Reasons for the surge and ways to prevent it
Post-Hurricane Katrina, reduced access to cancer care was significantly associated with difficulty obtaining treatment.6 We believe that lack of timely access to care could lead to a similar post-COVID-19 surge of advanced stage HNC across the country. During these unprecedented times, there are many reasons for which a patient may be evaluated later than usual. Patients themselves may fear visiting their doctor at the risk of potentially contracting COVID-19, while physicians have limited their schedules and a patient could be given a later appointment time. Clinics have limited their schedules in order to optimize the safety of their staff and their patients. Reasons for these restricted schedules include but are not limited to, lack of personal protective equipment (PPE), lack of rapid COVID-19 testing, lack of transportation, social distancing and shelter-in-place orders, limiting office visits for patients deemed high risk of contracting COVID-19, lack of access to telemedicine services, and staffing concerns. Fear of contracting COVID-19 has been shown to play a significant role in patients not seeking medical care. In Italy, hospital statistics from the period of March 1-27, 2020, showed substantial decreases (ranging from 73-88%) in pediatric emergency department visits compared with the same time periods in 2018 and 2019. All parents who were surveyed reported avoiding hospitals for fear of infection with COVID-19.8 In light of this, patients and their primary care physicians should be reminded that Otolaryngology – Head and Neck Surgery clinics are still open and consider patient safety the highest priority. This can be done through a variety of platforms such as social media, phone calls, emails, virtual town halls, and online patient portals just to name a few. Patients who are concerned about coming to clinic should be made aware that adequate precautions are in place to decrease the risk of contracting COVID-19 and when appropriate, can be offered telemedicine services.