The evidence we present to date would support the current national guidance as being appropriate, but we would emphasise the importance of clinical indication along with timing of procedure. The limitations of this study are the sample size and follow-up time; however it does represent a high-volume, prospective study completed in a short time frame, against a defined protocol. A co-ordinated national effort, as is being delivered by the ENT-UK COVID-19 tracheostomy audit will provide far more comprehensive evidence, and no doubt define the standards of care in the near future.