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.