Management of children with rheumatic diseases in covid-19 outbreak in the tertiary pediatric rheumatology center in Iran

Introduction: The COVID-19 disease identified and reported from Wuhan, Hubei, China At the time being, the disease is a pandemic and has involved the entire world Objectives: The aim of this study is reporting the planning and actions after the COVID-19 epidemic for prevention of spread of the disease, supporting patients, and managing the disease at our center's outpatient clinic as a referral center for children suffering rheumatic diseases Methods: Since the first report of disease, we tried to reply to the patients' questions in a virtual social network We were following lab data, radiograms, sonograms, CT scans, and MRI results in this network and provided solutions for the management of the children's problems without need to encountering Results: In cases that were controlled and their diseases were in remission, we invited one of the patient's parents to come and receive the prescriptions We put some instructive short films about COVID-19 in the virtual network and in LED screens of our outpatient hospital clinic to provide useful information About the turn rating system (queuing system) we omitted manual turn-taking stands to prevent virus transmission In the peak of the epidemic, we stopped outpatient clinics for three weeks After that, we started clinics with the least number of patients and the most standard protection measures for physicians, patients, and other staff All people were triaged in the hospital yard before entering the waiting hall of the clinic by taking their temperature and screening questions If they didn't have a fever and symptoms compatible with the disease, we let the patient and only one compeer enter the clinic hall with giving a free three-layer surgical mask to each of them We requested the physicians to increase the time of their clinics to distance the appointments of the patients and to prevent overcrowding in the clinic Each clinic was held with the presence of the attending physician and only one fellow physician Gowns, protective glasses and face shields, surgical masks, and latex gloves were provided for secretaries and the other staff in the clinic In the first eight weeks, daily disinfection was performed for all the surfaces of the clinic and after that, a disinfecting tunnel at the door of the clinic was added With the screening of about 100 staff in the clinic, we found only one IgM positive person for COVID-19 during the first eight weeks who was one of the secretaries without any signs and symptoms and were quarantined at home Among the physicians, 6 of them (8 percent) developed COVID-19 disease with laboratory confirmation All of the involved physicians were working in the private section as well as a state-run system From about 200 patients with different rheumatic diseases came to the clinic in eight weeks, 11 of them (5 5%) were in the relapse of their disease which in comparison to the same time in the last year, 26 from 760 patients (3%), a remarkable increase (almost double) is seen for which different causes can be considered Most of the patients who came to the clinic in the COVID-19 outbreak were those who had to come due to the severity of their disease In the patients who came before the epidemic, the most causes were musculoskeletal pains such as hypermobility and skeletal benign reasons and rheumatic diseases were in the next rank but in the epidemic outbreak, the prior group came in a lower number Follow up on the patients after the epidemic will reveal this matter better Conclusion: Employing personal and patient protective equipments, patients' triage, postponement of face-to-face appointments, social distancing, telemedicine, and using the virtual social networks may be effective policies in outpatient clinics in the COVID-19 outbreak