Otolaryngology Experience Worldwide with SARS-CoV-2
During the current SARS-CoV-2 pandemic, reports from multiple countries
suggest that Otolaryngologists and support staff are at a unique risk of
SARS-CoV-2 exposure. An early case in China with devastating results
involved endoscopic pituitary surgery in a patient with flu-like
symptoms 5. Contact
tracing confirmed that 14 health care workers became infected with
SARS-CoV-2 from this one procedure. In Wuhan, otolaryngologists and
ophthalmologists were among the most commonly infected health care
workers. N95 masks did not appear to completely prevent infection of
healthcare workers. PAPR suits were more
effective5. In Iran,
over 20 Otolaryngologists have been hospitalized after testing positive
for SARS-CoV-2 with at least 2 deaths, including a chief
resident5. Two ENT
physicians required ventilatory support in the United Kingdom, with at
least one ultimately succumbing to the infection. To date, over 60
physicians have died in Italy as a result of SARS-CoV-2 infection6. In Spain, over 12,000
health care workers have tested positive for the disease (14.4% of
total reported cases) 7.
In the US, Ohio and Minnesota have reported 16-28% of their COVID
positive cases involve health care
workers7. The American
Academy of Otolaryngology- Head and Neck Surgery has recommended a
multidisciplinary approach in determining indications for tracheotomy in
SARS-CoV-2 patients. In addition to the necessity of donning appropriate
PPE, they recommend not performing tracheotomy until 2-3 weeks post
intubation and repeat SARS-CoV-2 testing is negative. The procedures
should be performed under a closed circuit with a minimal number of care
providers and duration of
procedure8.
Emergent tracheostomy secondary to upper airway distortion or
obstruction precluding endotracheal intubation has not been reported in
patients with SARS-CoV-2. Early experience suggests that patients with
SARS-CoV-2 produce relatively little mucus and secretions in relation to
other causes of respiratory failure. For these reasons, tracheotomy
appears less critical for pulmonary toilet for
SARS-CoV-2patients9.