Discussion
COVID-19 has spread across the world, involving 213 countries with at
least 1.8 million confirmed cases and 117,021 confirmed deaths as of Apr
14, 2020(12). Evolving data from China and Italy has shown that
nosocomial infection occurred when there was insufficient protection.
1716 cases of nosocomial infections have been reported in China
including 5 mortalities(13). The fact that a significant proportion of
asymptomatic carriers continue to shed virus during the incubation
period poses increased risk to health care professionals(8). It is
therefore of paramount importance to ensure adequate protection for
health care workers and to prevent the spread of the virus by providing
suitable protective equipment and limiting clinic and operation
sessions. Otolaryngologists have been known to be of notable risk
because of the need to examine the upper aerodigestive tract, which
carries the highest viral load, particularly in the nose and throat(8,
9).
It has been encouraging to see no single case of nosocomial infection in
Hong Kong
despite more than 1000 confirmed cases of COVID-19. This confirms that
the current practice of infection control is successful in preventing
nosocomial infection.
However, these efforts to contain the spread of the virus has given rise
to issues of accumulating caseload in the clinics and operating lists
and diminishing personal protective equipment supplies. Head and neck
surgeons have been faced with the unique challenge of balancing
infection risk and appropriately timed surgery due to the risk of
disease progression in head and neck cancers. Faced with these
challenges, extensive efforts have been made both in the clinics and
operation theatre services to minimize the disruption to usual
healthcare services. Novel methods such as telemedicine and regional
collaboration with other ENT centers have been implemented with some
success, with plans for further development in the coming months.
Despite all the measures taken, a substantial number of patients remain
greatly affected. Lower priority surgeries such as those for low grade
malignancies and benign head and neck tumors have been postponed and
will require resolution as soon as the pandemic settled.