The Risks of COVID-19 to Surgeons
As of May 6th, 2020, the Johns Hopkins coronavirus
resource center had reported 3,689,887 confirmed cases involving 187
countries worldwide, with 258,160 deaths. Data from Italy revealed that
up to 20% of healthcare workers were potentially
infected1, and as of 29th April
2020, a total of 154 Italian doctors had succumbed.2Surgeons dealing with the upper aerodigestive tract were found to be
equally at risk as their counterparts in the emergency room, general
ward and intensive care units.3 It is notable that the
first healthcare workers to succumb of COVID-19 complications in Wuhan,
China and UK were both ORL surgeons.4,5
High viral loads have been detected in the nose and throat especially
after symptom onset.6 Thus, both office-based and
operating theatre-based procedures such as nasal endoscopy,
laryngoscopy, tracheostomy and all transoral interventions are
considered to be aerosol generating procedures, and deemed to put the
clinician at higher risk of viral infection. In their recent
recommendations for the COVID-19 pandemic, the International Head and
Neck Scientific Group (IHNSG) have advised to avoid all forms of aerosol
generating procedures and that they should be employed only when it is
absolutely necessary.3
Issues with personal protective equipment (PPE) have been reported
worldwide.7 While the IHNSG have strongly recommended
the use of full PPE for healthcare personnel involved with procedures of
the upper aerodigestive tract,3 reports of surgical
teams having to resort to creating their own PPE using garbage bags,
glue, rubber bands and plastic cover of folders bought from stationary
shops have emerged.8 Health care workers have
expressed concerns over acute supply shortages, insufficient time for
adequate training and unavailability of mask fitting test. A survey of
258 ENT surgeons was conducted across the UK during the peak of the
pandemic in March 2020, seeking their opinion around PPE-related
issues.9 Among the respondents, 40% stated that they
had not attended a PPE training course or that one was unavailable. More
worrying was the fact that N95 masks were only available to 27% of ENT
surgeons with 95% predicting that PPE stocks would deplete in due
course. More than half were aware that there was a COVID-19 protocol in
place implemented by their Trust.9