Watch the video "How laryngectomees can cope with the COVID-19 pandemic"
There has been a deadly outbreak of a
novel strain of coronavirus in China causing severe respiratory illness and
death. The virus has been spreading arround the world causing pandemic. The causative virus has been identified
and its genome sequenced, which will allow confirmation of cases and
development of a vaccine, though most likely not for about a year. As of
today the CDC has recommended travelers avoid all nonessential travel to areas where the virus is prevalent. The virus is most likely spread by droplets. Those traveling to
high risk areas should practice certain health precautions like avoiding contact
with people with respiratory disease symptoms and careful hand-washing.
Wearing a surgical mask is helpful, but it's more effective when worn by those
with the disease.
Human coronaviruses most commonly
transmit from an infected person to others via:
- The air by coughing and sneezing and rarely, fecal contamination
- Close personal contact, such as touching or shaking hands
- Touching an object or surface with the virus on it, then touching the mouth, nose, eyes or stoma (in neck breathers) before washing hands
Coronaviruses are usually transmitted from animals, particularly bats,
camels, and even snakes to humans. The first 4 cases were all workers in the
Huanan Seafood Wholesale Market, which sells live poultry, aquatic animals,
bats, and snakes to the public. Unfortunately, the virus has mutated to cause
human to human transmission.
Symptoms can range from those of a mild
cold to severe respiratory distress and death. The first signs and symptoms are
a fever, cough, and initially mild respiratory distress that often worsens due
to development of pulmonary edema ("water on the lungs"). All deaths
to date have been in Wuhan City. The incubation latent periods are not certain.
The virus is likely to spread throughout
the world because of international travel and precautions may be needed to implemented
everywhere. Head and neck cancer may be more vulnerable to respiratory
infections and should exercise caution to prevent getting infected.
As the epidemic of corona virus is
spreading throughout the world it is important for laryngectomees to protect
themselves. Most laryngectomees experience less
“colds” than non laryngectmees. This is believed to be because respiratory
viruses generally first infect the nose and move to other body sites (including
the lungs). Because laryngectomees do not inhale through their noses this mode
of getting infected does not exist.
However, respiratory viruses can also
access the body through the mouth, and conjunctiva. In laryngectomees the virus
can access the lungs directly through the stoma. Although the exact mode of
infection transmission of Corona virus is yet unknown, it is prudent to assume
that it would behave in a similar fashion.
It is not yet known if laryngectomees are
more susceptible to COVID -19. It is therefore prudent to be extra careful. There
are several risk factors that places laryngectomees in increased risk to get infected.
Once laryngectomees get infected they may be more
likely to develop a serious pneumonia because their airway are
compromised. Many have chronically
dry and irritated trachea and bronchi,
and they often have reduced lung capacity and lower lobes athelectasis.
This is why it is wise that
laryngectomees are careful and follow the Health Departments direction.
laryngectomees and neck breathers can protect themselves by:
- Wearing HME 24/7 especially when being around
other people. HME with greater filtering ability would work better in reducing
the risk of inhaling the virus ( i.e., Provox Micron TM, Atos Medical's
XtraMoist). Provox Micron, has an electrostatic filter and 99.9% filtration rate and it’s cover prevents direct finger contact of the stoma. Wearing it protects other individuals from becoming
infected when the laryngectomee is infected. A
- Wearing hands free tracheostoma valve because it does not require touching when speaking)
- Those who use a regular HME should wash their hands before touching their HME.
- Wearing a face mask ( preferable N95 respirator) over the stoma. A facemask with four strings can be modified to fit over the stoma. One of the strings can be extended with extra string; and the lower pair of strings can be tied behind the back. (see pictures)
- Wearing face mask or respirator over the nose and mouth, and
protective glasses. (see picture below) This can prevent the virus from entering the body through these sites or spread to other people when infected. Men should
shave their facial hair prior to wearing facemask or respirator.
- Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
- Avoid touching your stoma, eyes, nose, and mouth with unwashed hands.
- Avoid close contact with people who are sick.
- Staying at least 6 feet from other who don't live with you.
- Clean and disinfect frequently touched objects and surfaces.
To prevent the spread to others stay home
when you are sick, and cover your cough or sneeze with a tissue, then throw the
tissue in the trash.
If worn properly, a face mask can help
block large-particle droplets, splashes, sprays or splatter that may contain germs
(viruses and bacteria). Face masks may also help reduce exposure of the wearer’s
respiratory secretions to others.
While a face mask may be effective in
blocking splashes and large-particle droplets, it does not filter or block very
small particles in the air that may be transmitted by coughs, and sneezes.
Face masks also do not provide complete protection from germs and other
contaminants because of the loose fit between the surface of the face mask and
the skin over the stoma.
Some face masks (i.e., N95) offer greater
filtering abilities of germs and small dust particles. However, neck breathers
and people with chronic respiratory, cardiac, or other medical conditions that
make breathing difficult should check with their healthcare provider before
using a N95 face mask because it can make it more difficult for the wearer to
breathe.
It is prudent that laryngectomees follow the government and local health authorities’ instructions and
avoid exposure to the virus by strictly isolating themselves.
To obtain more suggestions for laryngectomees how to cope with COVID-19 pandemic click the Laryngectomee Newsletter link.
Technique to place a facemask over the stoma in a laryngectomee
Wearing a facemask over the nose and mouth and protective glasses
Message from the Japanese Head and Neck Support Society. (in Japanese and English)
Message from the Singapore Cancer Society
Message from Nu Voice ( University of Southern California) Los Angeles.
Click for further reading about protection of laryngectomees (International Achieves of Otorhinolaryngology)