severity of COVID-19 infection, and effect of skin diseases and their treatments on outcome of COVID-19 infection. The risk and benefit ratio needs to be considered when there are no guidelines or valid scientific evidence is available for the management of skin diseases. A protocol with step-wise approach needs to be prepared based on our current experience in case we may face with similar situation in the future.

COVID-19–related skin lesions

The exanthematous cutaneous changes spontaneously resolve and only require symptomatic treatment. However, understanding relevance and significance of cutaneous manifestations as diagnostic and/or prognostic markers of COVID-19 is very important. This can only be achieved with research study with robust study design. Keeping research protocols ready and implementing them immediately when such pandemics occur will generate the scientific evidence within a short period.

Role in COVID-19 pandemic

Acquisition of additional knowledge and skills is necessary for dermatologists to work in a team involved in the prevention and management of COVID-19 infection and similar disasters. Training in disaster management is essential which can be taught as part of curriculum during UG and PG course and thereafter as regular refresher course. This will ensure a reserve workforce to be utilized for the management of health-related problems arising from any kind of disasters.

Teaching and learning

Never been in the history of humanity, thousands of people who are thousands of miles away can be reached with just a click of a button. There are several online platforms, with teaching and learning tools incorporated, are available for communication. These platforms can be used effectively and efficiently for sharing of knowledge among colleagues, contemporaries, and students. Anticipation of future scenario at the beginning of the pandemic in relation to medical education and assessment is crucial for the concerned authorities to develop valid and feasible teaching methods. Many universities have recommended online teaching for UG students. Similarly, virtual examinations have been conducted for final assessment PG training.[3] However, availability of logistics to every students for online classes or virtual examination is a concern.

The current pandemic is first of its kind for many of us. We are exposed to many challenges and loopholes in the healthcare system. The current COVID-19 pandemic is not the last one, in future; we will definitely witness many more pandemic or natural disasters bringing suffering and damages which may vary in terms of volume, nature, severity, and impact. Based on our present experiences, we must anticipate the challenges and keep the preventive measures on standby so that any major damages can be successfully averted.

References

1World Health Organization?. Responding to Community Spread of COVID-19: Interim Guidance; 07 March, 2020. Geneva: World Health Organization; 2020. Available from: https://apps.who.int/iris/handle/10665/331421. [Last accessed on 30 Dec 2020].
2Galván Casas C, Català A, Carretero Hernández G, Rodríguez-Jiménez P, Fernández-Nieto D, Rodríguez-Villa Lario A, et al. Classification of the cutaneous manifestations of COVID-19: A rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 2020;183:71-7.
3Guidelines for Conducting of PG Examination; July, 2020. Available from: https://www.rguhs.ac.in/Exam/2020/Guidelines%20for%20conducting%20of%20PG%20examinaiton%20-%20July%202020.pdf. [Last acces?sed on 2020 Jul 30].