Introduction
Coronavirus disease-2019 (COVID-19) was first reported in Wuhan, Hubei
province, China in December 2019 and has since rapidly spread across the
globe, infecting 952,000 people and causing 48,000 deaths as of April
2nd, 2020.1 This disease is caused
by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), a novel
coronavirus closely related to the SARS and Middle Eastern Respiratory
Syndrome (MERS) viruses. 1,2 The exact route of
transmission remains unknown but the primary mechanism of spread is
believed to be via respiratory droplets and aerosols.3Due to the high viral load present in the upper airway, otolaryngologic
procedures are considered high risk for occupational exposure and a
number of otolaryngologists have been infected with
COVID-19.4
The most common initial symptoms of COVID-19 are cough, fever, fatigue,
increased mucous production, dyspnea, sore throat, and
myalgias.5 Ground-glass opacities are found on chest
computed tomography in 56% of patients on admission, with 2.3% of
patients eventually requiring mechanical ventilation.6In an analysis of 72,314 COVID-19 patients in China, the overall
case-fatality rate was 2.3% but was 7.3% in patients with pre-existing
conditions (10.5% for cardiovascular disease, 7.3% for diabetes, 6.3%
for chronic respiratory disease, 6.0% for hypertension, and 5.6% for
cancer).5 Notably, symptoms can take 1-2 weeks to
manifest from the time of infection, and asymptomatic patients can still
be contagious.
Total laryngectomy, which results in an interruption between the upper
airway and trachea with complete respiratory dependence through a
tracheostoma, represents a unique challenge for patient management in
the setting of COVID-19. Laryngectomy patients are at risk for poor
outcomes with COVID-19 due to frequently present medical comorbidities
including chronic pulmonary disease, peripheral vascular disease,
cardiac disease, cerebrovascular disease, diabetes, the underlying
cancer history, and a propensity for atelectasis due to loss of upper
airway resistance.7 Furthermore, as the majority of
laryngectomy patients have a smoking history, they are also prone to
acute infections due to impaired mucociliary function and mucosal
irritation from cold, dry inspired air.7 In addition,
salvage total laryngectomy can result in post-operative wound
complications and prolonged hospital stays and greater risk of exposure
to the virus as hospitals are inundated with COVID 19 patients. If
infected, laryngectomy patients carry a high risk of transmitting viral
particles to health care workers or members of the community due to
their significantly altered anatomy and to aerosolization of tracheal
secretions.8,9