Safety Recommendations for Evaluation and Surgery of the Head and Neck during the COVID-19 Pandemic

Abstract

Importance: The rapidly expanding 2019 novel coronavirus pandemic (COVID-19, caused by the SARS-CoV-2 virus) has challenged the medical community to an unprecedented degree. Physicians and healthcare workers are at added risk of exposure and infection during the course of the patient care. Due to the rapid spread of this disease through respiratory droplets, healthcare providers such as otolaryngologists-head & neck surgeons who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures are particularly at risk. Here we present a set of safety recommendations based on our review of literature and communications with physicians with first-hand knowledge of safety procedures during the 2019 COVID-19 pandemic.Observations: A high number of healthcare providers were infected during the first phase of the pandemic in Wuhan province. Subsequently, by adopting strict safety precautions, other regions were able to achieve high levels of safety for healthcare providers without jeopardizing the care of patients. We reviewed the most common procedures related to the examination and treatment of upper aerodigestive tract diseases. Each category was reviewed based on the potential risk imposed to healthcare workers. Specific recommendations were made, based on the literature, when available, or consensus best practices. Specific safety recommendations were made for performing tracheostomy in COVID-19 patients. Conclusions and Relevance: Preserving highly skilled healthcare work force is a top priority for any community and healthcare system. Based on the experience of healthcare systems in Asia and Europe, by following strict safety guidelines, the risk of exposure and infection of healthcare providers could be significantly reduced, while providing high levels of care. The provided recommendations could be used as broad guidance for all healthcare workers who are involved with the care of COVID-19 patients.

Care of immunocompromised patients with head and neck cancer during the COVID‐19 pandemic: Two challenging and informative clinical cases

“…If the decision is made to operate, appropriate PPE, such as an N95 mask with a face shield and eye protection, is of utmost importance to protect the entire surgical team as well as the patient. 8,[13][14][15] Telemedicine appointments and photographic monitoring should be used whenever feasible in order to allow home isolation. Most importantly, we recommend an honest discussion of the situation with the patient, taking into account their comfort and goals of care.…”

“…6,7 During the current pandemic, any decision that could lead to airway emergencies or more extensive surgeries in the near future has the potential for putting health care providers at greater risk of COVID-19 exposure. [8][9][10] Aerosol-generating procedures, including tracheal intubation, tracheotomy, noninvasive ventilation, and manual ventilation, are associated with increased risks of acute respiratory infections among health care workers. 11 Anecdotal reports from Wuhan, China, report higher rates of infection specifically among otolaryngologists.…”

CORONA-steps for tracheotomy in COVID-19 patients: A staff-safe method for airway management

“…As of today, evidence that early tracheotomy could improve the outcomes in COVID-19 intubated patients are lacking; even more so, no evidence that these patients could benefit from tracheotomy exists at all. Givi and others [3] suggest that the decision whether to perform tracheotomy or not must be carefully pondered in COVID-19 intubated patients, balancing risks and benefits both for patients and for healthcare workers. The authors encourage to avoid tracheotomy or postpone it beyond the first 14 days from intubation in order to let the most acute phase of infection pass and allow for the viral load to decrease, lowering the transmission risk.…”

An oncologist perspective on COVID 19: A mysterious cryptic virus

“…*The American college of surgeons advocates that surgeons look at the Elective Surgery Acuity Scale (ESAS) and triage the patients accordingly [9].…”