To the Editor
Coronavirus disease 2019 (COVID-19) has affected over tens of millions
of people globally since the World Health Organization declared it a
pandemic on March 11, 2020.1 The Asia-Pacific is a
diverse geographical region with different health care systems and
levels of access to specialist services. This survey was commissioned by
the Asia Pacific Association of Allergy Asthma and Clinical Immunology
(APAAACI) Task Force on COVID-19 with the premise to understand the
epidemiology,2 clinical profile (including severity
and risk factors),3, 4 therapeutics/access to clinical
trials,5 impact on clinical immunology and allergy
services/therapeutics,6 occupational health and mental
well-beingS1, S2 of healthcare providers in the
region.
A questionnaire comprising 44 questions was electronically sent out to
15 member countries of APAAACI using Survey Monkey ® on
8th May 2020. Responses were received from 14/15
(93.3%) member countries. The respondents were from Australia, China,
India, Hong Kong, Indonesia, Japan, Korea, Malaysia, Mongolia,
Philippines, Vietnam, Singapore, Taiwan and Thailand.
The most common clinical phenotypes among children and adults comprised
acute respiratory infection (76.9%), asymptomatic individuals (15.4%),
and pneumonia (7.7%). Acute respiratory distress syndrome (ARDS) and
cytokine release syndrome (CRS) were the least common clinical
phenotypes (Online supplementary Figure 1) . Intensive care was
most often needed among those aged 61 years and above (61.3%) followed
by the 40-60-year age group (38.5%). Paediatric cases were overall
mild, with multisystem inflammatory syndrome in children rare.
Hypertension (100%), diabetes mellitus (91.7%), cardiac disease
(58.3%), chronic obstructive pulmonary disease (COPD) (33.3%), and
malignancy (16.7%) were the most common comorbidities reported by
respondents. Asthma and obesity were only reported by 8.3% respectively(Online supplementary Figure 2) .
National guidelines for COVID-19 were available in the 84.6% of the
respondents’ countries. On-going clinical trials were available among
69.2% of respondents, most commonly involving remdesivir (72.7%),
hydroxychloroquine/chloroquine (45.5%), convalescent plasma or
lopinavir/ritonavir (36.4%), corticosteroids or intravenous tocilizumab
(27.3%) (Table 1) .
Immunosuppressive therapies (76.9%), biologics (69.2%) and allergen
immunotherapy (53.9%) were continued in patients with allergies. Among
the respondents, 92.3% reported a decrease in the frequency of regular
/ follow-up visits by allergy patients or stopping of clinic visits
during the pandemic; while 61.5% actively conducted telehealth for
diagnosis and treatment, patient education (61.5%) and patient
assistance (53.9%).
Among healthcare workers, allergic rhinitis (62.5%), asthma (50.0%),
chronic rhinosinusitis (25.0%) and ocular allergy (25.0%) were the
most common allergic conditions exacerbated by the prolonged use of
surgical masks/N95, eye protection/ goggles. Contact dermatitis
(88.9%), atopic dermatitis (44.4%), natural rubber latex allergy
(22.2%) and urticaria/angioedema (22.2%) were the most common skin
conditions aggravated with use of gloves, personal protective equipment
(PPE), and repeated handwashing (Figure) . The psychological and
mental well-being of healthcare workers were also constantly monitored
throughout the pandemic.
The pandemic has provided our specialty an opportunity to restructure
our practice, promote the use of digital technology for clinical care/
medical education, and promote home and community management for
hitherto hospital-based procedures like allergen immunotherapy. With the
roll-out of community vaccination starting with Singapore, India and
Indonesia since January 2021, the emergence of COVID-19 vaccine
anaphylaxis, potentially mediated by polyethylene glycol, polysorbates
and other unknown mechanisms,S3 impacts our ability to
risk stratify patients at risk of developing vaccine adverse reactions
versus the benefits of increasing herd immunity and preventing
moderate-severe COVID-19 infection in different parts of the
Asia-Pacific - especially among the elderly with cardiovascular disease
which is increasing within our region.
Lessons learnt from the first year of the pandemic provide crucial
information for public health, infection prevention and control, and
vaccination policies as we work towards disease control and economic
recovery for the region. New testing and therapeutic modalities continue
to evolve especially with SARS-CoV2 mutations/variants developing over
time.