INTRODUCTION
The novel coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2 virus. SARS-CoV-2 is found in high abundance in the upper aerodigestive tract mucosa [1]. It is known to be transmitted via close contact, droplet and aerosols from aerosol generating procedures (AGP) such as tracheostomy [2].
COVID-19 is associated with acute respiratory distress syndrome that requires patients to be intubated and may become dependent on mechanical ventilation. Patients with prolonged ventilation may require tracheostomy to optimise weaning from ventilatory support. [3] In Queen Mary Hospital, an experienced head and neck surgeon will be summoned to perform tracheostomy on such patients.
As head and neck surgeons, we are constantly exposed when resecting tumours arising from mucosa in the upper aerodigestive tract, in addition to tracheostomy and laryngectomy. Our patients may be asymptomatic at the time of presentation, and there is currently no accurate way of COVID-19 diagnosis. [4-5] Hence, we are at particular risk of becoming infected when performing tracheostomy during the COVID-19 pandemic.
World Health Organisation (WHO), Centres for Disease Control and Prevention (CDC) and Centre for Health Protection (CHP) recommend full barrier protection when performing AGP for unknown, suspected and confirmed COVID-19 patients in order to avoid disease transmission to health care providers. Such personal protective equipment (PPE) includes gloves, goggles, face shield and gowns, as well as items filtering facepiece respirators such as N95 or powered air-purifying respirator (PAPR) hoods and aprons [6-8].
The number of confirmed COVID-19 cases has soared since its first description in. December 2019 - as of 18 April 2020, there are 2121675 confirmed cases worldwide, of which Hong Kong accounts for 1024. [9,10] Such an escalation in the number of infected has resulted in a global shortage of PPE.
This study describes a novel approach which aims to decrease viral transmission when performing tracheostomy during the COVID-19 pandemic and at times of PPE shortage.