Staying ahead of the curve: Early lessons from a New York City Otolaryngology Department's organizational response to the coronavirus pandemic

• Published in: Laryngoscope Investigative Otolaryngology 2020-06, Vol.5 (3), p.401-403
• Main Authors: Schwam, Zachary G., Jategaonkar, Ameya A., Teng, Marita S., Horn, Scott, Lebovics, Robert S., Genden, Eric M., Wanna, George B.
• Format: Article
• Language: English
• Subjects: Airway management; Comprehensive (General) Otolaryngology; Coronaviruses; COVID-19; Disease transmission; Hospital systems; Hospitals; Intensive care; Internal medicine; Intubation; Ostomy; Otolaryngology; Pandemics; Patients; Personal protective equipment; Pulse oximetry; Severe acute respiratory syndrome coronavirus 2; Surgery; Teams; Telemedicine; Tracheotomy
• ISSN: 2378-8038; 2378-8038
• DOI: 10.1002/lio2.400

Herein we present our early logistical experience as it pertains to the Department of Otolaryngology—Head and Neck Surgery in a large hospital system within New York City, the current American epicenter of the pandemic. 2 CESSATION OF NONURGENT CASES, REMAINING CLINICAL ACTIVITIES, AND THE ROLE OF TELEMEDICINE Early in the course of our hospital system's response, a decision was made by department leadership to cease nonurgent surgical cases as well as routine in‐person outpatient visits. [...]an attending otolaryngologist was available on premises at all times to assist. The purpose of defining roles and a chain of command was to minimize unnecessary disease exposure by having the most experienced clinicians performing airway interventions and to preserve PPE as much as possible. 6 POLICIES REGARDING TRACHEOSTOMY With 9.8% to 15.2% of COVID patients requiring prolonged invasive mechanical ventilation,9, 7, 10, 8, 4 it is of critical importance to establish early guidelines with respect to performing elective tracheostomy, as risks to the healthcare team may be significant.12, 11 Our departmental policies regarding tracheostomy are consistent with those of the New York Head and Neck Society (NYHNS), which recently released comprehensive guidelines on the matter.13 When feasible, we generally advocate delaying elective tracheostomy until 21 days after symptom onset to balance the risk of laryngotracheal stenosis with the higher viral loads present during the acute phase of the infection.13-15 In addition, in the SARS‐1 literature, mean time from disease onset to death was 23.7 days, providing little incentive to perform tracheostomy before this timeframe.12, 16 Patients with poor prognoses with imminent risk of death are also considered to be poor candidates for elective tracheostomy; we recommend consulting with the involved medical teams, the patient's family, and relevant hospital ethics committees as appropriate. All staff are also to be carefully screened daily; anyone with concerning symptoms or pulse oximetry