Introduction
The novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) causing coronavirus disease 2019 (COVID-19) emerged in December 2019 and has spread on a global level leading to unprecedented health, social, and economical unrest. The virus is spread via respiratory droplets and causes mortality in up to 7% of infected patients1. Curative treatment and vaccines are non-existent, and the only protection is the prevention of spread of virus particles. Many asymptomatic patients might be carriers of disease, while current testing paradigms might have false negative rates as high as 40%2. As such, all patients and healthcare providers are considered a potential source of disease.
On March 11th, 2020, the World Health Organization (WHO) declared the SARS-CoV-2 outbreak a pandemic3, at a time when the Center for Disease Control (CDC) reported 1,215 positive cases in the United States4. At the time of this report, the United States has reached 395,011 cases4. At the current rate of disease progression, intensive care unit (ICU) beds are projected to be at or over capacity with COVID-19 patients across the country. Health institutions in several states have implemented mandatory postponement of elective and/or non-urgent cases to decrease nonessential patient density in hopes of decreasing COVID-19 transmission and preserving hospital resources. As the current pandemic is rapidly evolving, the American College of Surgeons has recommended triaging surgeries according to a three-tier state of hospital resource availibility5. In the field of head and neck surgical oncology, postponing a surgery can significantly impact survival due to the increased risk of cancer progression. Furthermore, early reports suggest that cancer patients are at higher risk for COVID-19 associated severe events such as ICU admissions requiring mechanical ventilation or death6,7. Given the cancer patients’ vulnerability to COVID-19 complications and potential hospital resource limitations, judicious selection of oncologic surgical cases is of utmost importance, not only in an attempt to alleviate the burden on the healthcare system, but also to ensure the safety of patients, their families, as well as their healthcare providers. Ultimately, one must balance healthcare priorities and the risk of cancer progression.
In this report, we outline guidelines based on expert consensus opinions from our experienced multidisciplinary team for the triage and prioritization of head and neck surgical cases in a subsite-specific manner. We present these guidelines to serve as a reference for practicing head and neck clinicians during this serious and unprecedented situation, recognizing that feasibility, pandemic intensity, and resource availability will vary widely geographically and over time.