Introduction
The novel coronavirus (severe acute respiratory syndrome coronavirus 2
[SARS-CoV-2]) causing coronavirus disease 2019 (COVID-19) emerged in
December 2019 and has spread on a global level leading to unprecedented
health, social, and economical unrest. The virus is spread via
respiratory droplets and causes mortality in up to 7% of infected
patients1. Curative treatment and vaccines are
non-existent, and the only protection is the prevention of spread of
virus particles. Many asymptomatic patients might be carriers of
disease, while current testing paradigms might have false negative rates
as high as 40%2. As such, all patients and healthcare
providers are considered a potential source of disease.
On March 11th, 2020, the World Health Organization
(WHO) declared the SARS-CoV-2 outbreak a pandemic3, at
a time when the Center for Disease Control (CDC) reported 1,215 positive
cases in the United States4. At the time of this
report, the United States has reached 395,011 cases4.
At the current rate of disease progression, intensive care unit (ICU)
beds are projected to be at or over capacity with COVID-19 patients
across the country. Health institutions in several states have
implemented mandatory postponement of elective and/or non-urgent cases
to decrease nonessential patient density in hopes of decreasing COVID-19
transmission and preserving hospital resources. As the current pandemic
is rapidly evolving, the American College of Surgeons has recommended
triaging surgeries according to a three-tier state of hospital resource
availibility5. In the field of head and neck surgical
oncology, postponing a surgery can significantly impact survival due to
the increased risk of cancer progression. Furthermore, early reports
suggest that cancer patients are at higher risk for COVID-19 associated
severe events such as ICU admissions requiring mechanical ventilation or
death6,7. Given the cancer patients’ vulnerability to
COVID-19 complications and potential hospital resource limitations,
judicious selection of oncologic surgical cases is of utmost importance,
not only in an attempt to alleviate the burden on the healthcare system,
but also to ensure the safety of patients, their families, as well as
their healthcare providers. Ultimately, one must balance healthcare
priorities and the risk of cancer progression.
In this report, we outline guidelines based on expert consensus opinions
from our experienced multidisciplinary team for the triage and
prioritization of head and neck surgical cases in a subsite-specific
manner. We present these guidelines to serve as a reference for
practicing head and neck clinicians during this serious and
unprecedented situation, recognizing that feasibility, pandemic
intensity, and resource availability will vary widely geographically and
over time.