Strategies to mitigate the HNC surge
HNC patients, along with otolaryngologists, are high-risk populations for contracting COVID-19, primarily due to the fact that high viral loads of SARS-CoV-2 are located in the upper aerodigestive tract and procedures in this area (e.g. endoscopy, tracheostomy, surgery, etc.) lead to aerosolization of viral particles.9 In addition to this, HNC patients in particular may be susceptible to rapid deterioration and worse outcomes (e.g. admission to an intensive care unit, mechanical ventilation, and death) if they do contract COVID-19 due to coexisting comorbidites.10-11 Therefore, in order to manage the surge of HNC patients, certain precautions and strategies must be implemented by otolaryngologists to effectively treat these patients.12 First and foremost, ample PPE should be available before seeing any patients or doing any procedures. In association with this, pre-appointment screening should be done on all patients and (rapid) COVID testing should be utilized when available and appropriate.13
Scheduling should be streamlined to allow for timely care. Telemedicine has been shown to be a valuable tool in this era, and although it comes with its’ own limitations, it can be optimized in order to provide care for HNC patients.14-15 Visits that are expected to predominantly involve reviewing results and counseling can be performed with telemedicine. One strategy would be to schedule all patients for telemedicine visits, except for those which require an in-office procedure (such as a biopsy or laryngoscopy) or for whom in-person physical examination is critical for decision-making (such as palpation of an oral tongue cancer).
Multidisciplinary care through a head and neck tumor board has been clearly shown to improve outcomes in patients with head and neck cancer.16-18 During the COVID-19 pandemic, utilization of a multidisciplinary decision-making is of critical importance, especially when there is an influx of many patients during a time of limited resources and high risk of COVID-19 transmission. In some situations, surgical and non-surgical treatment options may have similar outcomes. In such situations, the preferred option is the one which allows for timely initiation of treatment while conserving resources and minimizing risks to patients and healthcare workers. Given the complexity of such decisions and influence by evolving local and regional factors, multidisciplinary consensus is critical. Since many otolaryngologists whose practices do not focus on HNC may not be experiencing the clinical volume that they normally have, their clinical skills could be of critical importance in managing an influx of HNC patients. Having these providers available to provide care for patients during the HNC surge could facilitate timely diagnosis, workup, and treatment. However, close monitoring of outcomes is necessary, as is always the case, to ensure that patients are receiving the highest level of care.