Discussion
Coronavirus disease 2019 (COVID-19) is highly transmittable pathogenic
viral infection caused by a novel coronavirus (2019-nCoV) closely
related to the Severe Acute Respiratory Syndrome (SARS) and Middle
Eastern Respiratory Syndrome (MERS) Coronaviruses. was first identified
in Wuhan, Hubei province, China on December 8, 2019. and has rapidly
spread around the world causing a global health crisis.
The signs & symptoms of SARS-CoV-2 induced COVID-19 are a bit similar
to those seen in other respiratory infections and include the following
finding at onset of illness [1, 2 ,3] fever (83 % -98.6 %), Dry
cough (59.4-82) & fatigue, myalgia “(muscle pain) (69.6 % -44 %)
with less common symptoms headache (8%), sore throat (5%) & diarrhea
(3%)
Until presently there are no safe promising clinical treatments, no
vaccine or documented anti COVID 19 drugs are validated to develop
efficient therapeutic strategies except for Remdesivir, in addition
favipiravir & combination therapy with hydroxychloroquine plus
azithromycin which all been evaluated against COVID-19 in clinical
trials, resulted in clinical recovery [4]
The World Health Organization had declared the outbreak to be Public
Health emergency of international concern on 30 January 2020 and as the
cases spread from Wuhan, throughout China and into other countries. The
first case of 2019-20 corona virus was confirmed to have reached Bahrain
in February 21st 2020, substantially followed by Saudi Arabia in March
2nd 2020, soon after on march 11 2020 as the cases surged the world
health Organization (WHO) recognized it as pandemic
As COVID-19 began to spread and according to the current evidence
[5] the primary method of transmission between people is thought to
occur through respiratory droplets and contact routes. In order to
protect the health care workers and non-infected patients from potential
COVID-19 patients, infection control measures were established in most
of institutes especially the ENT departments to minimize the nosocomial
spread among the health worker
The strategy for infection control against COVID-19 includes material
preparation and distribution upon the availability, triage strategy,
training on infection prevention measures, limiting the traffic to the
hospital inpatient and outpatient, preparedness for hospital disaster
plan and specific disaster plan for each department, emergency expansion
plan for the intensive care unit capacity, Preparedness for field
medical words and Intensive care unit, etc.
5 days after WHO announced the CoVid 19 pandemic We followed the new
policy guidelines by avoiding the grouping so decisions were made
regarding departmental meeting including the training activities and
journal club to withhold it and transferred into a virtual meeting and
internal memo which is distributed through emails till recently
To reduce the number of patients’ visits in our clinics, in a manner
without compromising the patientcare we started using phone call
consultation method (figure 1). We offered to refill medication for
stable patient’s and sending medications using the hospital pharmacy
transport service (figure 2)
We confined the appointments for the emergency and the post-operative
cases, we Minimize the elderly patients and the patients with
comorbidities traffic into the hospital and we restricted the walk-in
patients for the clinics for all the consultants.
As well as we follow the policy of separating or distancing the
appointment time for the patient presented to the department
We also limited access to the clinics by arranging the following: we
started sending List of Outpatients appointments information at least
one day in advanced to the Security Gates for allowing only the
scheduled patients to enter, then the patient had to pass by two visual
triage units one at the hospital entrances and other at the clinic
entrance following the score criteria for the COVID-19
After being screened by the triage station the patients were requested
to get seated in the Waiting area and the seats arrangements were
distant for the safety precautions (figure 3)
In the clinical room, nose and throat examinations were considered to
present the highest risk, and additional protective measures were
implemented from our side., so all patients have been requested to sit
on the non-clinical chair and in case of the condition required clinical
examination then they are requested to get seated on the clinical
examination chair
On the Ent clinical examination, the threshold for the endoscopic
examination of the nose and pharynx have been reduced to the maximum and
the personal protective equipment use has been implicated as the rules
and hospital guidelines and in case of endoscopic examination needed a
local anesthetic spray was replaced by gel anesthesia, and the smallest
possible diameter laryngoscope was recommended to reduce sneezing and
cough reflexes
Hence the endoscopic procedures are considered an aerosol generating so
all surfaces in the clinic room can potentially become contaminated thus
we performed an appropriate disinfection between each patients & post
the endoscopy procedures
Our department has decided to reschedule and postpone all elective
procedures that may aerosolize tissue including tonsillectomy,
adenoidectomy Sino-nasal surgery, and other airway procedures. While we
agreed that’s the otological procedures along with the oncology
procedure where continued until further notice for phase 1 emergency
response to an outbreak
When a procedure is indicated, appropriate personal protective equipment
must be worn including fluid-resistant gown, gloves, eye protection,
full face shield, fit-tested N95 respirator, head cover, and impermeable
shoes that can be disinfected (figure 4)
Inside the operating room we Limited the number of healthcare providers
participating in any procedure to only those absolutely necessary.
After surgery we try to minimize the hospital stay postoperatively and
trying to discharge the patient same day of the surgery
With fewer cases and clinics, we have begun assigning our staff to
attend a comprehensive training and Operational courses to support
country preparedness and response to this pandemic as well we encourage
them to be involved in research related activities & creating a
database for departmental and/or multidisciplinary