Otolaryngology Providers Must Be Alert for Patients with Mild and Asymptomatic COVID‐19

Abstract

More than half of COVID-19 patients are afebrile early in the disease course, yet mildly ill or asymptomatic patients can still spread SARS-CoV-2 with high efficiency. Atypically presenting patients may be seen in noninfectious disease settings such as otolaryngology, which is a specialty prone to occupational exposure. Otolaryngologists have been infected with COVID-19 at higher rates than other specialties in China and other countries. Otolaryngology providers should maintain high clinical suspicion for mild and asymptomatic COVID-19 patients. Protective strategies should be implemented including preappointment screening, triaging, restriction of nonurgent visits and surgeries, telemedicine, and appropriate personal protective equipment use.

Effect of the COVID-19 Pandemic on the Activity of Physicians Working in the Areas of Head and Neck Surgery and Otorhinolaryngology

“…Physicians who work in the field of the head and neck are among the HCPs most infected with SARS-CoV-2 in different regions of the world. 5,[8][9][10][11] Patients with COVID-19 usually present with symptoms seen by these specialists, such as cough, sore throat, headache, increased sputum production and anosmia. Half of these patients do not present fever at the onset, lowering the index of suspicion of the disease.…”

“…Half of these patients do not present fever at the onset, lowering the index of suspicion of the disease. 8,12 Furthermore, physical examination in these specialties require exposure to the nasal and oral cavities and oropharynx. These regions present high concentrations of SARS-CoV-2, even in the asymptomatic patients, who may also spread the disease.…”

“…These regions present high concentrations of SARS-CoV-2, even in the asymptomatic patients, who may also spread the disease. 8,9,13 This survey aimed to quantify the impact of the COVID-19 pandemic in the daily practice of otorhinolaryngologists, head and neck surgeons, clinical oncologists, and radiation oncologists. It revealed a drastic reduction in outpatient visits, and in the number of exams and surgical procedures.…”

“…Some degree of reduction in the volume of outpatients was expected, as many institutions and medical societies have suggested postponing non-urgent appointments, in response to the elevated occupational hazard of these specialists. 5,8,9,12,14,15 Furthermore, on March 20th 2020, due to the progression of the pandemic, the Brazilian Federal Council of Medicine recommended cancelling appointments and elective procedures for all physicians in Brazil. 16 Finally, patients may be reluctant to seek medical care, due to the fear that the physician or the health care unit may be a source of COVID-19 contagion.…”

The UK national registry of ENT surgeons with coronavirus disease 2019

“…4 Asymptomatic coronavirus carriage has been a further concern. 5 There was an urgent need to recognise, manage and reduce the risk of Covid-19 to ENT clinicians. 6 ENT UK, the professional membership body representing ENT surgeons in the UK, created a designated Covid-19 resource and has published multiple guidance documents.…”