Introduction
Since December 2019, a number of patients with novel coronavirus
pneumonia (International name, 2019 novel coronavirus disease
(COVID-19); China’s domestic name, novel coronavirus pneumonia (NCP))
have been identified in Wuhan, Hubei Province, China [1, 2]. With
the spread of the epidemic, patients with NCP have been reported in many
cities in China as well as in many countries and regions around the
world, such as South Korea, Australia, the United States and Italy
[3-6]. Currently, the main source of infection is severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients.
People with asymptomatic infection may also become a source of
infection. Airborne droplets and contact are the main routes of
transmission [7]. As of 9 am on March 25, 2020, there were 81850
confirmed cases in China and 3287 cumulative deaths; there were 339081
confirmed cases and 15487 cumulative deaths in other countries.
One study summarized and analyzed the proportion of patients with NCP
with tumors and the prognosis of these patients, presenting the first
published clinical evidence of the risk level of patients with tumors in
the NCP epidemic [8]. Because of reduced immune function, patients
with tumors, especially those associated with chronic underlying
diseases, are susceptible populations for SARS-CoV-2 infection. For
patients with head and neck tumors, particularly those with laryngeal
cancer, hypopharyngeal cancer and thyroid tumors with dyspnea, prompt
surgical treatment or tracheotomy is needed. For these patients with
head and neck tumors, during the NCP epidemic, developing a treatment
plan is very important. The National Health Commission of the People’s
Republic of China has also recently issued guidelines for the diagnosis
and treatment of this disease, and these guidelines have been revised
several times in the short time since the outbreak began, with the
latest being the sixth edition. However, there are relatively few
suggestions and measures for patients with tumors, especially those with
head and neck tumors. This article summarizes the prevention and control
of disease in our medical institution to provide a reference for
front-line head and neck surgeons.
The situation of tumor patients during the epidemic:
During the epidemic, patients with tumors have represented a very
special patient group. A study that specifically targeted 1,590 patients
with NCP with previous medical records in 575 hospitals found that there
were 18 patients with a history of cancer. Compared with NCP patients
without cancer, NCP patients with a history of cancer were older (63.1
vs. 48.7 years), and a higher proportion of NCP patients with cancer had
a history of smoking (22.2% vs. 6.8%), shortness of breath (47.1% vs.
23.5%) or severe symptoms according to computed tomography (CT) imaging
(94.4% vs. 70.8%). More importantly, the study found that patients
with tumors had a higher risk of developing severe disease than did
non-tumor patients. Moreover, for all comorbidities, patients with a
cancer history had the highest risk of severe disease. In addition,
researchers also found that tumor patients with NCP worsened faster than
did non-tumor patients (median time from onset to severe symptoms was 13
days vs 43 days, P<0.0001). Therefore, the research team
proposed three strategies for patients with tumors during the NCP
outbreak and other possible epidemics of severe infectious diseases in
the future: first, in endemic areas, for clinically stable patients with
tumors, delayed chemotherapy or elective surgery should be considered;
second, patients with tumors and cancer survivors should strengthen
their personal protection; and third, if patients with tumors are
infected with SARS-CoV-2, especially elderly patients or patients with
other comorbidities, extra monitoring or treatment should be provided
for priority treatment [8].
Organizational guarantee
After the outbreak of NCP, our hospital attached great importance to and
implemented the corresponding prevention and control measures for
patients with head and neck tumors according to the characteristics of
these patients. The Department of Head and Neck Surgery quickly set up
an Emergency Incident Command Team (EICT). The members include the
department director, head nurse, medical and nursing team leaders,
infectious disease doctors, infectious disease nurse, and protective
material management nurse. The role of this group is to scientifically
analyze departmental epidemic situations, reasonably integrate existing
resources, develop appropriate infection management procedures and
systems that conform to the characteristics of this department, and
complete the rational allocation of personnel and materials to fully
control the dynamic situation in the department regarding epidemic
prevention and control. All staff was required to study the latest
diagnostic, treatment and preventive measures for NCP every week.