Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic | Facial Plastic Surgery | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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    Special Communication
    March 31, 2020

    Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic

    Author Affiliations
    • 1Department of Otolaryngology, NYU Langone Health, New York, New York
    • 2Department of Otolaryngology, Montefiore Medical Center, New York, New York
    • 3Department of Otolaryngology, University of Michigan, Ann Arbor
    • 4Department of Otolaryngology, Oregon Health & Science University, Portland
    • 5Department of Head and Neck Surgery, Singapore General Hospital and National Cancer Centre, Singapore
    • 6Department of Otolaryngology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    • 7Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
    • 8Department of Otolaryngology, Louisiana State University, Shreveport
    • 9Department of Otolaryngology, Stanford University, Palo Alto, California
    • 10Department of Otolaryngology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
    • 11Department of Otolaryngology, University of Cincinnati, Cincinnati, Ohio
    • 12Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
    • 13Department of Veterans Affairs, White River Junction, Vermont
    JAMA Otolaryngol Head Neck Surg. 2020;146(6):579-584. doi:10.1001/jamaoto.2020.0780

    Importance  The rapidly expanding novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged the medical community to an unprecedented degree. Physicians and health care workers are at added risk of exposure and infection during the course of patient care. Because of the rapid spread of this disease through respiratory droplets, health care workers who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures, such as otolaryngologists–head and neck surgeons, are particularly at risk. A set of safety recommendations was created based on a review of the literature and communications with physicians with firsthand knowledge of safety procedures during the COVID-19 pandemic.

    Observations  A high number of health care workers were infected during the first phase of the pandemic in the city of Wuhan, China. Subsequently, by adopting strict safety precautions, other regions were able to achieve high levels of safety for health care workers without jeopardizing the care of patients. The most common procedures related to the examination and treatment of upper aerodigestive tract diseases were reviewed. Each category was reviewed based on the potential risk imposed to health care workers. Specific recommendations were made based on the literature, when available, or consensus best practices. Specific safety recommendations were made for performing tracheostomy in patients with COVID-19.

    Conclusions and Relevance  Preserving a highly skilled health care workforce is a top priority for any community and health care system. Based on the experience of health care systems in Asia and Europe, by following strict safety guidelines, the risk of exposure and infection of health care workers could be greatly reduced while providing high levels of care. The provided recommendations, which may evolve over time, could be used as broad guidance for all health care workers who are involved in the care of patients with COVID-19.