Patients management during COVID-19 two-months period
Indications . The criteria for hospital admission were established as follows[5]:
Swab specimens . Indications for nasopharyngeal and/or oropharyngeal swab collection evolved during the COVID-19 two-month period. In the early period, swab testing was performed before hospitalization in case of body temperature more than 37.5°C and/or in presence of at least one of the following factors: fever, cough, dyspnoea, gastrointestinal signs/symptoms, myalgias, fatigue, headache, pharyngodynia, rhinorrhea, active pneumonia and close contact with a SARS-Cov-2 positive patient. Otherwise, patients were admitted without getting tested. Given the worsening of the pandemic and the growing body of data available, indications changed on March 23rd, 2020, when all inpatients were systematically submitted to swab specimen collection, so that only emergencies have been performed notwithstanding their COVID-19 status. More specifically, the execution of two swabs, with an interval between the two tests of at least 2 days and the latest performed within 48 hours prior to surgery, has become mandatory, in order to minimize the possibility of false negatives.
Individual protection . Indications for the use of personal protective equipment (PPE) have also evolved during this period. At the beginning, no specific protection was recommended during surgery and all healthcare workers in the Operating Room (OR) continued to wear standard surgical masks and gowns, leaving viral-filtering-PPE available to be used only in case of confirmed COVID-19 patients. However, after March 23rd, 2020, indications for PPE use changed and, since then, surgical procedures in COVID-19 negative patients required the use of the highest individual protection standards (at least FFP2 masks), in consideration of the significant number of false negatives resulting from the swab tests currently used. For positive patients, procedures were postponed until after swab test negativization, when feasible. If the procedure was strictly necessary for the patient’s survival, surgery was performed in a dedicated negative-pressure operating room with a pre-established allocated run, without interfering with the COVID-19-free areas. All medical and nursing staff in the operating room were recommended to wear FFP3 and/or powered air-purifying respirators (PAPR), goggles, full-face visor, double gloves, water-resistant gowns and protective caps, not only for the entire duration of surgery but also for the whole of the patient’s stay in the operating room.[6] If testing for COVID-19 was not available (emergency procedures such as trauma, major bleeding, abscesses), patients were considered COVID-19 positive unless otherwise demonstrated.
Follow-up. Postoperative management and follow-up for patients undergoing sinus and skull base procedures followed standardized protocols already established at our Department[7–9]. Nasal packing are removed on the second postoperative day and following endonasal medications are performed as needed, until hospital discharge. Then, patients are prescribed daily nasal rinses and postoperative control in the outpatient clinic, where further medications are performed. Even though the SARS-Cov-2 outbreak influenced long term follow-up of outpatients in our Clinic, post-operative medications were guaranteed in all cases, even during the COVID-19 era, thanks to an accurate reorganization of several aspects of the outpatient service.[10] In order to investigate the health of the patients belonging to the PANDEMIC-Group after their last postoperative medication, a telephone interview was carried out retrospectively, examining the following factors: fever, cough, dyspnoea, anosmia, dysgeusia, gastrointestinal signs/symptoms, myalgias, fatigue, headache, pharyngodynia, rhinorrhea, active pneumonia, need for hospitalization for any reason, potential swab or serological tests performed and if they had been in contact with COVID-19 positive individuals.