Introduction
The emergence of the SARS-CoV-2 virus has led to a worldwide pandemic with close to 100 million confirmed cases of COVID-19 reported, and over 2 million deaths in approximately 200 countries. Increasing evidence shows sustained human-to-human transmission, with high numbers of exported cases internationally given the highly globalized world. Based on the initial experience of COVID-19 outbreak in China, the estimated infection rate of HCWs is around 4%. (1) This is despite strict adherence to full PPE measures among HCWs. Our prior knowledge of the SARS outbreak in China showed a mortality rate of 1.4% among the 966 HCWs afflicted with SARS. (2). However, in European countries such as Italy, 20% of responding HCWs were infected, making up 3% of cases.
While the mortality rate of COVID-19 lies between 2-4% (1, 3), which is lower than the case fatality rate of SARS at 11%, a significant percentage of patients may still require tracheotomy. This is because COVID-19 positive patients can potentially develop severe pneumonia and acute respiratory distress syndrome (ARDS).
Faced with uncertain prospects of airway management in confirmed or suspected COVID-19 patients, we reviewed the literature regarding tracheotomy in COVID-19 positive patients on several aspects. COVID-19 is likely to co-exist with us for many years to come, and hence we also propose a new normal workflow for tracheotomy in COVID-19 positive patients, with a summary of the existing literature.