Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), known
colloquially as COVID-19, is a novel zoonotic infection that has caused
a worldwide pandemic 1. In many parts of the world the
medical system has been severely stressed by the burden of this novel
illness as the demand for medical care exceeds capacity. The illness is
highly contagious and is spread through respiratory droplets. The highly
contagious nature and relatively high mortality compared to other viral
respiratory illnesses has made COVID-19 a “perfect storm” for a
pandemic 2. Otolaryngologists are at high risk for
transmission of COVID-19 due to the high risk of contact with
aerosolized nasal, pharyngeal, or tracheal secretions during many of our
routine procedures 3,4. The first reported physician
death in Wuhan was an otolaryngologist 5.
As of April 26, 2020 there were 6,213 confirmed COVID-19 cases in the
state of Alabama (71,334 overall tested) with 213 reported deaths6. Of all patients tested, 8.7% were positive. For
comparison, the state of New York, the hardest hit state in the United
States thus far, had 282,143 total cases and 16,599 deaths (777,568
overall tested) 7. 36.3% of tests given in NY state
have been positive. Our institution is a large, tertiary care center
situated in Birmingham, AL and receives patients from our entire state
as well as portions of neighboring states (TN, MS, GA, FL). This is in
contrast with NY, which has a much larger healthcare system, with
multiple large hospital systems in the city of New York alone. Our
relatively low overall case numbers compared with other regions are due
to a multitude of reasons, including our relatively low population
density, low amount of travel in and out of the state, and testing
limitations. At our institution (University of Alabama-Birmingham), the
number of COVID-19+ inpatients has not exceeded 62. We have had no
documented positive COVID-19 tests among faculty, residents, advanced
practice providers (APPs), or ancillary staff in our otolaryngology
department. A focused timeline of events is shown in Figure 1.
There have been several recent publications focused on the response to
COVID-19 within the otolaryngology community. Currently, the American
Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) has
recommended delaying all non-emergent operations and postponing all
non-essential face-to-face clinic encounters 8.
Consistent with this is the recommendation that all tier 1 and 2
procedures as defined by the Centers for Medicaid and Medicare Services
(CMS) should be deferred during the pandemic 9,10.
Early data from the pandemic also showed that cancer patients have
significantly worse outcomes when infected with COVID-1911. These data are to be interpreted with caution
given possible regional differences in practice patterns with regard to
resource utilization. With this context in mind, the current paper will
retrospectively discuss the approach of the head and neck surgery (HNS)
division of our tertiary care center in Birmingham, AL with regards to
surgical care, outpatient care, and academics.