Otolaryngology during COVID-19: Preventive care and precautionary measures

Abstract

Since the outbreak of novel coronavirus disease (COVID-19) in December 2019, it has spread to various regions and countries, forming a global pandemic. Reducing nosocomial infection is a new issue and challenge for all healthcare systems. Otolaryngology is a high-risk specialty as it close contact with upper respiratory tract mucous, secretions, droplets and aerosols during procedures and surgery. Therefore, infection prevention and control measures for this specialty are essential. Literatures on the epidemiology, clinical characteristics and infection control measures of COVID-19 were reviewed, practical knowledge from first-line otolaryngologists in China, the United States, and Brazil were reviewed and collated. It was recommended that otolaryngology professionals should improve screening in suspected patients with relevant nasal and pharyngeal symptoms and signs, suspend non-emergency consultations and examinations in clinics, and rearrange the working procedures in operating rooms. The guidelines of personal protective equipment for swab sampling, endoscopy and surgery were listed. Indications for tracheotomy during the pandemic should be carefully considered to avoid unnecessary airway opening and aerosol-generation; precautions during surgery to reduce the risk of exposure and infection were illustrated. This review aimed to provide recommendations for otolaryngologists to enhance personal protection against COVID-19 and reduce the risk of nosocomial infection. Human to human transmission of SARS-CoV-2 has been confirmed [16], and the infection is highly contagious with about 2.2-3.6 basic

COVID-19 and anosmia: A review based on up-to-date knowledge

“…Otolaryngology is a high-risk department for COVID-19, especially for the otolaryngologists over 60 [49]. In this battle, it is especially important for medical personnel to do their personal protection [50]. Researchers detected the high concentration of SARS-CoV-2 RNA in aerosols in some public areas of two Wuhan hospitals during the COVID-19 outbreak [51].…”

Update of the current knowledge on genetics, evolution, immunopathogenesis, and transmission for coronavirus disease 19 (COVID-19)

“…Asymptomatic patients can spread SARS-CoV-2 with high efficiency in noninfectious disease settings such as otolaryngology, which is a high-risk specialty as it closely contacts the upper respiratory tract mucous, secretions, droplets and aerosols during procedures and surgery [107,108]. Otolaryngologists have been infected with COVID-19 at higher rates than other specialties [107].…”

“…Spike protein is proteolytically cleaved by the cellular enzyme furin into S1 and S2 subunits during intracellular processing [123,147]. The second cleavage S29 exposes the fusion peptide and is thus necessary for viral entry [108], whereas S1 contains the RBD, which directly binds to the peptidase domain (PD) of ACE2 [34]. The ectodomain of the SARS-CoV-2 S protein binds to the PD of ACE2 with a dissociation constant (Kd) of~15nM [126].…”

Asymptomatic COVID-19 patients: a threat to an active otolaryngologist

“…Suspected cases should be isolated and reported immediately. 23 Crowding in out-patient areas needs to be avoided at all costs. Judicious use of PPE while handing the patients.…”

“…Judicious use of PPE while handing the patients. 23,24 When examinations or procedures must be performed, it is of utmost importance that otolaryngologist and any other healthcare workers in the chamber practice effective use of personal protective equipment (PPE). Meticulous cleaning of facilities and equipment should be maintained.…”