Introduction
Travel has been identified as the single most important contributor to
the spread of the coronavirus disease 2019 (COVID-19) pandemic.
Reduction in the transmission of the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) has a direct link with the introduction of
travel control measures 1. The Wuhan shutdown delayed
the occurrence of the first case of SARS-CoV-2 in other cities by 2.91
days (95%CI: 2.54- 3.29 days), an intervention that benefited
>130 cities in mainland China, covering more than half its
geographic area (Tian et al). Social distancing measures are also a key
component of the control strategies during pandemics and form one of the
most effective techniques in reducing the number of infections. It is
also vital that social distancing and travel restrictions are not lifted
prematurely while there is a pool of susceptible hosts in the
population, as this will lead to an increase in the number of
infections2. When applied to the healthcare sector
these measures should aim to reduce hospital attendance by triaging out
low risk patients both to protect clinicians and hospitalised patients,
while still allowing timely investigations on those deemed to be at
higher risk.
Interventions, such as outpatient telemedicine consultations, can reduce
footfall in hospitals, thereby promoting adherence to social distancing
policies 3. These measures are especially relevant in
the cohort of patients with head and neck diseases as the nose and
nasopharynx have been shown to be reservoirs for high concentrations of
the SARS-CoV-2 4. Reduction of upper aerodigestive
tract interventions, including outpatient examinations, is important as
many are considered to be aerosol generating procedures5. Additionally, SARS-CoV-2 remains viable in aerosols
with a median half-life of 1.1 hours 6, potentially
making the examination room a source of infection.
The NHS guidance for managing cancer referrals during the COVID-19
pandemic recommends a telephone triage to minimise interactions and
appointments with health services and stream patients for investigations
where appropriate 7. Additionally, a telephone
appointment with a specialist clinician is accepted as a first
appointment for the purposes of recording cancer waiting times for new
referrals. As telephone triage is a relatively novel intervention for
suspected head and neck cancer, there is currently no established
structure to frame this consultation.
The aim of this paper is to demonstrate a rapid implementation of an
evidence-based, structured, remote triaging system for assessment of
suspected cancer referrals and patients who are on regular follow up
after treatment for HNC in the United Kingdom (UK).