Effect of the COVID-19 Pandemic on the Activity of Physicians Working in the Areas of Head and Neck Surgery and Otorhinolaryngology

THIEME 258 Original Research SPECIAL ARTICLE COVID -19 Effect of the COVID-19 Pandemic on the Activity of Physicians Working in the Areas of Head and Neck Surgery and Otorhinolaryngology Luiz Paulo Kowalski1 Rui Imamura2 Gilberto de Castro Junior3 Gustavo Nader Marta4,5 6 Aline Lauda Freitas Chaves Leandro Luongo Matos7 Ricardo Ferreira Bento2 1 Department of Head and Neck Surgery, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil 2 Department of Otorhinolaryngology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil 3 Clinical Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP) and Discipline of Oncology, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil 4 Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP Brazil 5 Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Medical School, Universidade de São Paulo, São Paulo, SP, Brazil Address for correspondence Luiz P. Kowalski, Avenida Enéas de Carvalho Aguiar, 255, 8° andar, sala 8174, São Paulo, SP, Brazil (e-mail: ). 6 Clinical Oncology, Grupo Brasileiro de Cabeça e Pescoço, Divinópolis, MG, Brazil 7 Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (Icesp), Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil Int Arch Otorhinolaryngol 2020;24 (3) :258–266. Abstract Keywords ► COVID-19 ► pandemics ► occupational groups ► health personnel ► work received April 23, 2020 accepted April 24, 2020 published online May 22, 2020 Introduction Coronavirus disease 2019 (COVID-19) is an acute infection caused by the new coronavirus (SARS-CoV-2) and it is highly transmissible, especially through respiratory droplets. To prepare the health system for the care of these patients also led to a restriction in the activity of several medical specialties. Physicians who work with patients affected by diseases of the head and neck region constitute one of the populations most vulnerable to COVID-19 and also most affected by the interruption of their professional activities. Objective The aim of the present study was to assess the impact of the COVID-19 pandemic on the practice of head and neck surgeons and otorhinolaryngologists in Brazil. Methods An anonymous online survey of voluntary participation was applied, containing 30 questions regarding demographic aspects, availability of personal protective equipment (PPE), and impact on the routine of head and neck surgeons and otorhinolaryngologists, as well as clinical oncologists and radiation oncologists who work with head and neck diseases. Results Seven hundred and twenty-nine answers were received in a period of 4 days,
40 days after the 1st confirmed case in Brazil. With professionals working in public and private services, there was a high level of concerns with the disease and its consequences, limited availability of PPE and a significant decrease in the volume of specialized medical care. Conclusion The study demonstrated a direct impact of the COVID-19 pandemic on the clinical practice of specialties related to the treatment of patients with diseases of the head and neck region already in the beginning of the illness management in Brazil. DOI https://doi.org/ 10.1055/s-0040-1712169. ISSN 1809-9777. Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil Effect of the COVID-19 Pandemic on the Activity of Physicians Introduction Infection by the new coronavirus (SARS-CoV-2) started in late 2019 in Wuhan, in the province of Hubei, in China. The virus spread very fast across Asia and quickly became a pandemic. It is a highly contagious disease, with many oligosymptomatic or even asymptomatic patients, with high mortality rates for vulnerable patients (those with chronic disease, immunocompromised and/or elderly).1 Another striking feature of the disease is the prolonged hospitalization of severe cases, which makes physicians and other health professionals very exposed to the virus. The main route of contamination by the disease is by droplets and aerosol dispersion, which makes professionals who deal with diseases of the upper airways tract particularly more susceptible to contamination.2,3 In this context, the correct use and availability of personal protective equipment (PPE) is essential to protect the healthcare providers (HCPs).4–7 To prepare the healthcare system to receive these patients has led to a major change in the routine of most healthcare services. Many institutions have restricted their activities only to the management of patients affected by the coronavirus 2019 (COVID-19), practically interrupting other treatments, especially the elective ones. This fact directly affected the care of patients with other health problems and also the professional activity of several medical specialties. Thus, the aim of the present study was to assess the impact of the COVID-19 pandemic on the practice of physicians working in the areas of otolaryngology and head and neck oncology in Brazil. Methods A web-based survey was created using the SurveyMonkey audience platform. Information on how data are collected, stored and exported may be obtained in: www.surveymonkey.com/mp/audience. Demographic, professional, and clinical practice data were collected through 30 questions of different formats: multiple choice, dropdown lists, and text boxes, with the possibility to add commentaries as open text in some questions. Specifically, we collected data regarding the impact of de COVID-19 pandemic on: 1) the amount and type of outpatient appointments, surgeries and exams with the risk of generating aerosols; 2) availability of adequate PPE in different settings and practices; 3) the preparedness of the responder’s health institution in orienting their HCPs and developing strategies to manage COVID-19 suspected and confirmed patients. Pilot testing of the survey was performed with members of the research team, and questions were modified to improve readability and adequacy. The target population consisted of specialists who worked in the field of the head and neck, particularly otorhinolaryngologists, head and neck surgeons, oncologists, and radiation oncologists. The survey platform generated a link to access the survey that was Kowalski et al. distributed electronically, through email and social media, to members and participants of the involved medical organizations (Grupo Brasileiro de Cabeça e Pescoço, Fundação Otorrinolaringologia, Sociedade Brasileira de Oncologia Clínica, Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Sociedade Brasileira de Radioterapia, Disciplinas de Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Oncologia e Radioterpia da Faculdade de Medicina da Universidade de São Paulo) Participation in the survey was voluntary, and all data that could identify the responder was kept anonymous in all phases of the study. The survey collected responses (...truncated)