On April 6, 2020, the number of confirmed cases of the coronavirus (COVID-19) was 338,995 in the United States. In New York City alone, 67,551 cases have been diagnosed and 3,048 deaths were attributed to the virus.1 As one of the many epicenters of the coronavirus pandemic in the US, New York City is experiencing a strain on its health care resources for first responders and emergency workers who are on the front lines of this pandemic.
Bobby Buka, MD, co-founder of The Dermatology Specialists in New York City, is one of many dermatologists working in the middle of these epicenters. He spoke with The Dermatologist about the coronavirus pandemic, what steps he is taking to protect his patients, and how some of the changes to telemedicine, iPLEDGE, and other organization regulations have helped improve patient care during this time.
The Dermatologist: How is your practice handling the coronavirus pandemic?
Dr Buka: The focus now is to maintain the health care structure of New York City, and to be there for people who do not have COVID-19 but still need dermatologic care. We are of course barring patients from coming in for cosmetic procedures or routine acne refills. However, those with drug eruptions, complicated lupus, or complicated psoriasis still require regular dermatologic care and follow up so we have kept about half of our offices open to serve this need.
For other patients, we have introduced our telemedicine platform. We had a rudimentary one before the pandemic and had to place a lot of time and operational creativity into making it a bit more seamless, patient facing, and user friendly. Teledermatology is a great technological advancement for us as a specialty. It serves as a helpful, though incomplete, gesture to be there for our patients who cannot or do not want to come in. We can advise and prescribe medications through Telederm, an initiative uniquely customized for those patients who are more vulnerable at this time.
The Dermatologist: How have changes to programs, such as iPledge, helped dermatologists provide the best care while dropping the number of unnecessary visits?
Dr Buka: The American Academy of Dermatology (AAD) released a statement on how to manage patients with acne taking isotretinoin.2 For example, at-home pregnancy tests are now acceptable. We need to document the date and time of the pregnancy test and counsel time with the patient. Prior to the COVID-19 pandemic, recommendations for blood work were decreasing from once a month to every 2 or 3 months on stable therapy. This trend is equally very helpful during this time because we can let patients continue to space out their bloodwork and avoid high-traffic phlebotomy centers.
On another note, specialty pharmacies have been super helpful during this crisis. Prior to the pandemic, there were an increasing number of medications requiring authorizations; specialty pharmacies have been instrumental in making this process more seamless.
The Dermatologist: How has the hydroxychloroquine shortage impacted dermatologists?
Dr Buka: We often use this medication to treat refractory urticaria or lupus. There is a shortage and now a government-mandated pharmacy restriction on hydroxychloroquine, which has made it more difficult for us to get this medication into the hands of our patients. So far though, we’ve managed.
The Dermatologist: How can dermatologists help their colleagues working in emergency medicine and hospitals?
Dr Buka: I believe our current role is to serve as an exhaust valve for the folks that are fully devoting their efforts and expertise to coronavirus. During the pandemic, the number of cases of skin cancers and high-acuity skin conditions do not drop. We are keeping these individuals away from urgent care centers and emergency rooms by providing access to care in our outpatient facilities. In addition, we do not have the luxury of postponing treatment for patients with these diseases for 2 to 5 months. We serve the health care community of New York City by triaging these cases whilst our colleagues in the emergency department can handle the more acute pandemic that threatens our city today.
1. Coronavirus COVID-19 Global Cases. John Hopkins University Center for Systems Science and Engineering. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6. April 6, 2020. Accessed April 6, 2020.