By Dr Azida Zainal Anuar
The world has changed overnight. Many countries are fire-fighting and yet others are functioning in war zone conditions. Some countries which are “flattening the curve”, are preparing for the long and arduous fight with this new common enemy, COVID-19. With the markets crashing virtually overnight and death tolls still announced daily, we search for light at the end of this tunnel. Many have been talking of “The New Normal”.
What does “The New Normal” mean for ENT surgeons, exactly?
We will definitely be more vigilant in screening clinic patients. Pre-COVID, most of us were not in the habit of using masks and gloves unless the patient was coughing badly during consultation or proven to have an infectious organism. We were not trained to do that routinely and never developed the habit. Many like me, will have looked back with incredulity at how we never protected ourselves with these simple barriers. Masks, gloves and a face shields are “trending” now and are here to stay.
Where previously, nasal endoscopies were an extension of our normal clinical examination, we will now most likely fall back on empirical treatments first and reserve endoscopies for cases which fail initial treatment or suspected malignancies. Hospitals must be ready to continue providing PPEs for anaesthetists and routine upper airway cases. The upper airway is our business and our fraternity has learnt the hard way, with ENT doctors in China and Europe succumbing to COVID-19 because of direct exposure to the high viral load in the nasopharynx and oropharynx. Vaccine development takes time and immunising whole countries is in the not-so-immediate future.
Technology in Our practice
Meanwhile, technology will be key in changing our practice and industry players will need to play an important role. Shields on endoscopic equipment, barriers to protect endoscopists and portable cameras and scopes will replace direct visualisation. Thus, better resolution for scopes and more affordable equipment will have to be developed.
Face shields, PPEs and PARPs need to be designed with lighter, stronger and more comfortable materials that enable better intra-operative visualisation for the surgeon. The risks are not only confined to specialists; primary care physicians are also exposed when dealing with the bread-and-butter presentation of coughs, sore throats and sinusitis. Never has there been more of a demand for new technology than now.
Teleconsultations will be more common and IT developers will need to strengthen encryption and server firewalls to protect patient confidentiality. Local laws will need to be more accepting of this and we have seen this change by our Ministry of Health advocating online consultations at dedicated portals during this period. Indeed, there will be more data-enabled services surrounding healthcare. We have realised with this pandemic that IT has more to offer than we realised. Look at how universities, schools and even kindergartens turned to online technology overnight, albeit with some initial glitches. This buy-in of technology is all we need to develop platforms for public health apps which can trace COVID-19 (or other new infections) in the future.
The economic impact on healthcare is another discussion for another day. This pandemic has left gaps in services and clinical practice, leaving plenty of room for contemplation and re-growth.