key: cord-0798506-08eqoxn9
authors: Xu, Kai; Lu, Xiang; Liu, Zheng
title: Our experiences of resuming services in ENT departments in Wuhan, once a COVID-19 epicenter
date: 2020-08-13
journal: American Journal of Otolaryngology
DOI: 10.1016/j.amjoto.2020.102678
sha: 2284b5d3d3fdadd85563390e3f67428a8174a644
doc_id: 798506
cord_uid: 08eqoxn9

Abstract The pandemic of coronavirus disease 2019 (COVID-19) showed a significant impact on routine daily services in departments of otorhinolaryngology head and neck surgery. The city of Wuhan, as the first reported epicenter in the world, resumed medical service since April 8, 2020. As the biggest ENT services provider in Wuhan, we share out institution's triage and screening system in the resuming period.

Since Jan 23, 2020, millions of people in Wuhan had been quarantined due to COVID-19 epidemic. A significant portion of health care workers (HCWs) had been recruited and were involved in treating patients with COVID-19, leading to the lack of HCWs and cancelation of all non-emergency services in ENT departments during this period.

Since late March 2020, only sporadic COVID-19 symptomatic cases have been diagnosed daily in Wuhan 1 . On April 8, 2020, Wuhan reopened. However, hundreds of COVID-19 asymptomatic cases emerged since then 2 , and their infectious potential had not been well defined 3 . This is extremely challenging for resuming daily services in the department of otorhinolaryngology-head and neck surgery, which is associated with many aerosol-generating procedures and is susceptible to viral dissemination 4 .

Considering that many HCWs were involved in treating patients with COVID-19, all employees in our hospital were screened for COVID-19 before resumption. Only employees who did not exhibit SARS-CoV-2 transmission potential were allowed to serve patients. In our hospital, among nearly 10,000 screened employees, 8 were positive for SARS-CoV-2 RNA, 39 were positive for serum SARS-CoV-2 IgM, and 310 were positive for serum SARS-CoV-2 IgG.

Our outpatient department has resumed following a three-layer triage strategy (Fig 1) . The first-layer triage begins at the hospital entrance where thermo-scanners were set up to determine those who will be assigned to the fever clinic. After registration, all patients will then be rechecked and their information will be taken at the triage service desk, where the second-layer triage is located. Those patients who have COVID-19 related symptoms, such as fever, cough or fatigue, will then be transferred to the fever clinic. Our patients will undergo the third-layer triage in our ENT outpatient department. The patients who need hospitalization or endoscopic examination, such as laryngoscopy or nasal endoscopy, will then have to register at the ENT service center. Only patients with recent COVID-free chest CT scans, as (Fig 1) . The patients who showed negative results for both rounds of screenings were allowed to move to the clean wards where wearing a surgical mask is enough for both the patients and HCWs.

Operation rooms (ORs) are classified into clean zone ORs and isolated zone ORs.

The patients sent from clean wards will then be operated on in the clean zone ORs, while the patients who need emergency surgery without receiving their SARS-CoV-2 screening results will be operated on in the isolated zone ORs. After the operation, patients who were operated on in either clean zone ORs or isolated zone ORs will be sent back to clean wards and buffering wards, respectively. In clean zone ORs, HCWs are only required to wear the basic surgical mask. However, in isolated zone ORs, an N95 mask, face shield or PAPR were warranted for HCWs 5 . We performed 29 surgeries in April and 119 surgeries in May, but these are still much lower than last

year's capacity (800 surgeries per month).

In May 2020, the Wuhan government had conducted a citywide screening for basically all residents. 300 out of nearly 10 million residents (0.003%) showed positive results for SARS-CoV-2 nucleic acid and were defined as asymptomatic COVID carriers 1 , which is much lower than results from an investigation one month ago (0.057%) 7 , indicating the good control of the COVID-19 epidemic in Wuhan.

This encouraging result seems bring confidence to the public, which is associated with the surge of daily services in our department in June (about 70% of last year's capacity).

Since the resumption of our department, no COVID-19 nosocomial infection has been reported due to the strict execution of triage and screening. Our experiences might be able to provide valuable suggestions to our medical community during the resuming period. 

Update on the novel coronavirus pneumonia outbreak in Wuhan

National Health Commission of the People's Republic of China

Asymptomatic Transmission, the Achilles' Heel of Current Strategies to Control Covid-19

Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic

At the center of the COVID-19 pandemic: Lessons learned for otolaryngology-head and neck surgery in China

Value and Challenges: Nucleic Acid Amplification Tests for SARS-CoV-2 in Hospitalized COVID-19 Patients

The rate of COVID-19 asymptomatic carriers