Challenges Facing Ear, Nose And Throat Specialists During The COVID Pandemic

Dr. Ashen Nanan ENT Specialist

MBChB (Natal), FCORL (SA), MMedORL (Wits)

The current pandemic caused by the SARS Cov 2 Virus has had a devastating effect on ENT Practices around the world and South Africa has not been spared in this context.The effects of the pandemic have just exacerbated the decline in practice incomes due to low remuneration from medical insurances and negative growth in our economy in South Africa.

Since the Lockdown was put into effect in March 2020, ENT Surgeons were prohibited from seeing elective patients in their rooms under Level 5 guidelines. This resulted in patients not having access to ENT’s which resulted in various complications in patient management. This also resulted in significant loss of income for ENT Practices resulting in ENT’s having to not pay staff salaries and seek payment arrangements for any debts. The irony of this situation was that despite being in a medical crisis, many doctors were sitting at home with no work.

ENT Surgeons have been particularly at risk due to the fact that the SARS Cov 2 Virus mainly infects the upper and lower airways. This has resulted in increased risk to the doctor and staff at the time of consultation as well as during Aerosol Generating Procedures in theatre.

The ENT Society of South Africa put out guidelines to support its members through this crisis. This included a set of clinical guidelines under Levels 3 and 4 of the Lockdown which would ensure the safety of the patient and staff. These measures have resulted in reduced numbers of patients seen at more prolonged intervals in consulting rooms, so as to ensure social distancing is observed.

Pre-screening and temperature checks of patients are required, and rooms are cleaned between patients to reduce the risk of cross contamination.

Surgical procedures that have been deemed necessary by the surgeon have been approved to proceed as long as certain criteria have been fulfilled. All patients requiring ENT Surgery during the pandemic should self isolate for 7-14 days prior to their procedure and have a Covid PCR test 48-72hrs prior to their procedure. The Covid situation in that particular hospital should be monitored closely, and elective procedures should be postponed if bed space is required to assist in Covid response.

These measures that have been introduced have resulted in a good balance between essential patient care and reducing exposure of patients and staff to the SARS Cov 2 Virus. It is in my opinion that despite the fact that we are facing a medical pandemic, no patient should be denied access to healthcare for other serious medical conditions. Patients needing to see their doctors for urgent medical conditions should take these measures into cognisance and proceed to make the necessary appointments. Patients requiring essential surgery should also take comfort in the fact that if your doctor or hospital feels that the risk of Covid exposure outweighs the benefit of your procedure – you will be informed that your procedure needs to be postponed.

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