Methods
At the University of California, San Francisco (UCSF) Medical Center, an ad hoc work group consisting of stakeholders in the departments of Otolaryngology -Head and Neck Surgery (OHNS), Infectious Diseases, Critical Care Medicine and Anesthesiology, was developed to analyze the impact of COVID-19 at various levels of clinical care and administration. Several COVID-19 related factors were considered, including availability of viral testing, critical care capacity, availability of PPE, and risk to healthcare providers. All phases of routine tracheostomy care were considered in the review and modification of existing tracheostomy guidelines and clinical pathways. The concurrent goals of these modifications were to (1) mitigate risk to the health care providers while (2) preserving the risk-benefit profile for patients. Published reports from countries with previous COVID-19 pandemic experience and the published literature from the 2003 severe acute respiratory syndrome (SARS) pandemic were reviewed and augmented by individual expertise in order to develop working guidelines for management of tracheostomy at UCSF.