General Principles
  1. All patients will be advised prior to their visits that they must wear a mask at all times while in a Penn Medicine facility and if they do not have a mask one will be provided.
  2. Patients will complete a COVID-19 questionnaire and undergo have their temperature and oximetry documented in the electronic medical record. All patients who qualify by Penn Medicine criteria will be instructed to go for immediate testing. Patients that have a minimum of one positive response on the questionnaire or an elevated temperature or decreased oxygenation will be escorted to a designated COVID 19 clinic room and be evaluated by a physician in consultation with infection control. This minimizes risk of exposure and maximizes safety for both patients and staff.
  3. Known COVID-19 positive patients or PUI who are asymptomatic from the perspective of their Head and Neck Cancer should have follow-up visits delayed until they test negative for Sars-CoV-2.
  4. During the surge leading up to and at the apogee of the COVID-19 incidence curve it is strongly encouraged that routine follow-up visits or visits for treatment-related symptoms be done via telehealth video visits whenever possible.
  5. During the surge leading up to and at the apogee of the COVID-19 disease curve suspicious symptoms or radiologic evidence of mucosal disease should be assessed in the operating room under general anesthesia in order to optimize control of potentially infectious aerosolized secretions.
  6. Known COVID-19 positive patients, or PUI with new head and neck symptoms that are potentially life threatening (e.g., bleeding, shortness of breath) should be seen in the emergency room by staff donning full protection, including PAPR.3
  7. Later in the COVID-19 disease curve when routine office visits have resumed it is suggested that physicians wear N95 masks, goggles and gloves routinely given their proximity to patients and the potential exposure risks of aerosolizing procedures (e.g., fiberoptic laryngoscopy, nasal endoscopy, tracheostomy change). Support staff should not be in the patient examining room during aerosolizing procedures and therefore should only require and wear standard masks, goggles and gloves.21
  8. Anesthetizing the nasal cavity with spray systems prior to scoping should be avoided until the COVID-19 pandemic is over.
  9. It is recommended that throughout the COVID-19 pandemic that all outpatients have their temperature taken and have a COVID-19 history taken before they are seen and that all patients with either elevated temperatures or affirmative responses to the COVID-19 history be escorted to designated COVID-19 clinic rooms for further evaluation by providers and consultation with infection control for next steps.
  10. Each department will create a phased plan to incrementally increase clinic volumes during this period with the goal of both avoiding exposure of staff, physicians and other patients to COVID-19 positive patients and creating a waiting room environment conducive with Social Distancing.