Mariam Hanna, MD
It’s pollen season and I don’t think anyone cares. Stories of seasonal allergies are usually abundant at this time of year. It’s awkward not discussing COVID19 and those impacted by the pandemic – essentially everyone. So while travel plans are cancelled, school is on hold and the economy is on a roller coaster – spring is coming as scheduled. I thought I would share a glimpse into allergy clinics right now. As is everything with the pandemic, this picture could rapidly change over the coming weeks.
About 10 days ago, it became clear that COVID19 was inching its way closer to our community. We had planned an office shut down for the week to attend the American Academy of Allergy and Immunology meeting and for March break. Then the American Academy meeting was cancelled only days before it was set to take place. Feelings of confusion and frustration were echoed throughout social media at the weeks of preparation that had occurred for this meeting to suddenly vanish.
That Thursday, as the staff and physicians parted ways feelings of anxiety loomed. Stock up and stay home was the message we all said. Enjoy a much-needed rest and recharge with family.
I am not a politician; so I make no apologies for saying this: this pandemic is not going away in a couple weeks for the time being, this physical and social distancing will become the new norm. While I would love the miracle cure, and the news flashes about off-label malaria, cancer, and AIDS drugs are intriguing, a treatment is likely months away and a vaccine over a year away.
So, like every part of our society, the allergy clinic has needed to adjust. Let’s face it, patients still need us but we need to maintain social distancing. Early on, we have made a controversial decision to offer entirely virtual care for consultations and follow ups during the anticipated peak of this pandemic. Any patients that at the initial assessment were deemed unstable or concerning were referred to public health for further evaluation.
There is a challenging realization when you restructure every part of your normal practice and objective testing because of a pandemic. After quickly coming to the realization, and the need for social distancing both for patient and healthcare safety, I set about during my March break, restructuring our office platform, patient and staff scheduling, website update and learned all about telemedicine. Many of my colleagues have known about the advantages of telemedicine for years. I am gracious that in my province, a billing code was quickly adopted in the middle of March to allow physicians to continue to care for our patients without the need of in office assessments.
It’s an interesting transition to virtual care when we consider that our specialty is frequently sought for the testing it does. Namely, skin testing, spirometry and oral challenges. These are the mainstay procedures of allergy. However, allergists have finely developed deductive reasoning. We generally use tests to confirm what we already suspect based on detailed medical history, not reveal the unknown. We don’t do broad panels of tests as primary care physicians do, resulting in panicky dietary restrictions. I have many patients that at this point, would prefer to wait for COVID19 testing to be done and decline speaking to the physician. To them, my message is the same – a virtual consultation with a specialist can give essential first steps for families to take.
Early in my medical training during our “art of medicine” lectures, it was ingrained in me that much of your diagnosis can be made thorough history. Ancillary testing, for many patients, only further supports the physician’s clinical suspicion. I think it’s essential for the public to hear that the clinical history, can hold so much of the answer!
This is true for societies, for nations, as it is for patients. The clinical history of what was happening an ocean away since January was largely dismissed until it appeared on home turf. I still hear stories of those that believe this is being blown out of proportion, in Canada as well as in the United States. Oh how I wish it were the case that we had all listened! Somehow, in my mind I think it would be easier if COVID19 had cutaneous manifestations. The inner allergist in me will tell you that for many people, seeing is believing, and that rash is easier to convince people. We have examples of this from prior years past: smallpox, measles, polio – people saw it, and it was perhaps easier to believe.
I think we will adjust, but I know it will be hard. It’s hard for me to do a consultation without my usual toolbox that I have trained for years at using. There is a huge psychological component to being able to see the person, hear their story and provide reassurance and guidance. COVID 19 robbed us all of certainty in many aspects in our daily lives. The diseases dealt with in my specialty, invoke a lot of anxiety in patients and parents alike. The mental burden of these illnesses was for many years poorly recognized but is now increasingly discussed. While I am unable to offer my usual tools, learning and understanding disease processes and mechanisms by which treatments work provides a lot of reassurance to my families. During this time with so much unknown, I find that virtual consultations provide a framework for families to more stable footing until we know the exact path to take.
I don’t think it would be fair to submit such an article without at least telling you about what I worry about these days. Health, and safety, and sustainability are the three big pillars that go on in my mind. Health for my patients, family and friends, their ongoing safety, and sustainability of physical/social distancing and isolation within these four walls. My daughter asks me, when will we go on holiday, we build a fort, dim the lights and tell campfire stories until these can be replaced with a crisp breeze, sounds of water, and warm sunshine.
I will end with the new societal salutation – Stay safe, and stay healthy!
Dr. Hanna is a Pediatric Allergy, Asthma and Immunology Specialist. She is a graduate of the University of Alberta, Canada where she obtained her MD degree and completed her post graduate training in general pediatrics. She completed her allergy and immunology fellowship at McMaster University, Ontario, Canada and is a fellow of the Canadian Society of Allergy and Clinical Immunology. Dr. Hanna is an Assistant Clinical Professor in the Department of Pediatrics at McMaster University. She is co-founder of Halton Pediatric Allergy Clinic. Her interests include early childhood allergy prevention, aeroallergen immunotherapy and oral food immunotherapy. Dr Hanna has focused her clinical practice at Halton Pediatric Allergy towards accurate diagnostics and management of food allergy.