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.