COVID19 and ENT Surgeons

ENT Surgeons and the COVID19 Pandemic

Updated 22nd March 2020

Key findings from literature as of today.

1. ENT surgeons are at higher risk and have higher rates of contracting the virus SARS-CoV2.

2. Thought to be due to high virus load in nose, nasopharynx and oropharynx, even in asymptomatic carriers hence we may be examining and operating on asymptomatic patients with high viral load.

3. Airway procedures are aerosol-producing activities therefore placing staff at risk (nasoendoscopies, cautery, even oral examinations). Delay if possible.

4. Urgent need for protection with N95 masks, gowns and gloves in clinic. We should ask authorities to provide ENT clinics with them.

5. Any airway intervention, in particular but not limited to, sinonasal surgeries, adenotonsillectomies, laryngobronchoscopies should be delayed if clinically appropriate. Severe, urgent, cancer, critical airway cases may go ahead on a case by case basis and intraoperative risk reduction strategies should be employed (masks during intubation, reduce personnel in theatre, N95 masks, smoke suction, etc.)

6. Testing is still limited in Australia and at this stage we cannot screen everyone for COVID19.

7. Ultimately we should screen all patients pre clinic or pre op but that’s not possible yet.

8. Please be reasonable and be cautious. There are still many patients requiring emergent and urgent ENT services. This does not mean we stop all ENT services. Please be supportive of your emergency colleagues. Wear a full PPE gear. Here’s a snapshot of ASOHNS recommendations. Full statement linked below.

9. Data is limited and imperfect. We are in a pandemic. Time to use whatever limited data we have to inform practice. Time to learn, support and not criticise colleagues.

10. Look out for anosmia. See this. Could be a red herring, could be true. Don’t know yet but be aware.

Resources to support the above statements:

1. Interview with Dr Jason Chan on managing ENT Services during Pandemic in Hong Kong. Excellent. https://edhub.ama-assn.org/jn-learning/audio-player/18326041?utm_source=twitter&utm_medium=social_jamaoto&utm_campaign=article_alert&utm_content=automated_rss

2. News of China Experience with higher number ENT Surgeons infected. https://www.bloomberg.com/amp/news/articles/2020-03-17/europe-s-doctors-getting-sick-like-in-wuhan-chinese-doctors-say?__twitter_impression=true

3. Paper on nasal viral load. Just as high in asymptomatic patient. https://www.nejm.org/doi/full/10.1056/NEJMc2001737

4. Paper on asymptomatic carriers. https://link.springer.com/content/pdf/10.1007/s11427-020-1661-4.pdf

5. Fever and cough are most common symptoms. But asymptomatic period really uncertain. https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

6. ENT UK RECOMMENDATIONS https://www.entuk.org/entuk-guidelines-changes-ent-during-covid-19

7. ENT UK general guidance. https://www.entuk.org/guidance-ent-during-covid-19-pandemic

8. American Academy Recommendations. Specific mention of high virus carrier rate in the nose, nasopharynx and oropharynx. https://www.entnet.org/content/academy-supports-cms-offers-specific-nasal-policy

9. Reliable personal sources have also reported the following: transsphenoidal pituitary case in Wuhan infecting 14 health care workers. One ENT surgeon in the UK has died, 2 intubated and 1 on ECMO.

10. COVID19 repository of papers, guidelines etc collated by Australian Crit Care clinicians. https://www.covid19repository.com/about/

11. Australian Society of Otolaryngology Head & Neck Surgery recommendations. http://www.asohns.org.au/about-us/news-and-announcements/latest-news?article=78

11. British Laryngological Society President. http://www.britishlaryngological.org/news/message-bla-president-covid-19

12. SkyNews on 2 intubated ENT Surgeons in the UK. https://news.sky.com/story/coronavirus-two-nhs-medics-on-ventilators-after-contracting-covid-19-from-patients-11961531

13. Suggested modifications to Sinus surgeries. Pre and post op concerns discussed. 12 minute lecture. https://youtu.be/ZEQPVnt7II8

14. American Academy update recommendations 23 March 2020. http://msg.entnet.org/q/1tgWzg1impN6Y2lbIZSAurCZ/wv

15. Be kind. Be kind. Be kind. This is an unprecedented Medical Emergency. We need to give every staff member the support that they need. This is the new normal for the next 3 months at least.


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  1. […] techniques. Can you operate under a plastic drape? Example here. Any mucosal specimens (eg sinus deb... ericlevi.com/2020/03/28/aerosol-generating-procedures-in-the-covid-era

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