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.