ENT surgery during COVID-19 pandemic: Tips for safe surgery and how to prioritize them

The outbreak of coronavirus disease 2019 COVID-19 has spread worldwide, causing health systems to collapse. The COVID-19 outbreak has disrupted outpatient and inpatient services, making it almost impossible for patients to access high-quality healthcare services. Additionally, there is a significant hesitation in the management of diseases in need of surgical treatment. Cancers, life-threatening infectious diseases, and injuries are cases where there is no option of treatment delay. Besides, mostly surgical methods are used in their treatment. Therefore, during the pandemic, hospitals need to reorganize themselves and continue to provide healthcare services that are not subject to postponement. While the COVID-19 outbreak continues, maintaining these services will put healthcare workers and patients at risk of transmission. Therefore, some articles about measures that hospitals and healthcare professionals should take were published. In this review, we developed a guide for the management of otolaryngological diseases which need surgical treatment.

___

  • Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020;382:727-33.
  • Chen Y, Liu Q, Guo D. Emerging coronaviruses: Genome structure, replication, and pathogenesis. J Med Virol 2020;92:418-23.
  • Tang B, Bragazzi NL, Li Q, Tang S, Xiao Y, Wu J. An updated estimation of the risk of transmission of the novel coronavirus (2019-nCov). Infect Dis Model 2020;5:248-55.
  • Available at: https://www.who.int/emergencies/ diseases/novel-coronavirus-2019/events-as-they- happen Available at: https://covid19.saglik.gov.tr.
  • Gane SB, Kelly C, Hopkins C. Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome? Rhinology 2020. [Online ahead of print]
  • Hopkins C, Surda P, Kumar N. Presentation of new onset anosmia during the COVID-19 pandemic. Rhinology 2020. [Online ahead of print]
  • Ollarves-Carrero MF, Rodriguez-Morales AG, Bonilla- Aldana DK, Rodriguez-Morales AJ. Anosmia in a healthcare worker with COVID-19 in Madrid, Spain. Travel Med Infect Dis 2020:101666.
  • Russell B, Moss C, Rigg A, Hopkins C, Papa S, Van Hemelrijck M. Anosmia and ageusia are emerging as symptoms in patients with COVID-19: What does the current evidence say? Ecancermedicalscience 2020;14:ed98.
  • Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-13.
  • Deng Y, Liu W, Liu K, Fang YY, Shang J, Zhou L, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study. Chin Med J 2020. [Online ahead of print]
  • Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;382:1708-20.
  • Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020;80:388-93.
  • Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med 2020;172:577-82.
  • Linton NM, Kobayashi T, Yang Y, Hayashi K, Akhmetzhanov AR, Jung SM, et al. Incubation Period and Other Epidemiological Characteristics of 2019 Novel Coronavirus Infections with Right Truncation: A Statistical Analysis of Publicly Available Case Data. J Clin Med 2020;9:538.
  • Chen X, Yu B. First two months of the 2019 Coronavirus Disease (COVID-19) epidemic in China: real-time surveillance and evaluation with a second derivative model. Glob Health Res Policy 2020;5:7.
  • Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med 2020;382:1177-9.
  • Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine 2020:100331.
  • Saadi RA, Bann DV, Patel VA, Goldenberg D, May J, Isildak H. A Commentary on Safety Precautions for Otologic Surgery during the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020:194599820919741.
  • Givi B, Schiff BA, Chinn SB, Clayburgh D, Iyer NG, Jalisi S, et al. Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID- 19 Pandemic. JAMA Otolaryngol Head Neck Surg 2020. [Online ahead of print]
  • Clinical guide to surgical prioritisation during the coronavirus pandemic. Available at: https://www. england.nhs.uk/coronavirus/wp-content/uploads/ sites/52/2020/03/C0221-specialty-guide-surgical- prioritisation-v1.pdf.
  • Topsakal V, Van Rompaey V, Kuhweide R, Garin P, Barbara M, Li Y, et al. Prioritizing otological surgery during the COVID-19 Pandemic. B-ENT 2020. [Online ahead of print]
  • Irish Head and Neck Society Considerations on H&N during COVID-19. 2020.
  • BAETS statement on COVID-19 and Thyroid Cancer Services confidential advice for health professionals to consider when planning thyroid cancer surgical services. 2020. Available at: https://www.entuk.org/ baets-statement-covid-19-and-thyroid-cancer-services
  • Canadian Association of Head & Neck Surgical Oncology (CAHNSO) guidelines for management of Head & Neck Cancer during the COVID-19 Pandemic. Available at: https://www.entcanada.org/wp-content/ uploads/CAHNSO-Cancer-Mx-Guidelines-COVID-19- Apr-3-2020-.pdf
  • Kaiser Permanente Northern California, Permanente Medicine Head and Neck Surgical Oncology. HN Cancer Care Guidelines during COVID-19 Epidemic. 2020.
  • Board on Health Sciences Policy; Institute of Medicine. The Use and Effectiveness of Powered Air Purifying Respirators in Health Care: Workshop Summary. Washington (DC): National Academies Press (US) 2015.
  • Ti LK, Ang LS, Foong TW, Ng BSW. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anaesth 2020;67:756-8.
  • Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19) situation summary. Available at: https://www.cdc.gov/ coronavirus/2019-ncov/summary.html [Accessed: March 2020]
  • Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth 2020;67:732-45.
  • Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth 2020;67:568-76.
  • Liu Z, Zhang Y, Wang X, Zhang D, Diao D, Chandramohan K, et al. Recommendations for Surgery During the Novel Coronavirus (COVID-19) Epidemic. Indian J Surg 2020. [Epub ahead of print]