INTRODUCTION
SARS-CoV-2 virus is the causative agent of the coronavirus disease 2019
(COVID-19) pandemic. Since it’s outbreak, health care systems around the
world are faced with unprecedented challenges with priorities of care
and resources being shifted to combat COVID-19.
With limited resources during the COVID-19 pandemic, the major
challenges that we head and neck cancer surgeons face are patient
selection and timing of treatment, whilst preventing transmission of
virus to health care providers and patients [1]. Majority of head
and neck cancer patients are elderly with multiple co-morbidities and
poor respiratory reserve from chronic tobacco use, predisposing them to
SARS-CoV-2 contraction and COVID-19 related mortality. However, if left
untreated, tumours in the upper aerodigestive tract may impair essential
functions such as breathing and swallowing, tumors may progress and
metastasise, eventually leading to mortality.
SARS-CoV-2 is found in high abundance in the upper aerodigestive tract
mucosa, particularly the nasopharynx [2]. Patients may be
asymptomatic at the time of presentation [3]. There is currently no
accurate way of diagnosis - polymerase chain reaction (PCR) testing for
nucleic acid sequence homology in nasopharyngeal and throat swabs may be
negative early in the course of disease [4]. The virus is known to
be transmitted via close contact, droplet and aerosols from aerosol
generating procedures (AGP) such as tracheotomy [5]. Hence as head
and neck surgeons, we are at great risk of becoming infected when
treating head and neck cancer patients.
Ideally full barrier protection should be advocated when treating
unknown, suspected and confirmed COVID-19 patients in order to avoid
disease transmission to health care providers. Such personal protective
equipment (PPE) includes gloves, goggles, face shield and gowns, as well
as items filtering facepiece respirators such as N95 or powered
air-purifying respirator (PAPR) hoods and aprons [6].
However, as the number of confirmed cases increases globally, resources
including PPE becomes scarce. As of 12 April 2020, there are 1695096
confirmed cases spanning 215 countries of which Hong Kong accounts for
1005 patients [7-8]. In Queen Mary Hospital, The University of Hong
Kong, the Division of Head and Neck Surgery has undergone a 50%
reduction in head and neck cancer operations since March 2020 as a
result of diminished supplies of PPE in particular N95 respirator and
face shields.
In view of global PPE shortage, we look at strategies to optimise PPE
availability, which includes minimising the need for PPE in health care
settings and ensuring rational and appropriate use of PPE.
This study aims to stratify face shield needs when performing head and
neck cancer surgery with the aim of conserving PPE during the COVID-19
pandemic.