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.