Results
A total of 194 Covid-19 related guidance relevant to the Otolaryngologist was identified during the 20 weeks between the 1st of January and 31st May 2020. 19 of these 194 duplicates published by multiple organisations as collaborative work. Therefore 175 original articles were published by international organisations 52/175 (29.70%), national organisations 57/175 (32%) and by ENT specific organisations 66/175 (38.20%). Figure 1.
All of the 175 guidance’s covered multiple topics, separating these into the 10 main topics PPE was the subject in 31%, Service prioritisation (13%). General advice relating to treating elective otolaryngological conditions either surgically or conservatively (20%). Screening (4%), Cancer care (8%), tracheostomy (7%) and specific areas of Otology (4.1%), Rhinology (4%), Paediatrics ENT (3%) and Service recovery (5%). In total 313 topic areas were covered in the 175 guidance’s. (Table 1)
The WHO declared the pandemic on the 11th March 202018. Before this date only 8/175 guidance had been published. Following this there was a rapid escalation in guidance being issued. The peak guidance production took place in the third and fourth week of March (16/03/2020- 29/03/2020) with 33/175 publications in the third week of March and 37/175 in the fourth week. (See Figure 2)
Of these 70 publications, 27 came from the international category, 17 from national bodies and 26 from ENT-specific organisations. During this peak period the majority of the advice was related to PPE (48/70, 68.5%). (Table 2)
Service recovery related publications commenced a fortnight post-peak guidance period. Between the 9th of April and the 20th of May, 16 guidances on service recovery were identified. During this period, the number of publications increased by an average of 2.2 per week with a peak of 5 publications during the second week of May.
12 came from national and ENT-specific bodies: 5 from ENT-UK, 2 from the Royal College of Surgeons, 3 from Public Health England, 1 from the Royal College of Radiologists and 1 from the NHS website. 4 came from International bodies included the American Academy of Otolaryngology and Head and Neck, Centres for Medicare and Medicaid.
Most guidance relevant to otology, rhinology and paediatric ENT was produced during the peak period and constitutes 10%, 7.1% and 7.1% respectively. During the subsequent four weeks 1-2 pieces of advice were produced per week before the number of publications tailed off.
A total of 13,863 peer-reviewed publications relating to COVID-19 were identified using PubMed and Cochrane searches. At the time of the pandemic being announced there had been 966 COVID-19 related publications of which 610 related to Otolaryngology. The volume increased over time, with a sharp increase occurring at the end of March 2020. Figure 3. A similar pattern was followed by the volume of publications relevant to ENT, where 10,567 total publications were identified.