Citizens around the world are experiencing a rapidly spreading pandemic infection due to the coronavirus, SARS-CoV2. The propensity to spread through human-to-human transmission has been demonstrated in many countries with a troubling exponential rate that has led to steep curves of onset in many areas. Currently, with no existing vaccine, the only effective way shown to flatten the curve of transmission has been isolation and social distancing, in addition to frequent handwashing and standard respiratory precautions. Anecdotal reports indicate that the SARS-CoV2 virus particles reside with extremely high concentrations in the nasal cavity and nasopharynx, and can be a significant source of transmission.
This characteristic property of the virus places healthcare professionals who examine and work in these areas at particular risk. Otolaryngologists and surrounding staff are especially vulnerable to viral transmission directly through mucus, blood, and aerosolized particles when examining or operating in these areas. There is evolving evidence from China, Italy, and Iran that otolaryngologists are among the highest risk groupof contracting the virus while performing upper airway procedures and examinations if not using appropriate Personal Protective Equipment (PPE). This dilemma puts otolaryngologists in a difficult situation when presented with patients with time-sensitive and emergent problems that require surgery.
Until the supply of testing materials catches up with the accelerating demand for testing, there will be circumstances that the COVID-19 status of these patients is unknown. Therefore, when a detailed examination or surgical procedure is necessary for urgent or emergent care and the COVID-19 status of the patient cannot be confirmed, then the patient should be handled as if they are COVID-19 positive. This consideration should apply regardless of whether in an office, hospital, or operating room setting. Furthermore, the provider and surrounding staff must have the necessary PPE. Particular attention must be taken to clean contaminated equipment and surfaces with appropriate disinfectants (e.g.. ≥ 70% alcohol) as recommended by the CDC.
It is incumbent upon the medical community, working in collaboration with the general population, to do everything possible to limit the spread of this virus. The need to flatten the curve of transmission and preserve critical supplies and equipment for those who need it most necessitates limiting care at this time to time-sensitive and emergent problems and the routine use of appropriate PPE when treating patients in all age groups. This policy applies to otolaryngologists in areas currently facing high infection rates as well as those in areas with limited penetration. COVID-19 is a dangerous disease that demands the participation of everyone to end this pandemic.
Important Disclaimer Notice (Updated 7/31/14)
Position statements are approved by the American Academy of Otolaryngology–Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.