DISCUSSION
It’s clear that our lives have changed with this pandemic and will
continue to change in the next months, when the worst phase will be
over. One of the most upset participants at this battle will definitely
be our health care system. Modification in the attribution of priorities
of care, reduction of non-COVID-19-related health care, redistribution
of human and economic resources, are just some of the new challenges
that will revolutionize our health care system. Clinicians and health
providers are experiencing several technical, clinical, managing and
ethical issues that are burdening their everyday activity. In our
experience, as one of the most involved countries by the pandemic, our
Institution has tried to guarantee a high-level standard of care for
non-COVID oncologic patients and for emergencies. However, it was not
simple to face up with the consequences of a huge re-organization in a
hospital assigned to be one of the few COVID-centers of a European
capital, as Rome is.
One of the hardest challenges was to guarantee the safety both for
patient in admission and those already hospitalized in our clinic. We
noticed that, during this pandemic, there was a general propensity, by
radiologists, to highlight even minimal signs of interstitial and
peri-bronchial lung inflammation, thus suggesting an adequate
continuation of clinical studies and so overestimating COVID diagnosis.
This represents one of the costs that we will have to pay for a safe way
to prevent the loss of any possible infected patient, who could
represent a high risk of infection for the community. However, this
particular attention could slightly slow down the usual clinical
activity in a Head and Neck oncologic department. Moreover, those
patients with respiratory comorbidities, old age and fever represent
another challenging issue in the post-operative period. Fever could be
present is a frequent sign in the immediate post-operative period11, as well as cough, increased C-reactive protein
level and elevated lactate dehydrogenase 12, but when
they occurred in a patient with dyspnea, oxygen desaturation and
tracheostomy, chest-CT and evaluation by the infectious disease
specialist are mandatory. We found several findings suggestive of novel
coronavirus pneumonia, such as ground-glass opacities (GGO), multilobe
and posterior involvement, bilateral pneumonia, and subsegmental vessel
enlargement 13, so the patients was transferred to a
COVID-dedicated ward, waiting for NP and OP swab results. Obviously,
technical difficulties showed-up immediately after the transfer, due to
the limited number of clinical evaluation possible in a day by the ENT
surgeon, and the difficult management of surgical dressings. This
patient never become positive to both NP and OP swabs, repeated three
times due to the persistence of fever, dyspnea and radiologic findings
suggestive of novel coronavirus pneumonia and was finally addressed to
our attention after antibiotic treatment. In conclusion, the changes in
the whole health system that have been put in place during the COVID-19
pandemic have impacted our daily clinical practice and the management of
head and neck cancer patients, which are the only patients, along with
those in emergency situations, suitable of surgical treatment in our
COVID-dedicated Institution. The guidelines in Italy are constantly
evolving and more efforts are needed to assess the future impact of
COVID-19 on oncology patients. Only a large multicenter study could help
the head and neck surgeons’ community to better standardize future
guidelines to optimize the management of our patients.