Background: Management of head and neck cancers (HNC) in Radiation Oncology in the COVID-19 era is challenging. Aim of our work is to report organization strategies at a Radiation Therapy (RT) Department in the first European area experiencing the COVID-19 pandemic. Methods: We focused on 1) dedicated procedures for HNC, 2) radiation treatment scheduling and 3) healthcare professionals’ protection applied during the Covid-19 breakdown (from 1st March to 30th April 2020). Results: Applied procedures are reported and discussed. Forty-three pts were treated. Image-guided, Intensity Modulated RT was performed in all cases. Median overall treatment time (OTT) was 50 (IQR: 47-54.25) days. RT was interrupted/delayed in seven pts (16%) for suspected COVID-19 infection. Two health professionals managing HNC pts were proven as COVID-19 positive. Conclusion: Adequate and well-timed organization allowed for the optimization of HNC pts balancing at the best of our possibilities pts’ care and personnel’s safety.

Introduction: The COVID-19 pandemic caused by the SARS-CoV-2 virus has altered the healthcare environment for the management of head and neck cancers.  The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits.Methods: Creation of consensus document.Results: The process yielded a consensus statement among a wide range of practitioners involved in the management of head and neck cancer patients in a multi-hospital tertiary care health system. Conclusions: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature. 

The coronavirus disease 2019 (COVID-19) pandemic has become a major public health crisis. The diagnostic and containment efforts for the disease have presented significant challenges for the global healthcare community. In this brief report, we provide perspective on the potential use of salivary specimens for detection and serial monitoring of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on current literature. Oral healthcare providers are at an elevated risk of exposure to COVID-19 due to their proximity to nasopharynx of patients, and the practice involving the use of aerosol-generating equipment. Here we summarize the general guidelines for oral healthcare specialists for prevention of nosocomial transmission of COVID-19, and provide specific recommendations for clinical care management.

IntroductionAs the novel coronavirus (2019-nCov) globally spreads, the coronavirus disease (COVID-19) pandemic is straining healthcare workers worldwide [1]. In hospitalized patients with severe COVID-19, endotracheal intubation is one of the most common and indispensable life-saving interventions. In a recent report from the City of New York, 12% of COVID-19 patients required invasive mechanical ventilation [2]. Since difficult weaning and prolonged mechanical ventilation represent the two most common indications for tracheostomy in Intensive Care Unit (ICU), it may play a central role in COVID-19 management [3]. During the 2019-nCov pandemic the aerosol generating procedures, such as tracheostomy, expose physicians at high risk to contract the \soutCOVID-19 infection [4]. Accordingly, special consideration may be done to protect otolaryngologists, general surgeons and critical care physicians from the risk of infection while performing a tracheostomy in COVID-19 patients [5]. Percutaneous tracheostomy (PT) is routinely performed at the bedside in intensive care unit (ICU); unfortunately, a modified protocol to perform PT in COVID-19 patients included several critical steps associated with increased risk of aerosol generation, such as changing the catheter mount, repositioning the endotracheal tube cuff to the level of the vocal cords and removal of large dilator [6]. So far, there has been no prior description in the literature of how to minimize the aerosol generation during PT. We reported a modified percutaneous tracheostomy technique aiming to minimize the risk of aerosol generation and to increase the staff safety in COVID-19 patients.

Vanessa Yee Jueen Tan MBBS (S’pore), MRCS (Glasgow), MMed (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalEdward Zhiyong Zhang MBBS (S’pore), MRCS (Glasgow), MMed (ORL), MCI, FAMS (ORL) Department of Otolaryngology – Head and Neck Surgery Sengkang General HospitalDan Daniel PhD Institute of Materials Research and EngineeringAnton Sadovoy PhD Institute of Materials Research and EngineeringNeville Wei Yang Teo MBBS (S’pore), MRCS (Glasglow), MMed (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalKimberley Liqin Kiong MBBS (S’pore), MRCS (Edinburgh), MMed (ORL), FAMS (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalSong Tar Toh MBBS (S’pore), MRCS (Edin), MMed (ORL), MMed (Sleep Med), FAMS (ORL) Department of Otorhinolaryngology – Head and Neck Surgery Singapore General HospitalHeng Wai Yuen MBBS (S’pore), MRCS (Edinburgh), MMed (ORL), DOHNS (England), GDFM Ear Nose Throat, Head and Neck Surgery Changi General HospitalCorresponding author: Vanessa Yee Jueen Tan vanessa.tan.y.j@singhealth.com.sg

Background The COVID-19 pandemic has reduced clinical volume with a negative impact on trainee education.   Methods Survey study of Otolaryngology trainees in North America, during the COVID-19 pandemic in April 2020.  Results Of 216 respondents who accessed the survey, 175 (83%) completed the survey. Respondents reported a universal decrease in clinical activities (98.3%). Among participants who felt their program utilized technology well, there were significantly decreased concerns to receiving adequate educational knowledge (29.6% vs. 65.2%, p=0.003).  However, 68% of trainees still expressed concern in ability to receive adequate surgical training. In addition, 54.7% of senior trainees felt that the pandemic had a negative impact on their ability to secure a job or fellowship after training. Conclusions Trainees universally felt a negative impact due to the COVID-19 pandemic.  Use of technology was able to alleviate some concerns in gaining adequate educational knowledge, but decreased surgical training remained the most prevalent concern.