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.