A new review paper accepted in March and published early on The Laryngoscope’s website contains COVID-19 demographic and safety information, and clinical and practice management recommendations for common procedures and care for at-risk patient populations.
“COVID-19 and the Otolaryngologist – A Preliminary Evidence-Based Review” (Laryngoscope. 10.1002/lary.28672), by Neelaysh Vukkadala, MD, et al., examines practices implemented in China and other countries, as well as practical strategies that have been successfully deployed at Stanford University in Stanford, Calif.
According to the review, COVID-19 shows a slight male predominance, with symptoms similar to those seen in other respiratory infections (fever, cough, fatigue, sore throat, dry cough, and sputum production), although nasal congestion and rhinorrhea are uncommon. Common laboratory findings include lymphocytopenia and increased values of C-reactive protein, serum lactate dehydrogenase, and erythrocyte sedimentation rate. COVID-19’s mortality rate varies dramatically by age group, from 0% in children under age nine [although on March 28 The Illinois Department of Public Health reported the death of an infant younger than one year in Chicago who tested positive for COVID-19] to 14.8% in those over age 80. During the early phase of the outbreak, there was a 41% nosocomial spread rate, with healthcare workers accounting for 29% of patients in Wuhan, China.
The authors note that current polymerase chain reaction (PCR) testing for COVID-19 is best taken in the nasopharynx, where there are higher viral loads, and chest imaging is discouraged for screening or diagnosis. PCR testing may be negative early in the course and turn positive on repeat testing.
Authors also examined transmission evidence and found that viable particles can remain in aerosol form after three hours. The longest survival times, however, are on plastic and stainless steel, meaning that high-level disinfection procedures should be followed for equipment like rigid and flexible endoscopes.
The study also contains recommendations for safety in aerosol-generating procedures that include non-invasive positive airway pressure, high flow nasal canula, nebulizer treatments, endotracheal intubation, bronchoscopy, and nasal endoscopy, as well as for removing and disinfecting or disposing of personal protective equipment. Procedural considerations for otolaryngologists include those for intubation and airway manipulation, tracheostomy, and endoscopic sinus and skull base procedures. The review paper also gives guidelines for management of special patient populations, including those with existing tracheotomies, pediatric patients, and patients with head and neck cancer. The authors also include information on changes to department activities such as outpatient visits and residency programs.