Dear MSOHNS Members,
We are now in the fight to flatten the second wave of COVID-19 pandemic while trying to prevent the tsunami that may cripple our health care system. While most cases of COVID-19 are mild, 5% of patients may require intensive care for acute respiratory distress syndrome (ARDS), shock and multiorgan failure.1
What concerns us most is the vulnerability of the ORL profession during this period. It has been reported that in Wuhan, otorhinolaryngologists and ophthalmologists were infected at higher rates than other colleagues in the same hospitals.2 Based on discussions with our international counterparts, there are similar findings in Italy and Iran which are hammered by the number of cases close to China’s proportions.
The route of transmission of COVID-19 is not yet fully elucidated but is thought to be mainly respiratory.3,4 Early signs and symptoms are vague and commonly misinterpreted as upper respiratory tract infection such as fever (43.8-88.7%) and cough (67.8%).5 These common symptoms could lead to patients seeking treatment in an ORL Clinic.
More recently, a significant number of COVID-19 patients complained of anosmia/hyposmia. In Germany, more than two-third of confirmed cases had anosmia. What is more alarming is that countries such as US, France and Italy reported of isolated anosmia as the presenting symptom.6 Once again, isolated anosmia would lead a patient to seek ORL consultation.
Besides the symptomology which may lead to undiagnosed COVID-19 patients coming to our clinic, some speculate that the higher risk in our profession could be due to high viral shedding from the nasal cavity. 5 The need for close contact with the patients during examination is one factor. The second factor is most of the ORL endoscopy procedures result in aerosolization. 7,8
At this juncture, we advise judicious use of scopes and emphasize the importance of personal protection equipment. WHO provides guidance on personal protection equipment in infection prevention and control when COVID-19 is suspected. Eye protection (face shield or goggles) or facial protection (face mask preferably N95), gown and gloves should be worn, and healthcare workers are advised against touching any mucosal membranes (eyes, nose or mouth).3,9 Do consult your relevant Infection Control Units for proper guidance if available.
Until we have flattened this curve, we wish all to remain safe and stay united in this fight against Covid 19.
Executive Committee 2019-2020
Malaysian Society of Otorhinolaryngologists Head & Neck Surgeons / Chapter of ORL-HNS, College of Surgeons, Academy of Medicine of Malaysia
1. Murthy S et al. Care for critically ill patients with COVID-19. JAMA 2020 Mar 11; [epub]. (https://doi.org/10.1001/jama.2020.3633)
2. https://www.bloomberg.com/news/articles/2020-03-17/europe-s-doctors-getting-sicklike-in-wuhan-chinese- doctorssay?fbclid=IwAR2ds9OWRxQuMHAuy5Gb7ltqUGMZNSojVNtFmq3zzcSLb_bO9aGY r7URxaI
3. World Health Organization Laboratory testing for 2019 novel coronavirus (2019- nCoV) in suspected human cases – Interim guidance, 2020.
4. Huang C , Wang Y , Li X , et al Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020. doi:doi:10.1016/S0140-6736(20)30183- 5. [Epub ahead of print: 24 Jan 2020].
5. Guan W, Ni Z, Hu Y, Liang W et al. Clinical Characteristics of Coronavirus Disease 2019 in China. NJEM DOI: 10.1056/NEJMoa2002032
6. Loss of sense of smell as marker of COVID-19 infection. https://www.entuk.org/losssense-smell-marker-covid-19-infection
7. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med. 2020 Mar 19;382(12):1177-1179. doi: 10.1056/NEJMc2001737. Epub 2020 Feb 19.
8. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020 Mar 17. doi: 10.1056/NEJMc2004973. [Epub ahead of print]
9. World Health Organization Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected. Interim guidance, 2020