INTRODUCTION
The COVID-19 pandemic in Italy has affected the entire national health
service, by imposing the clinicians to adopt new security measures for
out- and inpatients, and a re-organization of the clinical and surgical
procedures in almost all the hospitals. The ENT surgeon represents one
of the most exposed figures of the pandemic scenario, due to its field
of action that includes the upper aerodigestive tract with high-risk
procedures for COVID-19 transmission, such as endoscopic examination or
aerodigestive surgery, including tracheostomy 1,2. At
our Institution, “A. Gemelli” Hospital Foundation – IRCCS, immediate
measures have been taken to reduce transmission of virus and to protect
patients and providers. A neighboring building affiliated to our
Institution was primarily dedicated to COVID patients care but it
quickly got full, thus requiring more resources to our Foundation. All
the outpatient clinics were therefore closed, reducing the activities to
those strictly necessary, such as emergencies and indispensable
admissions only for oncologic patients. In this setting, health care
providers take part to the first cohort of infected patients and the
equilibrium between the clinician mission to care for patients and the
duty to protect them is fragile. Moreover, ethical issues are hard
testing the efficacy of this revised system of health care in the
distribution of resources among the needs of populations and the needs
of individuals, leading to unavoidably treatment delays, sometimes
dangerous especially for cancer patients 3. Alongside
these fundamental issues, for the ENT surgeon there are other challenges
that show-up in the clinical management of a patient affected by a Head
and Neck cancer, once admitted in the Clinic. This kind of patients, in
fact, usually presents old age and several comorbidities, including
cardiac disease, chronic pulmonary disease, peripheral vascular disease,
diabetes, previous cancer history and other factors that could be
confounding in the era of coronavirus pneumonia 4,5.
Moreover, in several surgical oncologic procedures, a new permanent or
temporary tracheostomy is required, increasing the risk of very
dangerous aerosol generating condition in case of unexpected concomitant
coronavirus infection.
6,7. The post-operative period management of these
patients, already rich of pitfalls for the clinician, could be
characterized also by cardiovascular and respiratory complications, thus
requiring complex differential diagnosis with COVID-related conditions,
in a setting of poor resources in the field of radiology and pneumology.
With this manuscript, our aim was to highlight the challenges
encountered during the hospitalization of oncologic patients at our ENT
Clinic, both from clinical and management point of view, during the
pandemic in a COVID-19 dedicated center.