Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus Epidemic

Abstract

An Experience in Hong KongThe 2019 novel coronavirus disease (COVID-19) with an epidemic centered in Wuhan, China, was declared a public health emergency on January 20, 2020, by the World Health Organization and a public health emergency by the US on January 31, 2020.A total of 28 130 cases in mainland China and 22 cases in the Hong Kong Special Administrative Region (HKSAR) have been confirmed as of February 6, 2020, with a reported epidemic doubling time of 6.4 days. 1 The early reported mortality rate of 4.3% 2 appears to be lower than that of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome, but this initial figure is believed likely to be an underestimation, as most of the confirmed patients are still inpatients, and their condition is not yet resolved.The first fatality of a physician documented globally was that of an otolaryngology physician in Wuhan on January 25, 2020, whose situation was similar to that of an otolaryngologist who died of SARS in the HKSAR in 2003.Thus, it is imperative that otolaryngologists and physicians globally stay abreast of this outbreak and appreciate essential precautionary practices that are potentially crucial in protecting themselves and patients during this epidemic.In many regions globally, including China and the HKSAR, it is a very common practice for patients with upper respiratory tract infections to seek family practitioners and otolaryngologists as a primary care physician.Such a practice inadvertently poses inherent risks for physicians examining patients potentially carrying the virus.The route of transmission has yet to be firmly established.However, based on current evidence, it is speculated that respiratory droplets and possibly fecal-oral routes are culprits, similar to the SARS epidemic in 2003. 3,4he association of COVID-19 with clinical services to the public has been severely disruptive, as redistribution of manpower and resources are required to critically meet the current and anticipated hospital service needs during the outbreak.There has been a reduction in elective clinics and operations to mobilize manpower to acute specialties combatting the outbreak and maximize hospital beds numbers available in anticipation of the outbreak.There is also understandably fear from the public in visiting hospitals.Both factors have resulted in a more than 50% reduction in daily patient visits to our specialist clinic.Although essential emergency and oncologic surgeries are still proceeding as usual, contingency plans are in place to reluctantly reduce such services if the outbreak becomes critical and significant.This rapid change in clinic provisions and rescheduling of patients causes substantial inconvenience to patients and potentially poses a risk with

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