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The next few weeks will be a challenging time for us all. The coronavirus is spreading rapidly throughout the UK, and I am sure that we have all been involved in the emergency planning taking place within each hospital.
It does appear that ENT specialists are particularly prone to virus exposure, and we have 2 examples of severe infection within the UK: 2 ENT consultants have required ITU admission this week, and whilst one is improving the other appears to remain critically ill. Experience from Wuhan shows that ENT and Ophthalmology doctors are particularly badly affected.
ENT examinations leave us particularly exposed to the virus due to the aerosolised secretions that are inevitably present. ENT-UK have updated guidance on their website today. All routine ENT clinics and operating should cease immediately. Only 2WW patients (who actually do meet referral criteria), known cancer cases and genuine emergencies should be seen. Proper PPE should be worn for all examinations involving the upper aerodigestive tract: this includes the use of FFP3 masks, which require all ENT staff to undergo fit testing.
Flexible laryngoscopy should, therefore, be restricted to the patient groups listed above. All therapist-led endoscopy should cease.
Laryngeal procedures in an outpatient setting are particularly prone to aerosol generation and should not be performed until the current emergency has passed. If procedures under LA need to be done (eg TNO guided biopsy) they should be done in a theatre setting, with all staff using proper PPE including FFP3 masks.
Laryngeal procedures under GA should be restricted to cancer work and urgent airway surgery. Jet ventilation procedures will carry a particular risk of aerosol exposure so intubation should be preferred. Again full PPE is required.
Tracheostomy is seen as particularly high risk, during the procedure, and for subsequent care. The need to carry out tracheostomy in Covid-19 patients should be assessed through careful multidisciplinary discussion. Guidelines are published on the ENT-UK website, and will also be available from the BLA site.
This will be a worrying time for us all. None of us have experience with this condition, and sharing learning points with the wider ENT community as we go along will help everyone. The BLA will have available the Handbook of Covid-19 from the First Affiliated Hospital, Zhejiang University School of Medicine on the website.
Good luck and stay safe,
21 March, 2020 – 15:56