1) Personnel Segregation
The Department of [removed for blind peer review] was divided into 2 teams comprising of otolaryngologists at different seniority. Each team comprised of Senior Consultants, Consultants, Registrars and Trainees. The subspecialties of Otology, Head & Neck Surgery, Sleep Surgery and Rhinology were represented in each grouping.
During the 2003 SARS outbreak, high HCW infection rate and subsequent mortality highlighted the importance of HCW inter-transmission. Segregation into teams allows for essential clinical services to continue in the event one team is quarantined due to a team member infection. It also allows for efficient contact-tracing should an unprotected exposure event occur.
Two distinct clinical areas distanced at least 200 meters apart were assigned for outpatient practice. Location A was designated as the “Active” clinical area and the team assigned to Location A took charge of the week’s emergency calls, inpatient care, surgeries and outpatient follow-up. Location B was designated as the “Passive” clinical area and its assigned team attended to a reduced number of new outpatient referrals, with their activities limited only to Location B. Disinfection of both areas was performed daily and each week, the teams swopped locations and duties. Patients requiring outpatient follow-up were instructed to report to the correct location for review by the same team of doctors. Strict segregation was enforced, and each team was discouraged from meeting professionally or socially.
In anticipation of referrals for otolaryngological assessment and/or tracheostomies of confirmed COVID-19 cases, a single Senior Consultant from the “Active” team each week was placed on a week-long call duty. Each of these senior staff members had been a practicing medical professional in the 2003 SARS outbreak. To minimize the personnel exposed to confirmed cases, junior staff were relieved of this duty.
In the initial phase of the outbreak, all department activities such as weekly morbidity and mortality (M&M), grand rounds and lectures were suspended. In the tenth week, recognizing that this outbreak was a prolonged battle, a new normalcy was sought with resumption of departmental activities. M&M meetings and teaching sessions were hosted via webcast facilities. Both teams participated at distinct physical locations.