COVID-19 Infection and Its Influence in Otorhinolaryngology-Head and Neck Surgery

THIEME Systematic Review SPECIAL ARTICLE COVID - 19 COVID-19 Infection and Its Influence in Otorhinolaryngology-Head and Neck Surgery Daniella Parilli-Troconis1 Peter Baptista1 Marcel Marcano-Lozada2 David Shahal3 Juan Armando Chiossone-Kerdel3 1 Department of Otolaryngology – Head and Neck Surgery, Clinica Universidad de Navarra, Pamplona, Navarra, Spain 2 Department of Medical Microbiology, Angios Centro Vascular, Caracas, Venezuela 3 Department of Otolaryngology – Head and Neck Surgery, University of Miami, Miller School of Medicine, Miami, FL, United States Stefania Goncalves3 Address for correspondence Daniella Parilli Troconis, MD, Department of Otolaryngology – Head and Neck Surgery, Navarra University Clinic, Pío XII Avenue, 36, Pamplona, Navarra, 31008, Spain (e-mail: ). Int Arch Otorhinolaryngol 2020;24(4):e527–e534. Abstract Keywords ► COVID-19 ► otolaryngology ► COVID-19 testing ► public health ► recommendations received June 29, 2020 accepted July 5, 2020 Introduction The novel coronavirus disease 2019 pandemic has rapidly spread worldwide, challenging healthcare resources and communities to an unprecedent degree. Simultaneously, the amount of clinical and scientific information released has overwhelmed journal platforms. Objectives This review aims to summarize the available diagnostic tools and current guidelines to safely assist patients while limiting the exposure of otolaryngologists during this pandemic. Data Synthesis Key articles were retrieved from the following databases: PubMed, Lancet, Springer Nature, BioMed Central, JAMA network and MEDLINE, as well as updated documents from the Spanish Ministry of Health, World Health Organization, Centers for Disease Control and Prevention, Spanish Association of Surgeons, ENT-UK, American College of Surgeons, and American Academy of Otolaryngology-Head and Neck Surgery. The terms used for the search were: COVID-19, Test COVID, Surgery in COVID, 2019-nCoV, ‘coronavirus’, and SARS-CoV-2. A total of 10,245 papers were retrieved. The inclusion criteria for the review included: COVID-19 testing (n ¼ 531), society guidelines for otolaryngologyhead and neck surgery patient care in the outpatient clinic (n ¼ 10) and surgical (n ¼ 18) settings. Studies not related to COVID-19 diagnosis were excluded. Conclusion Healthcare institutions around the world are outlining their own protocols regarding laboratory testing and personnel protective equipment usage based upon medical societies recommendations during the COVID-19 pandemic. We have summarized the available laboratory tests and their respective sensitivity and specificity. Moreover, clinical guidelines from different societies were reviewed and summarized to facilitate guidance for otolaryngologists in the operating room and in the clinical settings. DOI https://doi.org/ 10.1055/s-0040-1715586. ISSN 1809-9777. Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 527 528 COVID-19 Infection and Its Influence in Otorhinolaryngology-Head and Neck Surgery Introduction Discussion Since the 16th century, at least 3 pandemics have been documented. Pandemics are characterized primarily for their abrupt onset and rapid spread, leading to great morbidity and mortality in a short period of time, overwhelming the capacity of the existing healthcare system.1 The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged available healthcare resources and has imposed a high risk of exposure to healthcare workers. Otolaryngology-head and neck surgeons are amongst the highest risk specialties since they routinely work in the upper airway, where the virus is known to replicate. Therefore, the coronavirus disease 2019 (COVID-19) pandemic has forced the specialty to address the challenge of maintaining high-quality patient care, while protecting its healthcare workers.2 During the first days of COVID-19 lockdown, most clinics, inpatient consults, and surgical procedures were halted, and only strict emergencies were seen and treated. In the meantime, medical societies around the world were discussing evidence-based information coming from the recently affected countries, to create management guidelines focused on personnel and patient safety to be implemented in their home countries.3 This led to the public release of an immense number of guidelines and recommendations; however, the information available is difficult to read or summarize, and some may be challenging to apply in certain countries. Therefore, the present manuscript will summarize the current recommendations regarding COVID-19 diagnosis and how physicians may return to the clinic and the operating room safely. We hope this information can be used as a quick reference tool for otolaryngologists and providers of highrisk specialties. Pathophysiology Review This is a literature review of the available diagnostic tools and current guidelines to safely assist patients while limiting the exposure of otolaryngologists during the COVID-19 era. Key articles were retrieved from different databases: PubMed, Lancet, Springer Nature, BioMed Central, JAMA network, MEDLINE, combined with updated documents from the Spanish Ministry of Health, World Health Organization (WHO), Centers for Disease Control (CDC), as well as the recommendations of Spanish Association of Surgeons, ENT-UK, American College of Surgeons, and American Academy of Otolaryngology Head and Neck surgery. The terms used for the literature search were: COVID-19, Test COVID, Surgery in COVID, 2019-nCoV, coronavirus, and SARS-CoV-2. A total of 10,245 papers were found. The inclusion criteria for review included: COVID-19 testing (n ¼ 531), society guidelines for otolaryngology-head and neck surgery patient care in the outpatient clinic (n ¼ 10) and surgical (n ¼ 18) settings. Studies not related to COVID-19 diagnosis were excluded. International Archives of Otorhinolaryngology Vol. 24 No. 4/2020 Parilli-Troconis et al. The COVID-19 is an ongoing viral pandemic that emerged from East Asia and has quickly spread worldwide.4 Humanto-human aerosol transmission is undoubtedly the main source of infection. In detail, an infected individual releases contaminated respiratory droplets when coughing, sneezing, or breathing. These droplets can directly infect the mucous membranes of healthy individuals that are in close contact to the infective source or contaminated surfaces where the virus has been shown to remain alive for a variable period of time, depending on the surface (e.g., metal, plastic, or glass).5 Also, when a healthy individual touches recently contaminated surfaces, the virus will then contaminate his/her hands, followed by contamination of the mucous membranes when subsequently touching his/her eyes or mouth. Virus transmission from asymptomatic patients or those in the incubation period, plays a significant role in the transmissibility of the disease.6 Therefore, the WHO has continuousl (...truncated)