Physicians at the Stanford University School of Medicine and the Australian Society of Otolaryngology Head and Neck Surgery are warning otolaryngologists that they may be at high risk for contracting COVID-19. In separate statements, both organizations have noted that otolaryngologists may become infected with the new coronavirus through droplet spread that occurs during nose and airway procedures.
The statements cite anecdotal evidence that a single endoscopic pituitary surgery in China may have infected 14 people who were in the operating room at the time. In their statement, otolaryngologists and neurosurgeons at Stanford say that a neurosurgeon in Wuhan, China, has warned them that “a significant number of doctors who died in China were ENTs and Ophthalmologists, possibly due to the high viral shedding from the nasal cavity.” Click here to read the full statement, which was authored by Zara M. Patel, MD; Peter H. Hwang, MD; Jayakar V. Nayak, MD, PhD; Juan Fernandez-Miranda, MD; Robert Dodd, MD, PhD; Hamed Sajjadi, MD; and Robert K. Jackler, MD.
Stanford’s policy regarding patient care is “constantly evolving based on new information,” Dr. Patel, director of endoscopic skull base surgery at the Stanford University School of Medicine, said in an email to ENT today.
As of March 20th, nurses, schedulers, and support staff with Department of Otolaryngology-Head and Neck Surgery were cancelling non-urgent in-person appointments, converting some appointments to telehealth visits, and asking patients who urgently need surgery to take a pre-operative SARS-CoV-2 test, Dr. Patel said.
“Although there is little hard data at this time upon which to base guidelines and policy, we felt compelled to share this information with our colleagues so they could use this knowledge to protect themselves and their patients,” she said. “If, with time and more data, we realize the risk is actually lower than it currently seems based on these first person accounts, that is a much better outcome than seeing our comrades fall in the service of their patients without this knowledge, as our international colleagues have already experienced.”
Guidelines from the Stanford University School of Medicine:
- Elective cases are cancelled for one month or longer
- Urgent Cases (that should be done within 30 days): 48 hours pre-op COVID testing.
- If COVID positive: PAPR for all OR staff may be necessary until further data is available.
- Emergent Cases: perform with appropriate PPE (PAPR for all OR staff may be necessary until further data is available).
Recommendations from the Australian Society of Otolaryngology Head and Neck Surgery:
- Avoid powered atomisation – use actuated pumps sprays or similar soaked pledgets for topical anaesthesia.
- Limit intervention in the clinic/rooms as much as possible and wear appropriate protection
The American Academy of Otolaryngology-Head and Neck Surgery recommends that otolaryngologists “limit providing patient care activities to those individuals with time-sensitive, urgent, and emergent medical conditions.”