Impact of COVID-19 Pandemic and Pattern of Patient Care in Otorhinolaryngology Practice in a Tertiary Referral Centre

Indian J Otolaryngol Head Neck Surg https://doi.org/10.1007/s12070-020-02314-w ORIGINAL ARTICLE Impact of COVID-19 Pandemic and Pattern of Patient Care in Otorhinolaryngology Practice in a Tertiary Referral Centre Kalpana Sharma1 • Abhilasha Goswami1 • S. M. Sarun1 Received: 28 August 2020 / Accepted: 7 December 2020 Ó The Author(s) 2021 Abstract To study the effect of COVID-19 pandemic on patient load in a tertiary care centre and the innovations and methods used to improve the safety of the healthcare workers, to provide adequate treatment in the department of Otorhinolaryngology. This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, at a tertiary care hospital centre in North-East India. This study included data collected from the patient registers maintained in our department, and included data over a 4-month period, from April, 2020 to July, 2020. Age, gender, place of residence, clinical diagnosis and the operative procedure performed were included in the data profile for analysis. The above-mentioned registers were also reviewed to retrieve details about the rate of admission during the study period in the previous year. Data was collected and represented, in both descriptive and tabular forms, after proper statistical analysis. We found out that there is a drastic reduction in number of patients attending in our department of Otorhinolaryngology during this COVID-19 pandemic. Certain innovative methods for protecting healthcare workers from viral transmission were put into our practice based on the peer reviewed articles, from June, 2020 and the rate of elective procedures and inpatient admissions were thus increased. Knowledge of new innovative methods in Otorhinolaryngology will help overcome the difficulties faced during the current COVID19 pandemic. & S. M. Sarun 1 Department of Otorhinolaryngology, Gauhati Medical College, Guwahati 781032, Assam, India Keywords COVID-19
Innovative methods
Otorhinolaryngology Introduction Towards the end of 2019, there was an outbreak of pneumonia of unknown etiology, with the center of outbreak being Wuhan, the capital of the Hubei province in China [1]. By early January, 2020, Chinese scientists had isolated a novel form of coronavirus from patients with this viral pneumonia–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously called 2019-nCoV [1]. By January, 2020, the World Health Organization (WHO) labelled this disease as a public health emergency of international concern (PHEIC) and in March, 2020, declared it as a pandemic [2, 3]. On February 11, 2020, the WHO officially termed the disease caused by SARS-CoV-2 as coronavirus disease-19 (COVID-19) [1]. This virus has a high potential for human-to-human transmission and this led to the COVID-19 epidemic in China, followed by a subsequent global pandemic [1]. In an attempt to contain its spread, various restrictions were implemented, such as ban on international and interstate travel and government-mandated lockdowns [4]. Despite such stringent measures, there were a total of 638,146 confirmed cases and 30,039 deaths reported by WHO on 30th March, 2020. Higher fatality rates were observed in the elderly, patients with features of severe acute respiratory illness (SARI) and patients with comorbidities [5]. India reported its first case of this disease on 30th January, 2020, in a patient who travelled from Wuhan to Kerala [6]. On 24th March, 2020, the first COVID-19 case was detected in North-East India in a female patient who 123 Indian J Otolaryngol Head Neck Surg had travelled from UK to Manipur [7]. Assam reported its first positive case on 31st March, 2020 [8]. Even though the main route of transmission of SARSCoV-2 is through droplets and fomites, there is a potential risk of virus spread in smaller aerosols during various medical procedures causing airborne transmission [9–12]. Airborne transmission refers to transmission of infection via small (\ 5–10 um) inspirable aerosols over extensive distances, whereas droplet transmission refers to transmission of infection by larger aerosols over short distances directly from the infected to the susceptible person [13, 14]. Various procedures performed by Otolaryngologists to diagnose or treat patients may generate aerosols from areas of high viral shedding, i.e., nasal and oropharyngeal cavities [12, 15]. High titres of SARS-CoV-2 have been detected in the upper respiratory tract of both asymptomatic and symptomatic individuals suffering from COVID-19 [16]. The viral load in the nose is far higher than that found in the throat [15]. Thus, these sites are the primary source of infection and viral replication. This distinctive feature of the virus poses particular risk for health care workers who examine and operate these areas. Viral RNA has even been found in the blood of both symptomatic and asymptomatic COVID-19 patients and such inhaled aerosol of blood may potentially transmit infection [15, 17]. Thus, otolaryngologists, who frequently manipulate the upper airways and digestive tract are especially vulnerable to viral transmission. They are often exposed to contact with this virus, either directly through mucus/blood or via aerosolized particles when examining or operating in these areas. Data from countries with high COVID-19 positive cases-China, Iran, Italy and India, have shown that the group with the highest risk of contracting this virus are otolaryngologists and head and neck surgeons [16]. Thus, otorhinolaryngologists have been put in a quandary regarding management of acute and emergent problems requiring surgical intervention. It is essential that otorhinolaryngologists take extra precautions while examining or operating on the upper aerodigestive tract, so as to avoid contamination. Hence use of appropriate PPE is advocated while doing routine examinations and surgical procedures. To stabilize the health care system which is already overburdened with the rising number of cases, triaging of care is essential. While hospitals and health care workers are grappling with an increasing number of COVID-19 cases, there has been a decline in the number of nonCOVID-19 patients visiting the out-patient and the emergency clinic, including the otorhinolaryngology clinic. In this study, we have made a modest attempt to discuss the affect that COVID-19 pandemic has had on the Otolaryngology department at a tertiary care hospital-cum- 123 referral center in North-East India. The primary aims were to quantify the patient admissions and the operative procedures carried out over the first four-months of the virus’ impact, in comparison with the previous year. We also analyzed patient visits based on age and their place of residence. Methods This study was conducted under the aegis of the Department of Otorhinolaryngology and Head and Neck Surgery at a tertiary care hospital-cum-referral centre in North-East India. This study included data acquire (...truncated)