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.