Full author list
Luiz P. Kowalski, MD, PhD1, Alvaro Sanabria, MD, PhD2, John A. Ridge, MD, PhD, FACS 3, Wai Tong Ng, MBChB, MD, FRCR, FHKCR, FHKAM4, Remco de Bree, MD, PhD5, Alessandra Rinaldo, MD, FRCSEd ad hominem, FRCS (Eng, Ir) ad eundem, FRCSGlasg, FACS6, Robert P. Takes, MD, PhD7, Antti A. Mäkitie, MD, PhD8, Andre L. Carvalho, MD, PhD, MPH9, Carol R. Bradford, MD10, Vinidh Paleri, MS, FRCS (ORL-HNS)11, Dana M. Hartl, MD, PhD12, Vincent Vander Poorten, MD, PhD13, Iain J. Nixon, MD,MBChB,FRCS (ORL-HNS)PhD14, Cesare Piazza, MD15, Peter Lacy, MD, FRCSI16, Juan P. Rodrigo, MD, PhD17, Orlando Guntinas-Lichius, MD18, William M. Mendenhall, MD19, Anil D'Cruz, MS, DNB, FRCS (Hon)20, Anne W.M. Lee, MBBS, MD, FRCR, FHKCR, FHKAM21, Alfio Ferlito, MD, DLO, DPath,FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem,FDSRCS ad eundem, FACS, FHKCORL, FRCPath, FASCP, IFCAP 22
1Head and Neck Surgery Department, University of Sao Paulo Medical School and Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Sao Paulo, Brazil.
2Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia.
3Head and Neck Surgery Section, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
4Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
5Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
6University of Udine School of Medicine, Udine, Italy
7Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
8Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska Hospital, Stockholm, Sweden
9Screening Group. International Agency for Research in Cancer. IARC, Lyon, France
10Department of Otolaryngology, University of Michigan, Ann Arbor, USA
11Head and Neck Unit, The Royal Marsden Hospital, London, UK
12Departments of Otolaryngology Head and Neck Surgery, Institut Gustave Roussy and University Paris-Sud, Villejuif Cedex, France
13Department of Oncology, section Head and Neck Oncology, KU Leuven, and Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
14Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, University of Edinburgh, UK
15Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
16Department of Otolaryngology, Beaumont Hospital, Dublin, Ireland.
17Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias.  Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo. Oviedo, Spain
18Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
19Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
20Head Neck Services, Tata Memorial Hospital, Parel, Mumbai, 400012, India
21Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
22Coordinator of the International Head and Neck Scientific Group. Udine, Italy
This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).
Disclaimer: Andre L. Carvalho is responsible for his views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer / World Health Organization.
The facts
The 2019 novel coronavirus disease (COVID-19) pandemic started in December 2019 in the city of Wuhan, Hubei province in China. It is a highly contagious zoonosis (with a reproductive number of 2.8, which means that under preexisting conditions one case generates 2.8 new cases) produced by a beta coronavirus (SARS-CoV-2) that is spread human-to-human largely by respiratory secretions and occasionally by feces.12 Over a few weeks the disease spread to other Asian countries, to Europe, to the Americas and finally across the world demonstrating a rapid doubling time (6.4 days) and an asymptomatic but highly infectious prodrome.23 On January 20, 2020 it was declared by the WHO to represent a public health emergency. According to the Johns Hopkins Dashboard, as of March 20, 2020, 166 countries and 274,180 patients had been confirmed to be infected, 11,375 have died and 87,991 have recovered. The infections occurred predominantly (87%) in people of 30-79 years-old.4 Most infections (81%) are asymptomatic or produce only mild symptoms, whereas 15% occur in severe form that has required hospitalization. Some 3-4% benefit from respiratory support in an intensive care unit (ICU).4 The death rate has been calculated between 0.39 - 4%, but this depends upon patient age and is much higher in those older than 70 years.14  The most likely population to require mechanical ventilation are the elderly and people with associated comorbidities (in particular cardiovascular disease and hypertension, followed by diabetes mellitus) with a predicted mortality of around 15-49%.4
Transmission is mainly produced by symptomatic patients, but it has been reported that even asymptomatic individuals and those in the incubation period (which can last longer than 14 days), can also be a source of occult transmission.4 Swab PCR results for most asymptomatic patients turn negative in about 3 days, while symptomatic patients typically have detectable virus for 12-20 days. 35  There is still little information about the transmission during the recovering phase.1
Most patients treated by head and neck surgeons have cancer, the direct role of SARS-CoV-2 infection in their outcomes is unknown. To date, there is no clear evidence that cancer patients have an increased risk of infection or severe disease, beyond the immunosuppression caused by the malignancy itself.6 However, cancer patients have experienced a higher risk of death due to the limitations of access imposed by social distancing and the shortage of operating rooms and ICU beds.7