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Coronavirus (COVID-19)

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

Educational Objective
To understand the safety recommendations for evaluations and surgery during COVID-19

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: March 31, 2020

Special Communication

Article Information and Disclosures

Babak Givi, MD¹;

Bradley A. Schiff, MD²;

Steven B. Chinn, MD, MPH³;

Daniel Clayburgh, MD, PhD⁴;

N. Gopalakrishna Iyer, MBBS, PhD⁵;

Scharukh Jalisi, MD⁶;

Michael G. Moore, MD⁷;

Cherie-Ann Nathan, MD⁸;

Lisa A. Orloff, MD⁹;

James P. O’Neill, MD, MBA¹⁰;

Noah Parker, MD⁷;

Chad Zender, MD¹¹;

Luc G. T. Morris, MD, MSc¹²;

Louise Davies, MD, MS¹³

Author Affiliations

¹Department of Otolaryngology, NYU Langone Health, New York, New York
²Department of Otolaryngology, Montefiore Medical Center, New York, New York
³Department of Otolaryngology, University of Michigan, Ann Arbor
⁴Department of Otolaryngology, Oregon Health & Science University, Portland
⁵Department of Head and Neck Surgery, Singapore General Hospital and National Cancer Centre, Singapore
⁶Department of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
⁷Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
⁸Department of Otolaryngology, Louisiana State University, Shreveport
⁹Department of Otolaryngology, Stanford University, Palo Alto, California
¹⁰Department of Otolaryngology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
¹¹Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
¹²Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
¹³Department of Veterans Affairs, White River Junction, Vermont

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Abstract

Importance The rapidly expanding novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged the medical community to an unprecedented degree. Physicians and health care workers are at added risk of exposure and infection during the course of patient care. Because of the rapid spread of this disease through respiratory droplets, health care workers who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures, such as otolaryngologists–head and neck surgeons, are particularly at risk. A set of safety recommendations was created based on a review of the literature and communications with physicians with firsthand knowledge of safety procedures during the COVID-19 pandemic.

Observations A high number of health care workers were infected during the first phase of the pandemic in the city of Wuhan, China. Subsequently, by adopting strict safety precautions, other regions were able to achieve high levels of safety for health care workers without jeopardizing the care of patients. The most common procedures related to the examination and treatment of upper aerodigestive tract diseases were reviewed. Each category was reviewed based on the potential risk imposed to health care workers. Specific recommendations were made based on the literature, when available, or consensus best practices. Specific safety recommendations were made for performing tracheostomy in patients with COVID-19.

Conclusions and Relevance Preserving a highly skilled health care workforce is a top priority for any community and health care system. Based on the experience of health care systems in Asia and Europe, by following strict safety guidelines, the risk of exposure and infection of health care workers could be greatly reduced while providing high levels of care. The provided recommendations, which may evolve over time, could be used as broad guidance for all health care workers who are involved in the care of patients with COVID-19.

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Article Information

Accepted for Publication: March 24, 2020.

Corresponding Author: Babak Givi, MD, Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, 160 E 34th St, 7th Floor, New York, NY 10016 (babak.givi@nyulangone.org).

Published Online: March 31, 2020. doi:10.1001/jamaoto.2020.0780

Conflict of Interest Disclosures: Dr Morris reported receiving grants from Illumina, Inc. and AstraZeneca outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank our physician, nursing, advanced practice provider, respiratory therapy, administrative, and environmental services colleagues for their extraordinary professionalism and dedication. We gratefully acknowledge the expertise provided by colleagues around the world, including Dr Hui Chen (Department of Otolaryngology–Head and Neck Surgery, Eye and ENT Hospital, Fudan University, Shanghai, China), Dr Filippo Marchi (Department of Otorhinolaryngology–Head and Neck Surgery, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy), Dr Giacomo Sollini (Department of Otorhinolaryngology–Head and Neck Surgery, Ospedale Bellaria, Bologna, Italy), Dr Nevill Shine (Department of Otolaryngology–Head and Neck Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland), Dr Jason Y.K. Chan (Department of Otorhinolaryngology–Head and Neck Surgery, Chinese University of Hong Kong), Dr Woei Shyang Loh (Department of Otolaryngology–Head and Neck Surgery, National University Hospital, Singapore), and Drs Mini Kamboj, Richard Wong, and Robert Lee (Memorial Sloan Kettering Cancer Center, New York, New York).

References

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.