COVID‐19 pandemic: Effects and evidence‐based recommendations for otolaryngology and head and neck surgery practice

Head and Neck - Tập 42 Số 6 - Trang 1259-1267 - 2020
Luiz Paulo Kowalski1,2, Álvaro Sanabria3, John A. Ridge4, Wai Tong Ng5, Remco de Bree6, Alessandra Rinaldo7, Robert P. Takes8, Antti Mäkitie9,10,11, André Lopes Carvalho12, Carol R. Bradford13, Vinidh Paleri14, Dana M. Hartl15, Vincent Vander Poorten16,17, Iain J. Nixon18, Cesare Piazza19, Peter D. Lacy20, Juan P. Rodrigo21, Orlando Guntinas–Lichius22, William M. Mendenhall23, Anil D’Cruz24, Anne W.M. Lee25, Alfio Ferlito26
1Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Sao Paulo, Brazil
2Head and Neck Surgery Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
3Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
4Head and Neck Surgery Section, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
5Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
6Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
7University of Udine School of Medicine, Udine, Italy
8Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
9Department of Otorhinolaryngology–Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
10Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska Hospital, Stockholm, Sweden
11Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
12Screening Group, International Agency for Research in Cancer. IARC, Lyon, France
13Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
14Head and Neck Unit, The Royal Marsden Hospital, London, UK
15Department of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France
16Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
17Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
18Department of Otolaryngology Head and Neck Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK
19Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
20Department of Otolaryngology, Beaumont Hospital, Dublin, Ireland
21Servicio de Otorrinolaringología Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo Oviedo Spain
22Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
23Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
24Head Neck Services Tata Memorial Hospital Mumbai, Maharashtra, India
25Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
26International Head and Neck Scientific Group, Udine, Italy

Tóm tắt

AbstractThe 2019 novel coronavirus disease (COVID‐19) is a highly contagious zoonosis produced by SARS‐CoV‐2 that is spread human‐to‐human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case‐by‐case basis for patients with cancer. For those who are working with COVID‐19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID‐19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID‐19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID‐19 positive subjects, and their protection should be considered a priority in the present circumstances.

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Head and Neck

Tập 42 Số 6

1259-1267

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