Impact of COVID-19 on Elective Surgical Lists in Otorhinolaryngology: An Overview

Objective: To study how the COVID-19 is affecting the treatment and management of other ailments. Try to find a strategy to resume elective OR lists. Introduction:


Introduction
The outbreak of the novel coronavirus SARS-CoV-2 (COVID-19) was epi-centered in the Hubei province of China.On 30th January 2020, it was declared as a global health emergency by the WHO Emergency Committee. 1 The Coronaviruses are Positive single-stranded, enveloped large RNA viruses that infect a wide range of animals and humans.First described by Tyrell and Bynoe in 1966. 2 Probably SARS-CoV-2 made its animal to human transmission at the Huanan seafood market, but the exact route of transmission still needs to be identified.As the cases started appearing, different countries implemented different measures to stop the spread of contagion.Social distancing, stay-at-home, work from home, smart lockdown, or complete lockdown with police patrolling the streets were different types of strategies employed by different countries and different regions within a country.Identifying and screening of close contacts of confirmed cases was also carried out in some countries. 4,5n Pakistan, we started from complete lockdown, and then gradually the lockdown was uplifted till we progressed to "SMART LOCKDOWN".In Hospitals, the elective operation theatre lists are still at a stop.OPDs are partially functional.We overviewed the effect of COVID-19 on the elective surgical lists and management of non-communicable diseases and tried to devise some strategies to cope with these problems.

Materials and Methods
Objective: To study how the COVID-19 is affecting the treatment and management of other ailments.Try to find a strategy to resume elective OR lists.Setting and Participants: It is a descriptive study done in the ENT Department of Holy Family Hospital, Rawalpindi, the data was collected from the dating register of patients and elective OT lists.The data, from Jan 2020 to June 2020, was analyzed and data of 3 months before the lockdown was compared with 3 months after lockdown due to COVID-19.Statistical Analysis: Done using Microsoft excel spreadsheet version 7. Ethical Approval: Research was approved by IRF.

Results
From Jan 2020 to March 2020, a total of 1500 surgeries were done in the elective operation theatre of ENT, and from March 2020 to July 2020, the number of surgeries done in ENT operation theatre reduced to 120.There was an overall 92% decrease in the elective surgical procedures done in the ENT Department of Holy Family Hospital, Rawalpindi during the COVID-19 lockdown period.Engineering control measures that can be adopted to reduce the spread of infection include the use of HEPA filters at the patient end of the breathing circuit and also between the expiratory limb of the circuit and anesthesia machine, use of only one door while the patient is inside the operation theatre and applying a surgical mask on the patient.Personal protective equipment should be used by all the personnel involved in the care of a patient in the OT which includes an anaesthetist, surgeon, staff nurses, OT assistants, and technicians.These may include N95 masks, goggles, visors, and protective gowns made of non-woven material.Operation theatre should be disinfected after every surgical procedure with 0.1% Sodium hypochlorite solution for 1 minute, which should be followed by hydrogen peroxide vaporization or UV-C irradiation. 11During induction of anesthesia, rapid sequence induction should be preferred to reduce the risk of aerosolization of the virus.If pre-oxygenation is needed, it should be done by a well-fitting face mask, the patient should be fully sedated and paralyzed before intubation and it should be ensured that full expiration has occurred before lifting the face mask of the patient.The patient should wear a surgical mask after extubation, oxygenation should be done by nasal prongs beneath the face mask, venturi masks should be avoided.The patient should recover fully in the operation theatre.The operation theatre with a negative airflow system is ideal for avoiding the spread of infection beyond the OT 11, but our operation theatres do not have this system, so we can use high frequency (25/hr.) of air changes to reduce the viral load.
Routine postoperative visits should be done on phone calls if possible.Post-op patients should visit the hospital only if necessary.

Conclusion
COVID-19 has badly influenced the elective surgical lists of dept. of ENT Head and neck surgery Holy family hospital Rawalpindi as shown in the results above.Now as we are heading towards the 2 nd wave, we should adopt the measures listed above to lessen this effect of COVID-19 on our future work.The preparation for the 2 nd wave starts by reviewing the previous one.Preparation between the waves has to be done on personal, departmental, and hospital levels.Accurate data collection during the next wave has to be planned at this stage.