Introduction
As the COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2
continues to escalate globally, we are faced with developing methods to
provide care to our patients while also keeping them, our co-workers,
and ourselves safe. Healthcare workers are at increased risk of exposure
to the virus, and there is mounting evidence that otolaryngologists are
among the highest at risk. This is likely due to a high viral load of
SARS-CoV-2 in the upper aerodigestive tract and because of the direct
contact that practitioners have with the mucosa during both diagnostic
and therapeutic procedures.1–3 Once the respiratory
mucosa is manipulated, viral particles have the ability to become
aerosolized, can become airborne for three or more hours, and may spread
to contaminate multiple surfaces in the surrounding
area.4–6 Of particular concern is that even
asymptomatic patients may be responsible for viral aerosolization, given
its long incubation period (5-7 days), and that these asymptomatic
patients may unknowingly place our surgical teams at
risk.1,7–9
We do, however, still have an obligation to perform urgent and emergent
cases for life-threatening situations or diseases, such as cancer, where
failure to act will lead to high morbidity. Indeed, it is known that
cancer patients are susceptible to infection. Early data from China has
shown that among patients with COVID-19, there is an approximately
three-fold higher proportion of patients with cancer than the incidence
of cancer in the general population.10 Open,
endoscopic and robotic oncologic surgery of the upper airway may expose
providers to high levels of viral particles in the respiratory mucosa
and saliva.2,11 Several institutions have generated
head and neck specific algorithms to help risk stratify patients and
procedures advocating strongly for preoperative SARS-CoV-2 testing and
appropriate utilization of personal protective equipment (PPE) in
patients undergoing head and neck mucosal
surgery.12,13 There has been very little published,
however, regarding whether there exist any topical agents that could be
utilized preoperatively to potentially lower the viral load in the upper
aerodigestive tract thereby mitigating any risk of viral aerosolization
in persons undergoing head and neck mucosal surgery. In this review, we
aimed to review the literature discussing topical agents that are safe
to use as oral rinses and that may have virucidal activity against
SARS-CoV-2.