COVID-19 and elective cosmetic procedures: Asymptomatic transmission in epidemic area and subsequent burdens.

Dear Editor;

Coronavirus disease 2019 (COVID‐19) continues to spread rapidly across China. As of June 13, 2020, COVID‐19 was reported from 213 countries globally. To date, 7 801 786 patients have been confirmed to have COVID‐19, and 429 965 of them have died. COVID‐19 seems to be highly contagious and has rapidly spread worldwide. Transmission before symptoms develop is infrequent, although it cannot be excluded. Furthermore, individuals who remain asymptomatic could carry the virus. Hence, isolation is the best way to fight this epidemic. The transmission occurs through respiratory droplets from coughing and sneezing. Aerosol transmission is also possible in case of elevated aerosol concentrations in closed spaces. In general, the transmission is primarily limited to family members, healthcare professionals, and other close contacts.

In these situations, especially in hot point area, it seems that elective cosmetic procedures need extreme caution or even canceling plan with below concepts. It is notable that some cosmetic procedures have a high priority (for example skin biopsy) and others have a low priority. These procedures can categorized as a low risk procedures (for example filler injection) or high risk procedures (for example Laser therapy and those need sedation).

COVID‐19 can be transmitted from person‐to‐person without symptoms. Although there is a question of whether asymptomatic individuals with COVID‐19 or individuals in the incubation period or mild cases can transmit the virus to others remains controversial, , there is some reported from China that these subjects can be as asymptomatic carrier of virus without showing any symptoms, or an infected patients in incubation period that can be last up to 14 day. In both conditions, transmission is ongoing and can be worrying especially in procedures with laser therapy.

Myocarditis and heart failure are among the main manifestations of COVID‐19. Differentiation of severe cardiopulmonary manifestation of postoperation complication can be difficult especially in endemic area. This may lead to wrong diagnosis and irrational therapy with high economic burden.

Onset of COVID‐19 during recovery phase, due to hospital infection, can prolong the hospital stay or recovery period and finally complicate the outcome of a planned surgery.

So regarding the abovementioned points, current recommendations emphasize the importance of considerable efforts to reduce transmission in countries around the world, to ensure that the ongoing outbreak will not become an uncontrollable global pandemic. So, it seems elective cosmetic procedures in the outbreak of COVID‐19 need more caution and it is better to do with the delay in more safe conditions if the patients’ conditions will not critical with the times. These strategies can reduce the economic burden due to COVID‐19. If the cosmetic procedures are mandatory, management of aerosols to be strictly done during operation and the protection of operating room personnel should be strengthened.

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.