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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
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
1.
Wang  D , Hu  B , Hu  C ,  et al.  Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China  [published online February 7, 2020].  JAMA. doi:10.1001/jama.2020.1585PubMedGoogle Scholar
2.
Moore  D , Gamage  B , Bryce  E , Copes  R , Yassi  A ; BC Interdisciplinary Respiratory Protection Study Group.  Protecting health care workers from SARS and other respiratory pathogens: organizational and individual factors that affect adherence to infection control guidelines.   Am J Infect Control. 2005;33(2):88-96. doi:10.1016/j.ajic.2004.11.003PubMedGoogle ScholarCrossref
3.
Ng  K , Poon  BH , Kiat Puar  TH ,  et al.  COVID-19 and the risk to health care workers: a case report.   Ann Intern Med. 2020. doi:10.7326/L20-0175PubMedGoogle Scholar
4.
ENT UK. Guidance for ENT during the COVID-19 pandemic. Accessed March 23, 2020. https://www.entuk.org/guidance-ent-during-covid-19-pandemic
5.
Siddiqui  S . CMS adult elective surgery and procedures recommendations [version 3.15.20]. Accessed March 23, 2020. https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures-recommendations.pdf
6.
Tay  JK , Khoo  ML-C , Loh  WS .  Surgical considerations for tracheostomy during the COVID-19 pandemic: lessons learned from the severe acute respiratory syndrome outbreak  [published online March 31, 2020].  JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2020.0764Google Scholar
7.
Roberts  V .  To PAPR or not to PAPR?   Can J Respir Ther. 2014;50(3):87-90.PubMedGoogle Scholar
8.
Institute of Medicine.  The Use and Effectiveness of Powered Air Purifying Respirators in Health Care: Workshop Summary. National Academies Press; 2015.
9.
Wax  RS , Christian  MD .  Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients  [published online February 12, 2020].  Can J Anaesth. doi:10.1007/s12630-020-01591-xPubMedGoogle Scholar
10.
US Centers for Disease Control and Prevention. Interim infection prevention and control recommendations for patients with suspected or confirmed coronavirus disease (COVID-19) in healthcare settings. Accessed March 23, 2020. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
11.
Zou  L , Ruan  F , Huang  M ,  et al.  SARS-CoV-2 viral load in upper respiratory specimens of infected patients.   N Engl J Med. 2020;382(12):1177-1179. doi:10.1056/NEJMc2001737PubMedGoogle ScholarCrossref
12.
van Doremalen  N , Bushmaker  T , Morris  DH ,  et al.  Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1  [published online March 17, 2020].  N Engl J Med. doi:10.1056/NEJMc2004973PubMedGoogle Scholar
13.
American College of Surgeons. COVID-19: guidance for triage of non-emergent surgical procedures. Accessed March 23, 2020. https://www.facs.org/covid-19/clinical-guidance/triage
14.
Zheng  MH , Boni  L , Fingerhut  A .  Minimally invasive surgery and the novel coronavirus outbreak: lessons learned in China and Italy  [published online March 15, 2020].  Ann Surg. Accessed March 23, 2020. https://journals.lww.com/annalsofsurgery/Documents/Minimally%20invasive%20surgery%20and%20the%20novel%20coronavirus%20outbreak%20-%20lessons%20learned%20in%20China%20and%20Italy.pdfGoogle Scholar
15.
Patel  ZM , Hwang  PH , Nayak  JV ,  et al. [Statement from Stanford University School of Medicine Departments of Otolaryngology–Head and Neck Surgery and Neurosurgery]. Accessed March 23, 2020. https://www.docdroid.net/AyUBOji/covid-19-information.pdf
16.
Isakbaeva  ET , Khetsuriani  N , Beard  RS ,  et al; SARS Investigation Group.  SARS-associated coronavirus transmission, United States.   Emerg Infect Dis. 2004;10(2):225-231. doi:10.3201/eid1002.030734PubMedGoogle ScholarCrossref
17.
Ding  Y , He  L , Zhang  Q ,  et al.  Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways.   J Pathol. 2004;203(2):622-630. doi:10.1002/path.1560PubMedGoogle ScholarCrossref
18.
Pitkäranta  A , Virolainen  A , Jero  J , Arruda  E , Hayden  FG .  Detection of rhinovirus, respiratory syncytial virus, and coronavirus infections in acute otitis media by reverse transcriptase polymerase chain reaction.   Pediatrics. 1998;102(2, pt 1):291-295. doi:10.1542/peds.102.2.291PubMedGoogle ScholarCrossref
19.
Heikkinen  T , Thint  M , Chonmaitree  T .  Prevalence of various respiratory viruses in the middle ear during acute otitis media.   N Engl J Med. 1999;340(4):260-264. doi:10.1056/NEJM199901283400402PubMedGoogle ScholarCrossref
20.
Murthy  S , Gomersall  CD , Fowler  RA .  Care for critically ill patients with COVID-19  [published online March 11, 2020].  JAMA. doi:10.1001/jama.2020.3633PubMedGoogle Scholar
21.
Young  D , Harrison  DA , Cuthbertson  BH , Rowan  K ; TracMan Collaborators.  Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial.   JAMA. 2013;309(20):2121-2129. doi:10.1001/jama.2013.5154PubMedGoogle ScholarCrossref
22.
Gawande  A . Keeping the coronavirus from infecting health-care workers: what Singapore’s and Hong Kong’s success is teaching us about the pandemic. The New Yorker. March 21, 2020. Accessed March 23, 2020. https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers
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