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COVID-19 Update

To our dear patients,

Over the past week, we have kept you abreast of our contingency plans to grapple with the health risks of COVID-19 while doing our best to keep our practice functioning.

Unfortunately, over the last few days, there has been a significant uptick in the number of people in the surrounding region infected with the virus and admitted to local hospitals. This is already creating some strains in the medical system. There has also been a significant delay in access to testing and the availability of protective equipment for health care providers.

Given these circumstances, there will likely be a rapid and possibly logarithmic rise in community-acquired infections over the next few weeks in NYC and surrounding areas.

Other countries in Asia and Europe have already instituted draconian measures including social distancing and quarantining to curb the rate of new infections.

As a practice managing patients with allergic and respiratory issues coming into the allergy season, there is an inherent logistical difficulty in adequately screening patients who may have overlapping symptoms, or be contagious but not actively symptomatic.

Additionally, given our waiting-room layout, it will be difficult to guarantee an adequate degree of social distancing (at least a 6-foot zone) to reduce the likelihood of infection spread.

As such, we have decided to take the following steps to ensure the health and safety of our patients and staff:

  • For the next few weeks, we will be transitioning all New and Follow-up appointments to Telemedicine visits. These visits are covered by commercial insurances and can be set-up as an appointment with our receptionists. Please see below and on our website for further information.
  • Since the CDC strongly recommends social distancing as an important approach to reducing the rate of infection spread, we will temporarily pause the administration of immunotherapy in the office.
  • To allow the continuation of your immunotherapy, existing allergy shot patients will be given the option of transitioning temporarily to sublingual immunotherapy (SLIT) which can be self-administered at home. Please be reassured that, in almost all cases, any ground lost can be recovered without long-term impact on your treatment.
  • For patients on biologic agents (e.g. Xolair, Nucala, Fasenra), please call the office for additional instructions.
  • For those interested in more detailed information, please refer to our website: www.allergyexperts.com

We recognize this may feel like a significant sacrifice, but this is a time for everyone to help each other out as much as possible.

As always, we will do our utmost to keep you abreast of developments. We appreciate your patience and cooperation through this difficult time. We welcome your comments and suggestions to ensure that we deliver the best and safest care possible during this period.
Be safe and well,

Dr. Lighvani and the entire team at Allergy Experts

Additional Information:

  • Telemedicine visits through DOXY.ME which is covered by commercial insurances.
  • Refill requests and non-emergent brief questions through the smartphone app QuireME (Find jtoh387 for Dr. Jennifer Toh OR plomb653 for PA Patti Lombardi) — $10/refill request; $25/brief medical question.
  • Please email billing@allergyexperts.com for any billing inquiries.

 

Covid 19 Update March 13, 2020

We would like to take this opportunity to provide you with some information with regards to our office preparedness and the new Coronavirus (COVID-19). While the clear majority of COVID-19 cases have led to flu-like symptoms and resolve in 2-3 weeks, it is prudent to be proactive and very aggressive in preventing infection. Mortality rates are being updated but The WHO released an estimate of 3.4% overall mortality, though China reports under 2% and South Korea reported only 0.5% mortality. Mortality in those over 70 looks to be 8%, and for those over 80, it is approaching 15%. While low on an absolute basis, these numbers indicate that this is much worse than a particularly severe influenza.

Our most serious concern is for people who are immunocompromised or suffer from other serious health problems.  To ensure our patients can be seen in the healthiest and safest possible environment, If you have had a fever or flu-like symptoms in the past 2 weeks; you or someone with whom you’ve had close contact, has recently traveled to a CDC Level 2 or higher Country (e.g., China, Iran, Italy, South Korea or Japan), we ask that you DO NOT attend the office for your appointment or allergy shots. Call our front desk and we will be happy to provide you with a new appointment.

    • For NYC patients:  Call the NYC Health Department  866-692-3641  
    • For NYS patients: Call your specific county Health Department  https://www.nysacho.org/directory/
    • Patients who meet the criteria for testing may be referred to the Weill Cornell ED for testing.  Please give us the heads up so that we can plan and anticipate their arrival.  (212)-746-3300. 

Criteria for consideration of testing are:

  1. [Respiratory signs and symptoms / Fever] + [Close Exposure to a known / documented case].
  2. [Respiratory signs and symptoms requiring hospitalization] + [Travel to a country of concern (Japan, S. Korea, Italy, China, Iran)]
  3. Severe respiratory disease / ARDS / complicated pneumonia – regardless of contact or travel history
  4. Testing is determined by the DOH.  Therefore, it is possible that not all patients who meet the above criteria will be tested. This information is changing rapidly!

Below are a few updated guidelines for personal preparedness:
Exposure: Operate under the assumption that someone around you at all times is infected by the virus. It is not an airborne virus ー you’re not going to get it from someone 100 feet away from you via the wind ー but it is a respiratory virus, and you can get it by touching something an infected person touched or coughed on. Diligent hand washing, avoidance of touching objects in public places that you don’t need to touch, and minimizing (your own) face touching can’t hurt. Counterintuitively, some epidemiologists even caution against face masks due to the constant touching and readjustment of the mask providing opportunities for hand-to-face transmission.

Testing: Suspected cases need to be reported to the CDC. Testing kits are still not widely available and cannot be done “just to make sure.” If you have reason to believe you or someone you know has the infection, contact your primary care physician or local hospital. At this time we do not have any test kits or N95 masks available in the office.

Travel: If you are not comfortable with the prospect of contracting the virus, international travel to areas with a confirmed outbreak is not advised. Using international transit hubs out of NYC or LA is also not zero risk. If the CDC and U.S. government are able to track down and contain the current outbreaks, this may change within 2 to 3 weeks; however, there are too many unknowns to give any level of confidence currently.

Treatment: Far and away the most important consideration for treatment is access to supportive care through a hospital. There is no updated data on the effectiveness of antiviral or antimalarial therapies, as detailed in our previous guidance.

Supply: We don’t anticipate true food shortages, though short term clearing of supermarket shelves will be likely in affected areas and having 1 to 2 weeks’ worth of non-perishable food at hand is advisable. You should also have at minimum a 30-day supply of any essential medications.

We will continue to closely monitor all aspects of the COVID-19 situation, and will update any changes on our website.

Additional Resources:

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