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.