How to Reorganize an Ear, Nose, and Throat Outpatient Service During the <scp>COVID</scp>‐19 Outbreak: Report From Northern Italy

Abstract

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first described in Wuhan, China in December 2019. The first case in Italy was documented on February 21, 2020 in Lombardy, in northern Italy. Otolaryngologists are at particularly high risk even when performing routine procedures, as SARS-CoV-2 is transmitted through droplets.1 Evolving evidence demonstrated that oral, laryngeal, and nasal examinations are risky, being aerosol-generating procedures. However, the paucity of data at the early outbreak along with the shortage of personal protective equipment (PPE) have contributed to increased infections among otorhinolaryngologists, as demonstrated by the fact that the first fatality of a physician documented globally was an ear, nose, and throat (ENT) physician in Wuhan.2 Therefore, a profound structural reorganization of ENT departments, including outpatient activities, is mandatory.3 We describe our experience in the reorganization of ENT services during this pandemic, which is crucial for protecting both patients and healthcare workers while minimizing PPE depletion. A retrospective review of the outpatient procedures performed at the ENT department of a tertiary-care hospital in northern Italy, between February 21 and March 31, 2020 was performed. Waiting rooms rearrangements Visiting room setting ENT outpatient services have undergone a significant reduction in daily visits, with gradual decreases ranging from −7.3% the last week of February 2020 to −58.9% the last week of March 2020 (overall reduction rate = −51.2%). The procedures mainly cancelled or postponed were nasal endoscopy (−71%), laryngoscopy (−63%), biopsies in local anesthesia (−44%), and nasal cautery for epistaxis (−37%), whereas tracheostomy tube changes were stable in numbers (−2.9%). An inverse proportional relationship between the decrease in outpatient procedures and the increase of COVID-19 spread was registered. Remarkably, no viral cross-contamination was observed among the healthcare team, nor were there patients’ transmissions reported related to the ENT procedures. At the earliest phase of the pandemic, no otolaryngology-related guidelines were available. Because Italy was the earliest and hardest hit European country, we reorganized ENT services following World Health Organization guidelines, although not specific for otolaryngology visits and upper airway endoscopy. In recent weeks, several societies have developed separate guidelines focused on specific topics (rhinology, laryngology, head and neck cancers), but no widely accepted protocols are yet available.4-6 We cannot anticipate how long this emergency will last, and we suppose that old routines will probably change. Some of these preventive measures should be adopted as a standard of care of ENT services for months and potentially years to come.

Topics & Concepts