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The Academy is continuously monitoring the public health situation related to coronavirus disease 2019 (COVID-19) to provide information and resources for you, your practice, and your patients. COVID-19 information for patients can be found on ENThealth.org

 

AAO-HNS COVID-19 PODCAST SERIES

ANOSMIA

[March 26, 2020] NEW! COVID-19 ANOSMIA REPORTING TOOL  There is rapidly accumulating anecdotal evidence that anosmia with resultant dysgeusia are frequently reported symptoms associated with the COVID-19 pandemic. Similar reports are surfacing from multiple countries around the world including the United States. In an effort to establish the significance of these symptoms in diagnosis and progression of COVID-19, the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) has established the COVID-19 Anosmia Reporting Tool. This tool was developed by the AAO-HNS Infectious Disease and Patient Safety Quality Improvement Committees to allow healthcare providers of all specialties worldwide to submit data to confidentially report on anosmia and dysgeusia related to COVID-19. Access the Reporting Tool>>

[March 22, 2020] Anosmia, Hyposmia, and Dysgeusia Symptoms of Coronavirus Disease Anecdotal evidence is rapidly accumulating from sites around the world that anosmia and dysgeusia are significant symptoms associated with the COVID-19 pandemic.  Anosmia, in particular, has been seen in patients ultimately testing positive for the coronavirus with no other symptoms. We propose that these symptoms be added to the list of screening tools for possible COVID-19 infection.  Anosmia, hyposmia, and dysgeusia in the absence of other respiratory disease such as allergic rhinitis, acute rhinosinusitis, or chronic rhinosinusitis should alert physicians to the possibility of COVID-19 infection and warrant serious consideration for self-isolation and testing of these individuals

AAO-HNS STATEMENTS

FEDERAL AND STATE FINANCIAL RELIEF ASSISTANCE

CARES ACT RELATED FINANCIAL RELIEF INFORMATION

House of Medicine Letter on CARES Act Emergency Funding 

Today, April 7, 2020, the AAO-HNS joined scores of groups across the House of Medicine in sending a letter to U.S. Secretary of Health and Human Services (HHS) Alex Azar regarding immediate financial relief for physician practices. The coalition urged HHS to provide one month of revenue to each physician (MD or DO) enrolled in Medicare or Medicaid to account for financial losses and non-reimbursable expenses resulting from the COVID-19 crisis. This funding was included in the CARES Act, which authorized $100 billion in direct financial support for healthcare providers.

ADDITIONAL FINANCIAL RELIEF RESOURCES:

TELEMEDICINE

OTO JOURNAL COVID-19 ACCEPTED PAPERS

SHARED CLINICAL

NEWS FROM AROUND THE SPECIALTY 

LATEST NEWS FROM FEDERAL AGENCIES

Browse the “Guidance for Your Practice” section below for select information from the CDC, including patient triage, practice preparedness, device sterilization, personal protective equipment, and more. 

Guidance for Your Practice

Title: 
How can my practice minimize chance of exposure?
Body: 

According to the CDC, measures should be implemented before patient arrival, upon arrival, throughout the duration of the patient’s visit, and until the patient’s room is cleaned and disinfected. It is particularly important to protect individuals at increased risk for adverse outcomes from COVID-19 (e.g. older individuals with comorbid conditions), including HCP who are in a recognized risk category. [Source: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html]

Title: 
What if a patient is in my office who I suspect is a person under investigation (PUI) and should be tested?
Body: 

Healthcare providers should immediately notify their local or state health department in the event of a PUI for COVID-19.

Clinicians should immediately implement recommended infection prevention and control practices if a patient is suspected of having COVID-19. 

Follow the CDC’s guidance on Evaluating and Reporting Persons Under Investigation (PUI) and 

Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease.

Title: 
How do I assess any exposure risk to the healthcare personnel in my practice?
Body: 

Use the following guidance from the CDC: Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)

March 12: The CDC developed the following, Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission, which specifically addresses healthcare settings on page 8. It outlines potential mitigation activities according to level of community transmission or impact of COVID-19 by setting. Specific mitigation strategies have also been developed for Santa Clara, CASeattle, WA, New Rochelle, NY, Florida, and Massachusetts. Continue to check www.coronavirus.gov for added mitigation strategies by location. 

Epidemiologic Risk Classification1 for Asymptomatic Healthcare Personnel Following Exposure to Patients with Coronavirus Disease (COVID-19) or their Secretions/Excretions in a Healthcare Setting, and their Associated Monitoring and Work Restriction Recommendations (Retrieved March 14, 2020)

Click here for larger version. 

Title: 
What personal protective equipment (PPE) should be worn?
Body: 

This guidance was provided by the CDC for healthcare personnel who may care for patients who are confirmed with or under investigation for COVID-19 and to assist healthcare facilities in preventing transmission of COVID-19 in healthcare settings. [source: CDC https://www.cdc.gov/coronavirus/2019-ncov/infection-control/infection-prevention-control-faq.html]

CDC: Personal Protective Equipment (PPE) Burn Rate Calculator [March 25] 

CDC: Strategies for Optimizing the Supply of PPE [March 17]

Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings [source: CDC: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html]

Also, on March 10, the Centers for Medicare & Medicaid Services issued Guidance for use of Certain Industrial Respirators by Health Care Personnel that should be noted.

Title: 
How should we handle specimens from a PUI?
Body: 

See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Patients Under Investigation (PUIs) for COVID-19 and Biosafety FAQs for handling and processing specimens from suspected cases and PUIs.

Title: 
How do we handle disinfecting, sterilizing, and cleaning?
Body: 
  • Implement Environmental Infection Control [source: CDC] https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
  • Dedicated medical equipment should be used when caring for patients with known or suspected COVID-19.
  • All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.
  • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  • Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
  • Refer to List on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.
  • Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.
  • Additional information about recommended practices for terminal cleaning of rooms and PPE to be worn by environmental services personnel is available in the Healthcare Infection Prevention and Control FAQs for COVID-19.
Title: 
What State and Federal Financial Relief Assistance is Available?
Body: 

FEDERAL AND STATE FINANCIAL RELIEF ASSISTANCE

CARES ACT RELATED FINANCIAL RELIEF INFORMATION

House of Medicine Letter on CARES Act Emergency Funding 

Today, April 7, 2020, the AAO-HNS joined scores of groups across the House of Medicine in sending a letter to U.S. Secretary of Health and Human Services (HHS) Alex Azar regarding immediate financial relief for physician practices. The coalition urged HHS to provide one month of revenue to each physician (MD or DO) enrolled in Medicare or Medicaid to account for financial losses and non-reimbursable expenses resulting from the COVID-19 crisis. This funding was included in the CARES Act, which authorized $100 billion in direct financial support for healthcare providers.

ADDITIONAL FINANCIAL RELIEF RESOURCES:

Title: 
Related Research & Shared Clinical
Body: 

OTO JOURNAL COVID-19 ACCEPTED PAPERS

[State of the Art Review] Best Practice Recommendations for Pediatric Otolaryngology During the COVID-19 Pandemic Authors: Darrin V. Bann, MD, PhD; Vijay A. Patel, MD; Robert A. Saadi, MD; Neerav Goyal, MD, MPH; John P. Gniady, MD; Johnathan D. McGinn, MD; David Goldenberg, MD; Huseyin Isildak, MD; Jason May, MD; and Meghan Wilson, MD

[Commentary] Navigating the Ethics of COVID-19 in Otolaryngology Author: Andrew G. Shuman, MD

[Commentary] Impact of the COVID-19 Pandemic on the Management of Head and Neck Malignancies  Authors: Michael T. Werner, Ryan M. Carey, MD, W. Greer Albergotti, MD, John N. Lukens, MD, Robert M. Brody, MD

[Original Research] Approaching Otolaryngology Patients during the COVID-19 Pandemic Authors: Chong Cui, Qi Yao, Di Zhang, Yu Zhao, Kun Zhang, Eric Nisenbaum, Pengyu Cao, Keqing Zhao1, Xiaolong Huang, Dewen Leng, Chunhan Liu, Ning Li, Yan Luo, Bing Chen, Roy Casiano, Donald Weed, Zoukaa Sargi, Fred Telischi, Hongzhou Lu, James C. Denneny III, Yilai Shu, Xuezhong Liu

[Commentary] Otolaryngology Providers Must Be Alert for Mild and Asymptomatic COVID-19 Patients Authors: Xiaoting Chen, MD, PhD, Jialin Liu, MD, PhD, Ning Li, MD, PhD, Eric Nisenbaum, MD, MSc, Qing Sun, MD, Bing Chen, MD, PhD, Roy Casiano, MD, Donald Weed, MD, Fred Telischi, MD, James C. Denneny III, MD, Zuezhong Liu, MD, PhD, Yilai Shu, MD, PhD

[Commentary] COVID-19 Pandemic: What Every Otolaryngologist–Head and Neck Surgeon Needs to Know for Safe Airway Management Authors: Karthik Balakrishnan, MD, Samuel Schechtman, MD, Norman D. Hogikyan, MD, Anthony Y. B. Teoh, FRCSEd, MBChB, Brendan McGrath, MB, ChB, FRCP, FRCA, EDIC, DICM, AHEA FFICM, MAcadMEd, PhD, and Michael J. Brenner, MD

[Commentary] Pediatric Otolaryngology Divisional and Institutional Preparatory Response at Seattle Children’s Hospital after COVID-19 Regional Exposure Authors: Sanjay R. Parikh, MD, Randall A. Bly, MD, Juliana Bonilla-Velez, MD, John P. Dahl, MD, PhD, MBA, Sean S. Evans, MD, David L. Horn, MD, MS, Kaalan E. Johnson, MD, Scott C. Manning, MD, Henry C. Ou, MD, MA, Prasanth Pattisapu, MD, Jonathan A. Perkins, DO, and Kathleen C. Y. Sie, MD

[Commentary] A Commentary on Safety Precautions for Otologic Surgery during the COVID-19 Pandemic Authors: Robert A. Saadi, MD, Darrin V. Bann, MD, PhD, Vijay A. Patel, MD, David Goldenberg, MD, Jason May, MD, and Huseyin Isildak, MD

[Commentary] Role and Management of a Head and Neck Department during the COVID-19 Outbreak in Lombardy Authors: Saibene Alberto Maria, MD, MA, Allevi Fabiana, MD, PhD, Federico Biglioli, MD, and Felisati Giovanni, MD

OTHER RESEARCH

[Research] Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 PandemiGivi B, Schiff BA, Chinn SB, et al. Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg. Published online March 31, 2020. doi:10.1001/jamaoto.2020.0780.

[Research]  Surgical Considerations for Tracheostomy During the COVID-19 Pandemic Tay JK, Khoo ML, Loh WS. Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak. JAMA Otolaryngol Head Neck Surg. Published online March 31, 2020. doi:10.1001/jamaoto.2020.0764

[Research]Olfactory and Gustatory Dysfunctions as a Clinical Presentation of Mild to Moderate forms of the Coronavirus Disease (COVID-19): A Multicenter European Study, accepted for publication in Eur Arch Otorhinolaryngol

[Research] Anosmia outbreak in Iran: Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak, preprint shared by author Seyed Hamidreza Bagheri, MD.

Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020 Centers for Disease Control and Prevention [published March 31, 2020]

Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020, Centers for Disease Control and Prevention [published March 18, 2020]

Safe tracheostomy for patients with severe acute respiratory syndrome. Wei WI et al. Laryngoscope. (2003)

Content Related to Coronavirus in Annals of Internal Medicine

[Video] Stanford Medicine OHNS ENT Town Hall Regarding COVID-19 The AAO-HNS would like to thank Robert K. Jackler, MD and the Stanford Department of Otolaryngology-Head and Neck Surgery for the incredible effort required to produce the following Town Hall meeting on COVID-19 and for their willingness to share their information with all otolaryngologists.

[CDC: March 21] Information for Clinicians on Therapeutic Options for COVID-19 Patients

[Research] PRECAUTIONS FOR ENDOSCOPIC TRANSNASAL SKULL BASE SURGERY DURING THE COVID-19 PANDEMIC

NIH: Study Suggests New Coronavirus May Remain on Surfaces for Days [March 24]

[Resource] Handbook of COVID-19 Prevention and Treatment, The First Affiliated Hospital, Zhejiang University School of Medicine, Compiled According to Clinical Experience, Editor Prof. Tingbo LIANG

[Commentary] COVID-19 and Ear Surgery, (RK Jackler, Stanford)

  

ADDITIONAL RESOURCES

The following resources are from federal government agencies, institutions, and organizations. We also recommend that you stay connected with your state medical board and hospital systems for additional timely updates at the state and local levels.

Centers for Disease Control and Prevention (CDC): 

Food and Drug Administration (FDA)

Centers for Medicare & Medicaid Services (CMS)

World Health Organization (WHO)

Maps and Charts

ENThealth.org

Last reviewed April 7, 2020