Strategies to mitigate the HNC surge
HNC patients, along with otolaryngologists, are high-risk populations
for contracting COVID-19, primarily due to the fact that high viral
loads of SARS-CoV-2 are located in the upper aerodigestive tract and
procedures in this area (e.g. endoscopy, tracheostomy, surgery, etc.)
lead to aerosolization of viral particles.9 In
addition to this, HNC patients in particular may be susceptible to rapid
deterioration and worse outcomes (e.g. admission to an intensive care
unit, mechanical ventilation, and death) if they do contract COVID-19
due to coexisting comorbidites.10-11 Therefore, in
order to manage the surge of HNC patients, certain precautions and
strategies must be implemented by otolaryngologists to effectively treat
these patients.12 First and foremost, ample PPE should
be available before seeing any patients or doing any procedures. In
association with this, pre-appointment screening should be done on all
patients and (rapid) COVID testing should be utilized when available and
appropriate.13
Scheduling should be streamlined to allow for timely care. Telemedicine
has been shown to be a valuable tool in this era, and although it comes
with its’ own limitations, it can be optimized in order to provide care
for HNC patients.14-15 Visits that are expected to
predominantly involve reviewing results and counseling can be performed
with telemedicine. One strategy would be to schedule all patients for
telemedicine visits, except for those which require an in-office
procedure (such as a biopsy or laryngoscopy) or for whom in-person
physical examination is critical for decision-making (such as palpation
of an oral tongue cancer).
Multidisciplinary care through a head and neck tumor board has been
clearly shown to improve outcomes in patients with head and neck
cancer.16-18 During the COVID-19 pandemic, utilization
of a multidisciplinary decision-making is of critical importance,
especially when there is an influx of many patients during a time of
limited resources and high risk of COVID-19 transmission. In some
situations, surgical and non-surgical treatment options may have similar
outcomes. In such situations, the preferred option is the one which
allows for timely initiation of treatment while conserving resources and
minimizing risks to patients and healthcare workers. Given the
complexity of such decisions and influence by evolving local and
regional factors, multidisciplinary consensus is critical. Since many
otolaryngologists whose practices do not focus on HNC may not be
experiencing the clinical volume that they normally have, their clinical
skills could be of critical importance in managing an influx of HNC
patients. Having these providers available to provide care for patients
during the HNC surge could facilitate timely diagnosis, workup, and
treatment. However, close monitoring of outcomes is necessary, as is
always the case, to ensure that patients are receiving the highest level
of care.