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COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice.
Head Neck. 2020 06; 42(6):1259-1267.HN

Abstract

The 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.

Authors+Show Affiliations

Head and Neck Surgery Department, University of Sao Paulo Medical School, Sao Paulo, Brazil. Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Sao Paulo, Brazil.Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia.Head and Neck Surgery Section, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.University of Udine School of Medicine, Udine, Italy.Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland. Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska Hospital, Stockholm, Sweden.Screening Group, International Agency for Research in Cancer. IARC, Lyon, France.Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA.Head and Neck Unit, The Royal Marsden Hospital, London, UK.Department of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France.Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium. Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium.Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK.Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy.Department of Otolaryngology, Beaumont Hospital, Dublin, Ireland.Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain.Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany.Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA.Head Neck Services, Tata Memorial Hospital, Mumbai, Maharashtra, India.Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China.International Head and Neck Scientific Group, Udine, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32270581

Citation

Kowalski, Luiz P., et al. "COVID-19 Pandemic: Effects and Evidence-based Recommendations for Otolaryngology and Head and Neck Surgery Practice." Head & Neck, vol. 42, no. 6, 2020, pp. 1259-1267.
Kowalski LP, Sanabria A, Ridge JA, et al. COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. Head Neck. 2020;42(6):1259-1267.
Kowalski, L. P., Sanabria, A., Ridge, J. A., Ng, W. T., de Bree, R., Rinaldo, A., Takes, R. P., Mäkitie, A. A., Carvalho, A. L., Bradford, C. R., Paleri, V., Hartl, D. M., Vander Poorten, V., Nixon, I. J., Piazza, C., Lacy, P. D., Rodrigo, J. P., Guntinas-Lichius, O., Mendenhall, W. M., ... Ferlito, A. (2020). COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. Head & Neck, 42(6), 1259-1267. https://doi.org/10.1002/hed.26164
Kowalski LP, et al. COVID-19 Pandemic: Effects and Evidence-based Recommendations for Otolaryngology and Head and Neck Surgery Practice. Head Neck. 2020;42(6):1259-1267. PubMed PMID: 32270581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. AU - Kowalski,Luiz P, AU - Sanabria,Alvaro, AU - Ridge,John A, AU - Ng,Wai Tong, AU - de Bree,Remco, AU - Rinaldo,Alessandra, AU - Takes,Robert P, AU - Mäkitie,Antti A, AU - Carvalho,Andre L, AU - Bradford,Carol R, AU - Paleri,Vinidh, AU - Hartl,Dana M, AU - Vander Poorten,Vincent, AU - Nixon,Iain J, AU - Piazza,Cesare, AU - Lacy,Peter D, AU - Rodrigo,Juan P, AU - Guntinas-Lichius,Orlando, AU - Mendenhall,William M, AU - D'Cruz,Anil, AU - Lee,Anne W M, AU - Ferlito,Alfio, Y1 - 2020/04/15/ PY - 2020/03/26/received PY - 2020/03/31/accepted PY - 2020/4/10/pubmed PY - 2020/6/9/medline PY - 2020/4/10/entrez KW - COVID-19 KW - contamination KW - head neck KW - otolaryngology KW - risk of contamination KW - surgery SP - 1259 EP - 1267 JF - Head & neck JO - Head Neck VL - 42 IS - 6 N2 - The 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. SN - 1097-0347 UR - https://www.unboundmedicine.com/medline/citation/32270581/COVID_19_pandemic:_Effects_and_evidence_based_recommendations_for_otolaryngology_and_head_and_neck_surgery_practice_ L2 - https://doi.org/10.1002/hed.26164 DB - PRIME DP - Unbound Medicine ER -