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.