IPOG COVID -19 SURVEY REPORTA P R I L 1 S T 2 0 20
-IN COLLABORATION WITH ANZPO, APOG, IAPO, PENTAFRICA, ESPO AND ASPO This Photo by Unknown Author is licensed under CC BY

Dear Friends and Colleagues,
We are dealing with an unprecedented pandemic where local, regional, and national rules and regulation are being
revised on a daily basis.
This initiative started 5 days ago in collaboration with IPOG (International Pediatric Otolaryngology Group) and all
six major pediatric otolaryngology societies in the world (ANZSPO, APOG, ASPO, ESPO, IAPO, PENTAFRICA).
The response has been extraordinary, indicating the in-depth collaboration of the societies and sense of urgency
surrounding the COVID-19 pandemic. We have responses from 306 pediatric otolaryngology departments/institutions
worldwide, which, to the best of our knowledge, is unprecedented.
We remain aware that the situation is ongoing and evolving on a daily basis. Neither the timing nor the content of
this initiative will fully satisfy everyone’s needs with respect to adequate length, level of detail, and timing. It is clear to
all of us that, if some of the best and largest pediatric centers around the world are facing major challenges with patientmanagement in the setting of equipment shortages, absence of clear guidelines/policies, and the decreasing workforce,
it is difficult to imagine what other challenges smaller pediatric centers in remote parts of the world are facing. Despite
all the potential shortcomings of our approach, if we can help only a few of our colleagues and patients, we feel it is worth
a try.
We hope the results included below give institutions already dealing with the pandemic some perspective on how toadapt their current approaches moving forward. In parallel, institutions at the early stages of facing this disease mightfind insight into how best to PREPARE.
We thank each institution for taking the time to participate in this initiative and for the helpful comments andsuggestions we have received.
Regards,
Reza Rahbar DMD, MD
On behalf of IPOG (International Pediatric Otolaryngology Group)
ANZSPO (Australian and New
Zealand Society of PediatricOtolaryngology)
Paul Walker, MD (President);
Kelvin Kong, MD (Secretary)
APOG (Asia Pacific PediatricOtolaryngology Group)
Nguyen Thi Ngoc, MD (President);
Wei-Chung Hsu, MD (Secretary)

ASPO (American Society of PediatricOtolaryngology)
Anna Messner, MD (President);
Reza Rahbar, DMD, MD (Secretary)

IAPO (Interamerican Association of
Pediatric Otolaryngology)
Federico Murillo, MD (President);
Tania Sih, MD (Secretary)

ESPO (European Society of PediatricOtolaryngology)
Ann Hermansson, MD (President);
Martin Bailey, MD (Secretary)

PENTAFRICA (Pediatric Ear, Nose &Throat in Africa)
Chris Prescott, MD (President);
Shazia Peer, MD (Secretary)

Acknowledgement
We particularly want to thank Erika Mercier, MD (Pediatric Otolaryngology Fellow, Boston Children’s Hospital)
and Natasha Dombrowski, BA (Research Assistant, Department of Otolaryngology, Boston Children’s Hospital) for all
the work done with creation of the survey, collection of data, and putting this report together.

SURVEY R ESULTS
These results will be posted on the respective websites of each society for members to access. We would like to thankevery participating society and institution. Details of contributing institutions are at the end of the document.

TOTAL PEDIATRIC OTOLARYNGOLOGY/CHILDREN’S FACILITIES INCLUDED WORLDWIDE: 306
AfricaSouth Africa
Sudan
Asia
China
Hong Kong
India
Indonesia
IsraelJapan
Kazakhstan
Malaysia
Saudi Arabia
Singapore
South Korea
TaiwanThailandTurkeyUnited Arab Emirates
Vietnam
Australia/Oceania
Australia
New Zealand

3
2
1
56
5
1
2
1
3
1
1
12
3
2
10
5
2
3
1
4
8
7
1

EuropeBelarusBelgium
Bulgaria
FinlandFranceGermany
GreeceHungary
IrelandItaly
LatviaNetherlands
PolandPortugal
Romania
RussiaSerbiaSpain
SwedenSwitzerland
UkraineUnited Kingdom

58
1
4
2
1
6
1
1
1
2
7
1
1
1
3
2
4
1
3
2
1
1
12

North America
CanadaCosta Rica
Dominican Republic
El Salvador
GuatemalaHonduras
Jamaica
MexicoNicaragua
PanamaUnited States
South America
Argentina
Bolivia
BrazilChile
Colombia
EcuadorParaguay
Peru
Uruguay
Venezuela

79
7
9
4
2
1
5
1
5
3
2
40
102
10
4
43
3
10
3
4
5
5
15

**Please note that the results presented in this document are only a reflection of practices reported
to us by most institutions and are not to be taken as statistically accurate** .

INSTITUTIONAL PRACTICES
Outpatient
clinics

Urgency of cases seen inclinicFellow and resident
participation in clinic
COVID-19 screening forpatients in clinic

Use of telemedicine
Participation of pediatric
ORL teams in non-pediatric
ORL duties

Operative
procedures

Case selection by urgency

Education

Conference participation

PPE(personal
protective
equipment)

Surgical mask use in clinic

Fellow/resident participationin operative cases

N95/FFP3 use in clinic
N95/FFP3 use in OR
PPE shortages
Reusing PPE
Use of non-hospital provided
PPE

COVID-19
testing

Testing
protocolAccess to in-house COVID
testingPre-op COVID testing
COVID test turnaround time
Employees are tested if….
Employees are asked to stayat home preventively if…

Urgent cases (67%)
Urgent + Time-sensitive cases (41%)
Airway pathology/trach care, Acute infections (deep neck infection and neck mass, mastoiditis,
refractory or complicated otitis media, cochlear implant patients), Oncology, Trauma, Epistaxis,
Aero-digestive foreign bodies, Acute sensorineural hearing loss, Acute facial paralysis, Postoperative patients, Cholesteatoma

62% participating in clinic duties
24% participating in telemedicine
34% participating in phone triage• Questionnaire screening (74%)• Fever checks before visits (62%)• Using masks for patient and parents during visits (55%)• Adapting waiting room set-up (46%)
Limiting number of patients, alcohol gel use, limiting number ofparents, use of negative pressure rooms
Isolation areas for suspect/positive patients
55% of institutions are using telemedicine
40% introduced telemedicine as a result of COVID-19
Required in 22% of institutions, includes:••••

Adult ORL patient care and call
Shifts in emergency department, triaging patients
COVID-19 sampling
Relocating from private to public practiceParticipation in ethics committees•
Only performing urgent (82%)
Urgent + time-sensitive procedures (44%)
Emergent cases
41% are involved in all cases
31% are involved only in COVID-19 negative patientsNon-emergent cases
No participation (65%)
58% of institutions are using virtual conferences only
28% of institutions have no conferences at this time
Required with all patient contact (71%)•
When seeing all COVID-19 suspected (53%) and confirmed (58%) cases ( access?)•
For aerosol generating procedures regardless of COVID-19 status (58%)•
When operating on COVID-19 suspected (55%) and confirmed cases(57%)( access?)•
for aerosol generating procedures regardless of COVID-19 status (56%)•
N95/FFP3 (78%)•
Eye protection (56%)•
Surgical masks (45%)•
Gowns (43%)•
Eye protection (52%)•
N95/FFP3 (36%)
28% of institutions have resorted to the following non-hospital provided PPE:
Bought online or with own resources, Scuba diving face shield with HPF filter,
Homemade, Local donations, Made by university engineering department,
Welding visor, Speedo goggles
59% of institutions have in-house access•
Otherwise sent to outside institutions or centralized labs•
Government regulated in some institutions
65% of institutions do not routinely test for COVID-19 prior to operative procedures

1-2 days (38%)
Same day (27%)
3-5 days (25%)
•
•
•
•
•
•

Exposed under any circumstances (37%)
Exposed without PPE (22%)
Exposed and symptomatic (51%)
Exposed under any circumstances (28%)
Exposed without PPE (25%)
Exposed and symptomatic (34%)

C O V I D - 1 9 I N TH E O R L C O M M U N I T Y
COVID-19+
test in staff

Number ofattendingphysicians

Number ofresidents/fellows

Quarantined
staff forexposure to
COVID-19

Attendingphysicians

Residents/fellows

Duration ofquarantine

1-2

18 institutions

3-5

5 institutions

6-10

2 institutions

1-2

8 institutions

3-5

1 institution

1-2

55 institutions

3-5

17 institutions

6-10

4 institutions>10

2 institutions

1-2

42 institutions

3-5 cases

6 institutions

6-10 cases

1 institution

BelgiumBrazil (2)Colombia
Costa Rica (2)Ireland
Malaysia (2)BrazilEcuador

Saudi Arabia
Spain (2)United Kingdom (2)Uruguay
USA (2)Venezuela
Italy
UK
USA

BrazilSouth Korea
Brazil (2)CanadaIrelandIsraelThailandUSA (2)

USA
Argentina (3)Belgium (2)Brazil (2)Canada (2)China
Colombia (2)Brazil (2)CanadaChile
Colombia
Dominican Republic

BrazilItaly

Costa Rica (3)France (2)Israel (2)Malaysia (3)Paraguay
RussiaSerbiaSouth Korea
Ireland
Italy
MexicoPolandPortugal
Saudi Arabia

Spain (2)Taiwan (2)Thailand (2)UK (5)
Uruguay (4)USA (10)Venezuela
South Korea
Spain
UK
USA
Venezuela

Nicaragua
USA

Brazil (2)Argentina (2)Australia
BelgiumBrazil (5)Canada (2)Chile (2)China

CanadaItaly

Costa Rica
FranceIrelandIsraelMalaysia (2)Paraguay
Portugal
Saudi Arabia
Spain
TurkeyUSA (2)USA

2 weeks (85% of institutions)South Korea (2)TaiwanThailandUK (3)
Uruguay (2)USA (10)

C O V I D - 1 9 I N P E D I A TR I C O R L P A T I E N T S ( < 1 8 Y / O )COVID-19 +patients(<18 y/o)(total 87
institutions)

1-3 patients

23 institutions
Australia (3)Belarus
Chile
China (4)4-7 patients

12 institutions

Have patients, but cannot
report number

52 institutions

GreeceIreland
Italy (2)Australia
Belgium (2)Brazil (5)Canada (4)France (5)Honduras (2)Israel (2)Italy (3)

10 institutions

Patients
requiring ICU
care orintubation(<18 y/o)

1-3 patients

7 patients

1 institution
USA(total 42
institutions)Have patients, but cannot
report number

31 institutions

Patientshavingpassed away(<18 y/o)

1 patient

1 institution
China
1 institution
Vietnam
19 institutions(total 21
institutions)

BelgiumBrazilChina
Italy (2)Indonesia
Ireland (2)SerbiaSpain
Switzerland
Thailand
PolandUK (2)
UkraineLatviaMalaysia (3)PanamaPortugal
RussiaSouth Korea (2)Spain (2)SwedenTaiwanPanamaSerbiaUK
USA (2)

USA (6)
Philadelphia
Atlanta
Wilmington
Stanford
San Diego
RochesterVenezuela
USA (4)
AuroraBostonColumbus
New York

ThailandTurkeyUK (5)USA (8)ChicagoJacksonville
Houston (2)Philadelphia (2)Salt Lake City
BaltimoreAtlanta
BostonNYC

2 patients
Have patients, but cannot
report number

BelgiumBrazil (4)Canada (3)France (3)Honduras
Ireland

BelgiumBrazil (5)CanadaFranceIsraelIsraelMalaysia (2)Portugal
South Korea
Spain (2)TaiwanTurkeyItaly (3)
Nicaragua
PanamaSouth Korea
UK

UK (2)USA (7)
Colorado
HoustonNYC
Philadelphia (3)Salt Lake City

USA (3)
NYC
Philadelphia
Salt Lake CityC O V I D - 1 9 I N P E D I A T R IC O R L

Please see the following link for daily updates on covid-19 cases worldwide…
https://coronavirus.jhu.edu/map.html

Please see the following link for daily updates on covid-19 cases in America…
https://covid19.healthdata.org/

LESSONS LEARNED AND OBSERVATIONS FROM AFFECTED CENTERS
 Be ready! Experiences shared in this survey show that preparation is key.
Anticipating problems and putting in place strategies to combat them early is alesson stressed by several institutions.

A FEW LESSONS FROM AN EMAIL COMMUNICATION WITH OUR COLLEAGUES AT HÔPITAL NECKER-ENFANTSMALADES IN PARIS: DRS DENOYELLE, COULOIGNER, GARABEDIAN AND LOUNDONooooUbiquitous confinement is crucial
Cancel all non-urgent medical activities
Patients with high BMIs (body mass index), even young adults, are at high risk for more severe formsof COVID-19
Hydrochloroquine has been widely used at this institution but did not seem to have a significant impact on
the severity of pneumopathy
POINTERS ON HOW TO PERFORM A COVID-19 NASAL SWAB:oooThis is a procedure that can be difficult to perform as the nasopharynx can prove difficult and painful
to reach
Proper location of the swab however is essential to obtain an adequate specimen
As an alternative, the swab could be performed under the middle turbinate•
Evidence suggests it is an area of high viral load
USE OF PAPR (POWERED-AIR PURIFYING RESPIRATOR)oooMost institutions face a lack of availability of PAPR for contact with COVID+ cases
It has been reported that the use of PAPR makes communication in the OR difficult, especially for
airway cases in which communication is critical
Many institutions resort to an N95/FFP3 mask, face shield, gown and gloves instead●
However, to the best of our knowledge, these PPE are not equivalent to PAPR when treatinga COVID-19 + patient

GET READY
A few suggestions to help prepare if you are at the early stages of the pandemic or if
you are already affected and looking to adapt your current practice…
**All recommendations are based on survey results and institutional experiences. Every service should adhere to theirestablishment’s local rules/regulations and be mindful of varying availability of equipment.**

DIVIDE WORKFORCE INTO TEAMS TO MINIMIZE EXPOSURE••

Outpatient setting (front desk personnel, physician assistant, clinical assistant)o Consider dividing the team to minimize exposure
Inpatient settingo Consider splitting in two teams rotating every 1-2 weeks
o Each team would include attendings, residents, fellows, any other core memberso Suggest avoiding contact between teams to avoid contaminating the entire service

PREPARING CLINICS
•
•
•
•

•
•

Limit to urgent and time sensitive patientso Surgical post-ops, oncology, airway
Have a screening strategy to address potential COVID-19+ patients safely
o Pre-visit over the phone or video, survey on arrival, vitals on arrival
Plan for a different area to see COVID+ or suspected patients
Avoid unnecessary contact
o Handshakingo Wash hands frequently
Several institutions are wearing N95/FFP3 mask, gloves and gown whenever possible, at minimum surgical mask andgloves for all patients
Make use of telemedicine
o Follow-ups, immunocompromised or vulnerable patients

VIDEO CONFERENCES/EDUCATION••

Avoid in-person meetings
Prepare a platform allowing for video conferencing from home or isolated office (e.g. Zoom)

EQUIPMENT/PPE
•
•
•
•
•
•

There are severe shortages of N95/FFP3, eye protection and surgical masks
Ensure sufficient hand sanitizer and disinfectant wipes on all unitso Clean phones, keyboards, desks
Plan back-up strategies to reuse equipment such when possible in case of shortage
Several centers are resorting to homemade masks or donations
Practice proper donning and doffing procedures
PPE management videos from the Anesthesia and Critical Care team at BCH
o Welch, J. COVID-19 Personal Protective Equipment and Airway Management for the Operating Room. 2020. Online
video. OPENPediatrics. https://youtu.be/_Q_ZeQSJxu0.

oWelch, J. COVID-19 Personal Protective Equipment and Airway Management for the Operating Room: Demonstration.
2020. Online video. OPENPediatrics. https://youtu.be/d2sHRyAHKqI.

PREPARING FOR SURGERY
•
•
•
•
•
•
•

Limit surgery to urgent and time-sensitive caseso Have clear criteria
Limit number of people in the room (single surgeon)
Limit aerosol-producing procedures to a strict minimum and wear full PPE (if available)
Proposed PPE for at-risks procedures (aerosol generating procedures) and at-risk patients (potential COVID-19 +) : N95
masks, double gloving, face shield for surgeon, scrub nurse and anesthesiologist
Suggest rapid sequence intubation for at-risk patients
Consider using video tools for laryngoscopy rather than direct vision
Consider placing protective drapes around patient’s face during aerosol-generating surgical procedures

COVID TESTING•••

If possible, plan to have in-house testing
Consider pre-op testing for patients with symptoms, patients exposed to a positive person, patients coming from abroador having recently traveled
The ultimate goal is to test every patient before surgery, however, test being in short supply, this is not always possible

BEDSIDE EXAM AND PROCEDURES••

Wear PPE for oral cavity and nasal exam
○ Suggest mask and gloves (low-risk patient)○ Suggest N95/FFP3 if positive for COVID-19 or aerosol-generating procedures on any patient
Aerosol generating procedure (Flexible endoscopy, tracheostomy change)○ Only perform absolutely necessary procedures○ Limit number of people exposed (one person performing exam)○ Wear full PPE: N95 mask, gown, face shield, gloves○ Safe to change to surgical mask 30 minutes after aerosol generating procedures

EXPOSED OR INFECTED TEAM MEMBERS•••

Consider 2 weeks quarantine for unprotected exposure to COVID+ patient (based on survey responses), or per
institutional protocol
Consider 2 weeks quarantine for symptomatic personnel
Quarantine per institutional protocols for positive test

SUPPORT••

Plan to have a person of reference to whom people can address concerns
Plan to have adequate support systems for team members

RECENT COVID-19 RECOMMENDATIONS FROM PEDIATRIC ORLASSOCIATIONSANOSMIAAAO-HNS (03/26/2020)
There is rapidly accumulating anecdotal evidence that anosmia with resultant dysgeusia are frequently
reported symptoms associated with the COVID-19 pandemic. Similar reports are surfacing from multiple
countries around the world including the United States. In an effort to establish the importance of these
symptoms in diagnosis and progression of COVID-19, the American Academy of Otolaryngology–Head and Neck
Surgery (AAO-HNS) has established the COVID-19 Anosmia Reporting Tool for Clinicians. This tool wasdeveloped by the AAO-HNS Infectious Disease and Patient Safety Quality Improvement Committees to allow
healthcare providers of all specialties worldwide to submit data to confidentially report on anosmia anddysgeusia related to COVID-19.

PPE
ENTUK (03/27/2020)
I am pleased to announce that Public Health England has agreed and confirmed in writing to me the following
recommendations: upper-airway procedures such as nasal endoscopy, laryngoscopy and other interventions
in our specialty are to be considered Aerosol Generating Procedures (AGPs), requiring full prescribed PPE,
including an FFP3 respirator. They have also agreed that we are seeing widespread transmission of COVID-19
in the community, and therefore advise that appropriate PPE should be used in relation to AGPs undertaken
in ANY patient. Clinicians should plan to group patients requiring these procedures, all of whom should beassumed infected, to avoid changing respirators between patients and thereby preserve stock. In the absenceof an FFP3 respirator, the Health and Safety Executive has confirmed that an FFP2 or N95 equivalent
respirator would offer adequate levels of protection. However, it is important to note that FFP3 is officiallythe prescribed rating. Their official letter and guidance are expected shortly, but please be safe and take careof yourselves in the above manner. A useful document on the safe decontamination of endoscopes is linked
below, and will be on our website shortly.

AAO-HNS (03/23/2020)
Until the supply of testing materials catches up with the accelerating demand for testing, there will becircumstances that the COVID-19 status of these patients is unknown. Therefore, when a detailed examinationor surgical procedure is necessary for urgent or emergent care and the COVID-19 status of the patient cannot
be confirmed, then the patient should be handled as if they are COVID-19 positive. This consideration should
apply regardless of whether in an office, hospital, or operating room setting. Furthermore, the provider andsurrounding staff must have the necessary PPE. Particular attention must be taken to clean contaminatedequipment and surfaces with appropriate disinfectants (e.g., ≥ 70% alcohol) as recommended by the CDC.

ENTUK (03/24/2020)
We believe that it is imperative that PPE (Personal Protective Equipment: FFP3 masks, visors, gowns and gloves)
is available and used for all forms of nasal and throat examination, in both the hospital, outpatient clinic andcommunity settings. We should now assume that all our ENT patients are potential carriers of the virus. This
includes those patients who require an endoscopic examination of their nose and throat which exposes boththe operator and assistant to aero-digestive tract droplets.

AAO-HNSThe need to flatten the curve of transmission and preserve critical supplies and equipment for those who need
it most necessitates limiting care at this time to time-sensitive and emergent problems and the routine use of
appropriate PPE when treating patients in all age groups. This policy applies to otolaryngologists in areas
currently facing high infection rates as well as those in areas with limited penetration.

SURGICAL MANAGEMENTCEORL-HNS (03/23/2020)
1) Endoscopic examinations should be avoided and only be indicated when necessary.
2) Avoid non-urgent and non-cancer surgery. In particular, Endonasal Endoscopic
Surgery and Laryngological Surgery (especially jet ventilated - orotracheal intubation
appropriate) seems to be the riskiest procedures.

Sinonasal
is moreTracheostomy is considered to be a particularly high-risk procedure during surgery but also in aftercare which
could potentially also increase amount of PPE consumed many folds that are already universally in short supply.
The need for tracheostomy in COVID-19 patients should be carefully assessed by a multidisciplinary team.
COVID-19 should be excluded in patients undergoing surgery. If the acute medical condition does not allow it,
it is necessary to consider the patient positive until the result is negative.

ASPO (03/23/2020)
1. Surgical cases: We have all been asked to postpone elective cases- the debate centers around the issue ofthe definition of “urgent” cases and this appears to vary between institutions. The COVID-19 virus is spread via
nasal and oral secretions. Reports from other institutions indicate that the risk of virus spread is high with sinus
surgery and should be avoided. We need to presume that the risk is also high with adenoid and tonsil surgery
and nearly all institutions have concluded that these cases should not be performed unless there are
extraordinary indications. What about ear tubes? Most institutions are canceling all ear tube cases whileothers are proceeding with ear tubes in the young children with raging infections in an effort to keep the kidsout of their pediatrician’s offices and prevent complications. The risks of a short mask anesthesia (withaerosolization of secretions) in a young child are not known at this time. Eventually, I have no doubt that wewill get to a place where we can test patients pre-op to see if they are COVID-19 virus positive (as they are
doing in S. Korea)- hopefully this will be sooner rather than later.
2. Flexible laryngoscopy, nasal endoscopy. It is clear that these procedures are “high risk” for spreading thevirus and should be avoided whenever possible. When they need to be performed it is clear that we and anyother medical personnel in the room should wear gown, gloves, eye protection and mask. Nasal pledgets

should be used for topical anesthesia instead of sprays. At some institutions the debate is whether a surgicalmask is adequate versus an N-95. We definitely know that the virus is in the nasal and oral secretions ofasymptomatic children and so an N95 should be the standard of care. Again, we look forward to the day when
we can routinely do pre-procedure testing.
3. Telephone/teleconference patient visits. I have no doubt that in hindsight one day we will look back on
this pandemic as the true birth of video visits. The good news (always need to look for the silver lining) is thatfederal and state rules re visits are being relaxed so that now we can use non-HIPAA compliant platforms suchas facetime and we can now bill for telephone visits. Many of our institutions are rapidly pushing out protocols
and platforms for us to utilize so that we can continue caring for our patients.

USEFUL LINKS AND DOCUMENTATIONCOVID-19 MANAGEMENT RECOMMENDATIONS:
1. ENT UK COVID-19 information for health professionals: www.entuk.org/covid-19
2. Handbook of Covid-19 from the First Affiliated Hospital, Zhejiang University School of Medicine:
https://www.britishlaryngological.org/news/covid-19-important-guidance
3. CDC recommendations on how to extend the life of N95 masks:
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
4. Guidelines for naso-endoscopy: https://mcusercontent.com/e386d81be4a76bada89909666/files/24995686-73864260-a5a6e56aff56970c/Nasal_endoscopy_and_laryngoscopy_examination_of_ENT_patients.pdf?utm_source=ENT+UK+Me
mbers+05.03.20&utm_campaign=73aadcea8dEMAIL_CAMPAIGN_2020_03_23_05_26&utm_medium=email&utm_term=0_b992aea106-73aadcea8d-118550865
5. Aerosol Generating Procedures in ENT: https://mcusercontent.com/e386d81be4a76bada89909666/files/b384cf30e622-4469-9d9f7d2932b35330/Aerosol_generating_procedures_in_ENT.pdf?utm_source=ENT+UK+Members+05.03.20&utm_cam
paign=73aadcea8d-EMAIL_CAMPAIGN_2020_03_23_05_26&utm_medium=email&utm_term=0_b992aea10673aadcea8d-118550865
6. Tracheostomy Guidance: https://mcusercontent.com/e386d81be4a76bada89909666/files/a34a3934-d546-46e0affffcb3de7c9dfa/COVID_tracheostomy_guidance.pdf?utm_source=ENT+UK+Members+05.03.20&utm_campaign=73a
adcea8d-EMAIL_CAMPAIGN_2020_03_23_05_26&utm_medium=email&utm_term=0_b992aea106-73aadcea8d118550865
7. Remote triaging of head and neck cancer patients:
https://mcusercontent.com/e386d81be4a76bada89909666/files/7479ddef-359a-4b25-9b32c99d7a858e89/Remote_triaging_of_urgent_suspected_head_and_neck_cancer_referrals_during_Covid_19_pande
mic_FINAL.pdf?utm_source=ENT+UK+Members+05.03.20&utm_campaign=73aadcea8dEMAIL_CAMPAIGN_2020_03_23_05_26&utm_medium=email&utm_term=0_b992aea106-73aadcea8d-118550865

SCIENTIFIC ARTICLES
8. COVID-19 shedding in symptomatic vs asymptomaticpatients: https://urldefense.proofpoint.com/v2/url?u=https3A__www.nejm.org_doi_full_10.1056_NEJMc2001737-3Fquery-3DTOC&d=DwIFAg&c=ZQsKZ8oxEw0p81sqgiaRA&r=YVK9ucsKVuhN_CL0l7G0tQ&m=r7WxtCuTNeLrIrbVzHvJor3oM7oncxxVt3z2I
6CQHxs&s=jsJ6Lr1dr1Lajp392mIRrsw5U2fpn4cKFsGNTaEOs-k&e=

RESOURCES
9. AAO-HNS Resources: https://www.entnet.org/content/coronavirus-disease-2019-resources
10. Stanford Covid-19 town hall (Available Streaming Online via ZOOM):
https://stanford.zoom.us/rec/share/4o9bIJTU8F1LZIXKzHzPRqMHAdvLeaa80CcZqfdbnR0clnG_taBOr6
8Z2TMwNU-2
https://stanfordmedicine.box.com/s/unke9g5pllmdmp09yeyiq2qgkif100qq
11. Easy way to contact patients with your cellphone without revealing your number:
https://www.doximity.com/app
12. Risk calculator for head and neck cancer patients: https://urldefense.proofpoint.com/v2/url?u=https3A__entuk.us6.list-2Dmanage.com_track_click-3Fu-3De386d81be4a76bada89909666-26id-3D2aa586bf9d26e-3Dfdd2757341&d=DwMFaQ&c=qS4goWBT7poplM69zy_3xhKwEW14JZMSdioCoppxeFU&r=hOQOtdm22Ta9xatFu_kD1OC5oeSZ4Son4znIJzn0B8qSTZk7PLkGQpqzZJkI5Z&m=twP2ktheCedSLA9BUWRF4OMl6WfstYXKMEoIN3H
UfVc&s=hlV-qKG9LxVPOoVMzfNzQ6-7I_4Udzk3QUtDwaHLjKU&e=

IN THE NEWS13. Keeping healthcare workers safe: https://www.newyorker.com/news/news-desk/keeping-the-coronavirusfrom-infecting-health-care-workers
14. ORL makes the New York Times: https://www.nytimes.com/2020/03/22/health/coronavirus-symptoms-smelltaste.html

DISEASE STATISTICS AND PROJECTIONS
15. Map of global COVID-19 cases: https://coronavirus.jhu.edu/map.html
16. Number of cases: https://www.worldometers.info/coronavirus/
17. Projections for COVID-19 cases in the United States: https://covid19.healthdata.org/
18. Global statistics: https://www.statista.com/topics/5994/the-coronavirus-disease-covid-19-outbreak/PARTICIPATING INSTITUTIONSINSTITUTIONS BY CONTINENT AND COUNTRY** W e a p o l o g i z e i n a d v a n c e i f th er e a r e a n y s p el l i n g er ro r s o r o m i s si o n s i n th e n a m es l i s ted h er e. P l ea s e em a i ln a ta s h a . d o m b r o w s k i @ c h i ld r en s . h a r v a rd . ed u o r er i k a . m er c i er @ c h il d r en s . h a r v ar d . ed u w i th a n y c o r r ec ti o n s .

AfricaSouth Africa:• Red Cross Children's Hospital &University of Cape Town
• Universitas Academic
Hospital/University of the Free
State
Sudan:• Africa ENT Hospital
Asia
China:• Beijing Children's Hospital, Capital
Medical University• Children's Hospital of Shenzhen• Shanghai Children’s Hospital• Shanghai Children's Medical Center• The Children's Hospital at Zhejiang
University School Of Medicine
Hong Kong:• Hong Kong Children's
Hospital/United Christian Hospital
KEC Hong Kong
India:• Manipal Hospitals• Nanavati HospitalIndonesia:• Universitas Airlangga
Israel:• Private Practice• Samson Assuta Ashdod University
Hospital• Tel Aviv Sourasky Medical Center
Japan:• National Center for Child Healthand Development
Kazakhstan:• West Kazakhstan State Medical
AcademyMalaysia:• Hospital Raja Perempuan Zainab II,
Kota Bharu• Hospital Sultan Abdul Halim, Kedah• Hospital Sultanah Bahiyah Alor
Setar
• Hospital Tengku Ampuan Afzan• Hospital Tunku Azizah (Women andChildren’s Hospital), Kuala Lumpur• Hserdang Malaysia•

Sabah Women and Children’s
Hospital• Sarawak General Hospital (Ministryof Health)• Sunway Medical Centre• Universiti Kebangsaan Malaysia
Medical Centre• Universiti Sains Malaysia• University of Malaya
Saudi Arabia:• King Fahad Specialist HospitalDammam• National Guard Hospitals• Prince Sultan Military Medical City
(PSMMC)
Singapore:• KK Women’s and Children’s Hospital• National University HospitalSouth Korea:• Ajou University Medical Center• Asan Medical Center• Chungnam National University
Hospital• Ewha Women’s University School of
Medicine• Hallym University Medical Center• Hanyang University Hospital• Konyang University Hospital• Korea University College of Medicine• Kyung Hee University• Seoul National University Boramae
Medical Center
Taiwan:• Cathay General Hospital• Chang Gung Memorial Hospital• China Medical University Hospital• MacKay Memorial Hospital and
MacKay Children Hospital• National Taiwan University Hospitaland Children's HospitalThailand:• Chiang Mai University• Siriraj Hospital, Mahidol University
Turkey:• Hacettepe University• Koc University• Samsun Research and Training
Hospital

United Arab Emirates:• Al Jalila Children's Hospital, Dubai
Vietnam:• Children's Hospital 1, Ho Chi MinhCity
• Danang ENT Center• ENT Hospital Ho Chi Minh City• National Hospital of Pediatrics
Australia/Oceania
Australia:• John Hunter Children's Hospital• John Hunter Hospital• Perth Children’s Hospital• Queensland Children's Hospital• Royal Children’s Hospital• Sydney Children's Hospital• The Children's Hospital atWestmead
New Zealand:• Starship Hospital
EuropeBelarus:• Minsk Pediatric Hospital of
Infectious Diseases
Belgium:• Antwerp University Hospital• Centre Hospitalier de Mouscron• Centre Hospitalier de Wallonie
Picarde• Universitair Ziekenhuis Gent
Bulgaria:• Bulgarian Society of Pediatric ORL• UMHAT "Tzaritza Joanna-ISUL"
Finland:• Helsinki University HospitalFrance:• Aix Marseille University, La Timone
Children's Hospital• Hôpital Femme Mère Enfant• Hôpital Necker - Enfants Malades• University Hospital Gui de Chauliac• University Hospital of Brest• University Hospital of Lille
Germany:• Klinikum Bremerhaven
Reinkenheide

Greece:• Agia Sofia Children’s Hospital
AthensHungary:• Hogyi
Ireland• Children’s Health Ireland• Children’s Health Ireland at Crumlin
Italy:• ASST Spedali Civili• Azienda Ospedaliera Università di
Padova• Bambino Gesù Children's Hospital• Institute for Maternal and Child
Health IRCCS Burlo Garofolo• Meyer Hospital• Ospedale dei Bambini V. Buzzi
Milano• Ospedale Infantile Regina
Margherita
Latvia:• Children’s Clinical University
Hospital
Poland:• Karol Jonscher Childrens Hospital,
Poznan University of Medical
Sciences
Portugal:• Centro Hospitalar Universitário do
Porto• Hospital de Cascais• University of Porto Faculty of
Medicine Hospital Center S. Joao
Romania:• CMDTAMP Bucharest• University of Medicine andPharmacy "Victor Babes" Timisoar
Russia:• Clinical Hospital Lapino• Imma• Klinika Semeynaya• National Medical Centre of
Otolaryngology of FMBA of Russia
Serbia:• Mother and Child Health Care
Institute of Serbia
Spain:• Hospital San Rafael, Madrid• Hospital Universitario Son Espases• Sant Joan de Deu Children’s
Hospital Barcelona
Sweden:• Karolinska University Hospital• University Hospital Lund
Switzerland:• University Hospital Basel
Ukraine:•Lviv Regional Pediatric Clinical
Hospital OHMATDYT
United Kingdom:• Barts Health• Bradford Royal Infirmary• Evelina London Children's Hospital• Great Ormond Street• Imperial College• Royal Belfast Hospital for Sick
Children• Sheffield Children’s Hospital• St Georges• University College London Hospitals(3)
North America
Canada:• BC Children’s Hospital• Centre Hospitalier UniversitaireSainte-Justine• CHEO• CHU de Québec-Centre MèreEnfant• IWK Health Centre• Montreal Children's Hospital• The Hospital for Sick Children
Costa Rica:• Caja Costarricense del Seguro Social• CCSS• CCSS San Juan
• Dr. Gago’s Private Practice• Hospital Monseñor Sanabria• Hospital Nacional de Niños delSeguro Social• Hospital San Vicente de Paul
• INS
• Ministerio de Salud Costa Rica
Dominican Republic:• Cedimat• Hospital Pediátrico Dr Hugo
Mendoza• Hospital Salvador B. Gautier• LoloEl Salvador:• Hospital de Niños Benjamín Bloom• Instituto Salvadoreno Del Seguro
Social/ Hospital Regional San Juan
De Dios De San Miguel El Salvador
Guatemala:• Centró Otorrinolaringológico
Honduras:• AHONORL• Asociación de Rinologia Honduras• Honduras Medical Center• Hospital del Valle• Hospital San Felipe
Jamaica:• Bustamante Hospital for Children
Mexico:• Hospital Infantil de Mexico Federico
Gómez• Salud Auditiva México SA de CV• Tecnologico de Monterrey TECSalud• Instituto Mexicano del Seguro Social
Nicaragua:• Clinicentro• Hospital Vivian Pellas• Hospital Vivian Pellas /HospitalMonte España
Panama:• Hospital del Niño Dr. Jose Renan
Esquivel• Hospital De Especialidades
Pediatricas de la Caja de Seguro
SocialUnited States:• Albert Einstein College of Medicine& Montefiore Medical Center• Ann & Robert H. Lurie Children's
Hospital of Chicago• Arkansas Children's Hospital• Boston Children's Hospital• Center One Surgery• Children's Hospital Colorado• Children's Hospital Los Angeles• Children's Hospital New Orleans• Children's Hospital of Philadelphia• Children's Hospital of Pittsburgh• Children’s National Health System• Cincinnati Children's Hospital• Connecticut Children's Hospital• East Tennessee Children's Hospital• Emory University• Johns Hopkins University• Mary Bridge Children’s Hospital• Medical College of
Wisconsin/Children's Wisconsin• Miller Children’s Hospital• Nationwide Children's Hospital• Nemours/Alfred I. duPont Hospitalfor Children• Nemours Children’s Hospital
Orlando, FL• New York University• Oregon Health Sciences University• Penn State Milton S. Hershey
Medical Center• Primary Children's Hospital• Rady Children's Hospital San Diego• Seattle Children's Hospital• Stanford University• SUNY Downstate Medical Center• Texas Children's Hospital/Baylor
College of Medicine

•
•
•
•
•
•
•
•
•

University of California, San
Francisco
University of Michigan
University of New Mexico Children's
Hospital
University of Rochester
University of Texas - Houston
University of Vermont Medical
CenterUT Southwestern
Walter Reed National Military
Medical CenterWest Virginia University

South America
Argentina:• COAT Centro Otoaudiologico deAlta Tecnologia• Consultorio Otorrinolaringologico
Buenos Aires• Hospital Español de Mendoza• Hospital General de Niños Dr. Pedrode Elizalde• Hospital Nacional de Pediatria Prof.
Garrahan• Hospital Pediatrico Fleming• Hospital Privado de Nariz Gargantay Oidos• Sanatorio Allende• Sanatorio Argentino
Bolivia:• Caja de Salud CORDES• Clínica Alemana• Hospital Arco Iris
Brazil:• Clínica Crescer• Clinica Infancia Viva Pediatria• Clínica Integrada Aragão
• Faculdade Ciências Médicas deMinas Gerais• FAMERP• Fundação Ouro Branco• Hospital da Criança Conceição
• Hospital da Cruz Vermelha
Brasileira Paraná• Hospital das Clinicas da Faculdade
de Medicina da Universidade de São
Paulo

•
•

Hospital de Clínicas de Porto Alegre
Hospital de Otorrinolaringologia deSorocaba BOS• Hospital Infantil Darcy Vargas• Hospital Infantil Joana de Gusmão
• Hospital IPO• Hospital Israelita Albert Einstein• Hospital Mater Dei - Unidade
Contorno• Hospital Municipal Souza Aguiar• Hospital Paulista• Hospital Pequeno Príncipe• Hospital Português
• Hospital Regional de Taguatinga• Hospital Sao Lucas da PUCRS• Hospital Unimed Rio Verde• Hospital Universitário Antônio
Pedro• Hospital Universitário Pedro
Ernesto UERJ
• Iapo• Imigrantes Hospital• Instituto Fernandes Figueira• Instituto Fernandes Figueira /FIOCRUZ• Otos• Private/Independent Practice (3)• Santa Casa de Campo Grande• Santa Casa de Porto Alegre• Santo Antonio Children's Hospital• Sensorial• SMS RJ/CF JSH• Unimed BH• Universidade de Vassouras• Universidade Estadual de Campinas- UNICAMP• Universidade Federal de São PauloChile:• Hospital Clínico San Borja Arriarán• Hospital Regional de Concepcion• Red Salud Universidad CatólicaColombia:• Clínica Palermo• Clinica Portoazul• Fundación Santa Fe• Hospital Santa Clara• Hospital Universitario San Ignacio• Independiente• Otofon• Private Practice Office• Santa Cñara Hospital ESE• Universidad de Caldas
Ecuador:• Hospital Carlos Andrade Marín• Hospital Kennedy Alborada• Hospital Metropolitano
Paraguay:• Hospital de Clinicas• Hospital de Clinicas U.N.A.
• Hospital General Barrio Obrero• Hospital Nacional
Peru:• Clínica Internacional• Hospital Negreiros de EsSalud• Independiente• Instituto Nacional de Salud del Niño
de San Borja• Seguro Social de Salud
Uruguay:• 1- COMECA• CASMER- FEMI
• Centro Hospitalario Pereira Rossell• Comeri• Cosem
Venezuela:• Centro de Otorrinolaringología
Respira Libre• Centro Medíco de Caracas• CHET• Clínica Calicanto/ Prevaler Maracay• Clínica de Oídos, Nariz y Garganta
Barquisimeto• Clínica El Ávila
• Hospital de Niños HM de los Rios
• Hospital Domingo Luciani• Hospital Dr. Luis Gomes Lopez• Hospital Luis Ortega• Hospital Vargas de Caracas• Instituto Auditivo Barinas/ Centro
de Oido Nariz y Garganta• Instituto de Otorrinolaringología yOftalmologia• IVSS Ambulatorio El Limon Aragua• Policlinica Metropolitana

SURVEY RESPONDENTS(LISTED ALPHABETICALLY BY FIRST NAME*)*Names Are Written As They Appeared In Survey Responses. We Apologize In Advance If There Are Any Errors In
Names Listed Here. Please Email Natasha.Dombrowski@Childrens.Harvard.Edu Or
Erika.Mercier@Childrens.Harvard.Edu With Any Corrections.

Adelaida Bock
Ahmad Alkurdi
Alan Cheng (Palo Alto)
Alan Cheng (Sydney)
Albert Park
Alejandra Corrales
Alexey A. Borodin
Ali Taghi
Alvaro Carlos Calvo
Alvaro Ricardo Fuentes
PereiraAn Boudewyns
Ana Carolina
Ana Paula Dualibi
Ana Sandoval Valdiviezo
Anastasiya
Anatolii
Aneliese MairÁngela Pérez
Ann Hermansson
Anna Messner
Anna Meyer
Anne Doyen
Anne Schilder
Antonio Joaquin Ruiz
CoronaAraceli De La Guardia
Archwin Tanphaichitr
Ariel Ivars
Augusto Peñaranda
Bas Pullens
Bernardo Oliver
Blake Papsin
Bong Jik Kim
Bruce Maddern
Byun Jae Yong
Carina Valeriani
Carla Napolitano
Carlos De La Torre
Carlos Enrique Mena
CanataCarlos Humberto Cieza
Samillan
Carlos Mena Canata
Carlos Muñoz
Carol Macarthur
Cecilia Jové
Cecille Sulman
Cesar
César Franco Peña
Cesare Cutrone
Chiader Lin
Chris Raine
Christian Fernandez Zapata
Claudia Schweiger
Claudio Lindemberg
Cleverson Aguiar
Colleen Heffernan
Conor Jackson
Cristiane Abdo
Damien Phillips
Daniel Choo
David ChiDavid LandinDavid Tunkel
Deepa Shivnani
Diana Gomez
Diana Patricia Romero Lara
Diana Vanessa Sierra
Amador
Dilyana Vicheva
Douglas R. Sidell
Edgar Arturo Perdomo
FloresEdilberto Salazar Zender
Edio Junior Cavallaro
Magalhães
Elena Piña
Elise Zimmermann Mathias
Ellis Arjmand
Els De Leenheer
Enrique Muñoz Hernandez

Erica C. Bennett
Ericka King
Estelita Betti
Eva Orzan
Faruk Unal
Federica PeradottoFederico Murillo
Fedir Yurochko
Fernando Silva Chacon
Francis Sanchez De Losada
Francisco Bonilla Gomez
Francisco Medina
Franco Pignatelli
Franco Trabalzini
Françoise Denoyelle
Frida Scharf De Sanabria
Gabriella Kupecz
Gadi Fishman
Genaro Reynoso
George Evandro Boos
George Reitich
George Zalzal
Gerard Corsten
Gerardo Manuel Salas
Rivas
Gerardo Rene Barillas
German Gago
Gheorghe Iovanescu
Gi Jung Im
Goh Bee See
Graciela González Franco
Gresham Richter
Haifaa S. Alnasser
Halimuddin Bin Sawali
Hamid Daya
Harlan Muntz
Hashimah Ismail
Hassan Ramadan
Hazim Aleid
Heather Herrington
Helen Caulfield

Henry Tan KK
Hudson Dutra
Hugo Rodriguez
Huniades Urbina-Medina
Huynh Ba Tan
I Chun Kuo
Ian Jacobs
James S. Reilly
Jaroslaw Szydlowski
Jean Pierre Certain
Jean-Michel Triglia
Jeffrey Koempel
Jesus Franco Anzola
Jesus Peña Prato
Jeyanthi Kulasegarah
Jiarui Chen
Jie Zhang
Jin-Hwan Kin
Joana Ximenes Araújo
Joerg Ebmeyer
Johanna Nokso-Koivisto
Johanna Sembergman
John P. Little
John Russell
Jonathan B. Ida
Jordana Rosignoli
Jorge Astocondor
Jorge Osorio
Jorge Rafael Villamizar
Jorge SpratleyJose Colmenarez
Jose Daniel Pazzetti
José Faibes Lubianca Neto
José Manuel Meléndez
GarcíaJuan David Carvajal
Juan Ospina
Julie Wei
Julio Ernesto Cardona
González
Jungho Bae

Karen Mojica
Karen Zur
Katherine Kavanagh
Kelly Atencia Bueno
Kelvin Kong
Kenny H. Chan
Kim Chul-Ho
Kim Jong-Yeup
Kristaps Dambergs
Kristien Ghyselen
Kuo Sheng Lee
Lan LiLeandro Brandão
Guimarães
Lee Reyes
Lei WuLeonardo Conrado Barbosa
De Sá
Lilia Dimitrov
Lilian Scapol Monteiro
Liliana Palma
Lisa Elden
Lorena Rodrigues
Luca Redaelli De Zinis
Lucía Arias Asch
Luciana Pimentel
Oppermann
Luis Jiménez Ferreres
Luz Tobar
Magdalena Roques Revol
Mai Thy Truong
Malba Bastidas
Manoel De Nobrega
Manohar Shaan
Marc Thorne
Marcelo Otsuka
Marcelo Silber
Márcio Emrich Campos
Margo Mckenna Benoit
María Beatriz Rosales
Maria Beatriz Rotta Pereira
Mariana Pires De Mello
ValenteMariana Saad
Marilena Trozzi
Mario Zernotti
Marlene Soma

Marsha James
Matthew Brigger
Matthew Bromwich
Maura Neves
Mauro Zernotti
Mayra Coelho Bócoli
Meghan Wilson
Mehmet Umut Akyol
Mercedes Narváez
Meredith Lind
Michael Cunningham
Michael Kuo
Michael Rutter
Michel Neeff
Michelle Wyatt
Miguel Bebiano Coutinho
Mihaela Carmen Tomoiu
Moacyr Saffer
Mohamed Akkari
Moshe Chaitchik
Nara Orban
Nayara Lacerda
Neil Chadha
Nesrettin Fatih Turgut
Nguyen Tuyet Xuong
Niall Jefferson
Nicola (Nikki) Slee
Nicolas Guertler
Nicole Bejarano
Nina Yoshpe
Noemie Rouillard-Bazinet
Noriko Morimoto
Norzi Gazali
Nuntigar Sonsuwan
Nurliza Idris
Olga Karneeva
Oliver Haag
Oscar R.Terraza-Calderon
Ozan Gökler
Pamela Pol Paulino
Patricia Andrade
Patrícia Campos Elia
Patrícia Cristina Berenhi
Patricia Mesquita Vilas
Boas
Patricio Bellia Munzon
Paulo Pires De Mello

Peggy Kelley
Pham Dinh Nguyen
Pierre Fayoux
Priatharisiny Velayutham
Rachel Almeida Pra
Rafael Pontes Ribeiro
Rania Mehanna
Raquel Gomes De Arvalho
Pinto
Rebecca Maunsell
Remi Marianowski
Riaz Seedat
Ricardo Antonio De Hoyos
Parra
Ricardo Araujo Abimorad
Ricardo H. Encinozo K.
Ricardo Neves Godinho
Richard M. Rosenfeld
Rizka Fathoni Perdana
Robert Ruben
Rodolfo Villarreal
Rohit Verma
Rolanda Gil Ng
Ron Mitchell
Rosana Cristine Otero
Cunha
Rosaria Sano
Roy Francisco Acosta
Valerín
Safeena Kherani
Sahba Sedaghat
Sajidxa Mariño
Sam Daniel
Samir M. Bawazir
Sandra De Lucas Aragão
Sandra Toso
Sanjay Parikh
Sarah Morrison
Saraiza Abu Bakar
Scott Rickert
Scott Schoem
Seok Hyun Cho
Sergio Sarradell
Shamina Sara Moses
Sharon Ovnat Tamir
Shazia Peer
Shifa Zulkifli

Shirley Saavedra Rocabado
Shyan Vijayasekaran
Silvia Angela Bentancor
Ramirez
Silvia Ventura
Sofia Stamataki
Soham Roy
Sok Yan Tay
Sonia Ayari-Khalfallah
Sophie Lachance
Soraya Garcia
Stella Rowley
Stephen Rodrigues
Steve Maturo
Steven Goudy
Suhaimi Yusuf
Sung Wan Kim
Suzina Sheikh Ab Hamid
Tagwa Abdalla
Tal Marom
Tania Maria Sih
Teolinda Mendoza De
Morales
ThaisaThomas Mancinelli
Thuy Nguyen Thi Thanh
Toma Avramov
Udayan Shah
Valeria Rees
Veronica Rodriguez
Victor Abdullah
Victor Rachkov
Victoria Possamai
Victoria Tenías
Vincent Couloigner
Vinicius Ribas Fonseca
Vladan Subarevic
Wei-Chung Hsu
Wu Zebin
Yancy Acosta
Yin Tan Kuei
Yoo-Sam Chung
Yoon Se Lee
Youjin Li
Young Ho Kim
Zuleyma Hernandez RholasРита