Lessons Learnt from the COVID-19 Pandemic in Pediatric Otolaryngology

Current Otorhinolaryngology Reports https://doi.org/10.1007/s40136-022-00422-5 PEDIATRIC OTOLARYNGOLOGY: CHALLENGES IN PEDIATRIC OTOLARYNGOLOGY (W-C HSU, SECTION EDITOR) Lessons Learnt from the COVID‑19 Pandemic in Pediatric Otolaryngology Alan T. Cheng1,2 · Antonia L. Watson3 · Naina Picardo4 Accepted: 21 July 2022 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022 Abstract Purpose of Review The current COVID-19 pandemic has challenged the international paediatric otolaryngology community: we review its impact in clinical, resource, and human settings. Recent Findings The SARS-CoV-2 virus, while generally mild in paediatric populations, has caused an increased incidence in severe croup, invasive fungal sinus disease, and multi system inflammatory syndrome (MIS-C). The incidence of other common otolaryngology presentations such as otitis media and tonsillitis has decreased due to quarantine measures. The pandemic has also changed the way in which we work: guidelines for aerosol-generating procedures (AGPs) have changed, digital technology and videoconferencing platforms have flourished, and new pathways of providing healthcare have been developed to minimise footfall and avoid overcrowded waiting rooms. Finally, the importance of personal protective equipment (PPE) to protect healthcare workers and patients cannot be understated, although the mental and physical toll is considerable. Summary There has been a tectonic shift in paediatric otolaryngology and healthcare globally. Continued adaptability and resilience are required to face these challenges in the coming months. With lessons learnt from managing SARS-CoV-2, we are hopefully well equipped to combat any future pandemics. Keywords COVID-19 · Pediatric · Infectious disease · SARS-CoV-2 Introduction This article is part of the Topical Collection on PEDIATRIC OTOLARYNGOLOGY: Challenges in Pediatric Otolaryngology. * Alan T. Cheng Antonia L. Watson Naina Picardo 1 Department of Paediatric ENT, The Children’s Hospital at Westmead, NSW, Westmead, Australia 2 Discipline of Child and Adolescent Health, Faculty of Health and Medicine, Sydney Medical School, University of Sydney, Westmead, NSW, Australia 3 Discipline of Otolaryngology, Department of Surgery, Canterbury Hospital, Campsie, NSW, Australia 4 Department of ENT, Paediatric ENT Unit, Christian Medical College, Vellore, Tamil Nadu, India The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), beginning with the initial notification from Wuhan, China, on 31 December, 2019, heralded an international effort to control and mitigate its effects on the global population. As of 3 April 2022, there have been over 486 million confirmed cases and 6.1 million deaths reported worldwide [1]. In the field of paediatric otolaryngology, we have come together to demonstrate strong clinical leadership, showing an impressive adaptability to rapid change. Drawing on our close international community, we immediately shared the experiences of our colleagues in China, Italy, the Middle East, UK, and the USA, and later, South America, India, the rest of Europe, Africa, and Asia as they battled through repeated waves of coronavirus disease of 2019 (COVID-19) throughout 2020 and 2021 [2]. By virtue of continuous global communication efforts, we adopted — out of clinical necessity — a significant change in the way we work. At this point in time, 28 months since that first notification, it is important to reflect on the lessons learnt 13 Vol.:(0123456789) Current Otorhinolaryngology Reports as we continue to meet the challenges of the COVID-19 pandemic. In this article, we discuss the lessons learnt from a clinical perspective, a resources perspective, and from the human perspective in paediatric otolaryngology. We then consider which of these practices we should bring with us into a post-pandemic world, and how we should act if a new pandemic were to occur. Clinical Lessons SARS-CoV-2 has mutated significantly since it was first identified, and we have seen five major variants, with increasing infectiousness but with some reduction in disease severity. The most recent mutation, Omicron sublineage BA.2, which has been increasing in circulation relative to other variants, is the most transmissible variant to date [3]. Fortunately, early data from South Africa suggests that the clinical severity of the BA.2 variant is no worse than the earlier BA.1 variant [4]. COVID infection in paediatric patients is generally mild. Early studies of 171 paediatric patients in Wuhan Children’s Hospital demonstrated that up to 15% of COVIDpositive children were asymptomatic, with the most common symptoms including fever, cough, and pharyngitis or pharyngeal erythema [5]. Lower respiratory tract infections are less common in children, and mortality is low (0.1%) compared to adults (5–15%) [6]. Although most paediatric patients experience a mild or even asymptomatic clinical course with COVID infection, in our clinical practice, we have seen unique manifestations of the disease in paediatric populations, including croup, fungal sinus disease, and multisystem inflammatory syndrome (MIS-C). Conversely, we saw reductions in acute tonsillitis and otitis media and its complications. We have seen an increased incidence of COVID-19-associated croup in children. Brewster et al. [7] noted a significant increase in children presenting with croup to a paediatric hospital in Boston, Massachusetts, during a period of Omicron variant dominance. It was hypothesised that the increased incidence of laryngotracheitis may be caused by Omicron’s predilection for the upper airways, compared to earlier variants such as Delta. All children tested negative for other viruses. 12% of patients were admitted to hospital: of these, elevated median dosing of adrenaline (8 doses) and dexamethasone (6 doses) indicates that laryngotracheitis caused by COVID-19 may be more severe than the croup we see typically during winter months. Concerns for invasive fungal disease as sequelae of COVID-19 infection and its treatment were raised in the early stages of the pandemic [8]. Indeed, an increase in the incidence of acute invasive fungal rhinosinusitis has been described post COVID-19 infection [9, 10]. Although described predominantly in the adult population, the 13 paediatric population has not been spared. Anecdotally, colleagues from India saw in increase in paediatric presentations of invasive fungal sinusitis, with seven paediatric presentations from March 2020 to March 2022, compared with zero presentations from March 2018 to February 2020. They detected some unusual and aggressive forms of mucormycosis extending from the paranasal sinus to the nasal skin and dorsum cartilages. All were immunosuppressed: four had diabetes mellitus and three had haematological malignancies. Only two of the seven children tested positive for COVID-19 (...truncated)