Covid-19: advice for iSGS patients

This is the official medical advice for patients with airway stenosis as of Tuesday 7 April 2020.

GENERAL GUIDELINES FOR EVERYONE

  • Avoid touching your eyes, nose, mouth or stoma area (for those with a tracheotomy) as much as possible. It may take practice, touching the face is often done inadvertently.
  • Wash your hands regularly through the day with soap and water for around 20 seconds or use alcohol-based hand gel.
  • Stop shaking hands or kissing as a greeting
  • Keep a distance of around 2 metres (6 feet) from others
  • The benefits of using a face mask are not clear, except that if an infected person wears one the risks of spreading the infection are reduced.
  • Cover coughs and sneezes with a tissue or your elbow.
  • Avoid all non essential travel
  • If you can access the flu vaccine, ensure you are vaccinated now
  • Advice on cleaning to remove Covid-19 can be found here:

IF YOU ALREADY HAVE BREATHING ISSUES , ARE TAKING IMMUNE SUPPRESSANT MEDICATION/TREATMENT OR ARE AN iSGS PATIENT OVER 60 YEARS OF AGE:

Breathing issues include: 

  • Your airway is closing up and breathing is already a challenge 
  • You have regular mucus plugs and issues clearing your airway
  • You have a tracheostomy

First and foremost, you should self-isolate and plan to do so for the foreseeable future. This means minimising any contact with people outside of your household, staying home unless leaving for medical treatment.  Ensure you and fellow household members follow the general guidelines above. Organise for food and medicines to be delivered. 

Your doctor has likely stopped all clinic appointments and it is unlikely there will be access to operating theatres, ICU facilities or recovery nurses. 

If your doctor is still operating and you need dilation surgery, the recommendation is to proceed with the dilation as soon as possible.

You should be able to get advice via telephone from your airway specialist should you need it. You should assume it will be some time before you can have a dilation or surgery in hospital. 

Make sure you have access to your emergency medicine kit as detailed in the Rough Guide (especially oral steroids, antibiotics).

Contact your airway specialist by phone or email to find out the protocol should things get worse for you.

It is recommended you work at home for a period of three months where possible.

Follow the advice in the Rough Guide for dealing with mucus and inflammation:

IF YOU ARE IN A HIGH RISK JOB

If you work as a frontline worker likely to come into contact with people with Covid-19 (eg nursing, intensive care, dental or other medical work)

Talk to your airway surgeon about providing you a letter for your employer suggesting particular recommendations for safety measures to maintain your health. A PDF of an example letter can be downloaded here:

As always, follow advice in the Rough Guide.

IF YOU HAVE NO ISSUES AT PRESENT

Your airway is open/ breathing is not too bad

Ensure you and your household strictly follow the general advice above. Work from home if possible and minimise contact with people outside of your household. If working from home is not possible, talk to your employer about providing you a safe place away from colleagues to work. Avoid any time indoors with people other than your household members.

Make sure you have access to your emergency medicine kit as detailed in the Rough Guide (especially oral steroids, antibiotics).

Non essential visits to pharmacies, hospitals or doctors should be avoided, as these will be hubs of the virus. It is likely your doctor will have cancelled all routine checkups, particularly where a scope is involved – this can potentially be a means of transmission of the virus to your doctor and others in the office.

It is recommended you delay any non urgent visits for up to 3 months. If your airway health changes, talk to your airway surgery by telephone.

IF YOU HAVE CAUGHT THE VIRUS OR HAVE SYMPTOMS

Do not panic!

Remember that not all people who catch the virus will get seriously ill. Contact your airway specialist and GP/primary health care provider by phone to ensure they are involved in any treatment you receive.  

Warnings against the use of ibuprofen have now been revoked. You can use these and other pain killers to treat your fever and other symptoms.

For the majority of patients, the advice is to self isolate for at least a fortnight after your symptoms first appear. Guidelines from the British government for self isolation can be found here: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-people-with-confirmed-or-possible-coronavirus-covid-19-infection

Your whole household should also isolate for 14 days.

At the very first signs of shortness of breath, contact a doctor immediately and go to emergency.

Patients who have serious issues with breathing and pneumonia are often treated with intubation. This is not advised for iSGS patients – a laryngeal mask is likely first port of call, and if your symptoms worsen, a temporary tracheotomy at the area of stenosis is likely. The medical team dealing with you will need to know about your existing airway disease. This decision will be made at the time with the information available, tailored to your individual situation and with the expertise on hand.

Why can they not intubate with a smaller tube?

The main concern is that unlike a very short term intubation (such as for surgery) intubation in this situation is likely to be longer term and could cause spreading of your scar and worsened symptoms. The key thing is to let the hospital know the status of your airway. Airway doctors are reluctant to intubate stenosis patients for long periods of time and a trach is considered lower risk.

Follow the advice in the Rough Guide for dealing with mucus and inflammation. 

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Thanks to otolaryngologists Mr Guri Sandhu, Mr Martin Birchall, Mr Chad Al Yaghchi, Dr Hannah Burns, Dr Alexander Gelbard, Dr Alexander Hillel & Dr Thomas Schweiger for their help in preparing this document. Updates are adapted from the World Health Organisation.