>> I'm Dave Eisele,
Director of the Department of Otolaryngology here at Hopkins
and I'm with Dr. Carole Fakhry,
Chief of Head and Neck Surgery.
And we're with Dr. Jason Chan,
who is an alumnus of the Department of Otolaryngology-
Neck and Head Surgery Residency Training Program
here at Hopkins.
He's now on the faculty
at the Chinese University of Hong Kong.
And he's here to talk to us about his experience
with COVID virus and implications for otolaryngology-
head and neck surgery and medicine.
Jason, how have you been doing?
>> We've been doing okay here, I guess, so far.
I mean, we've basically been in this kind of semi lockdown
since end of January, just before Chinese New Year,
when they kind of meant
emergency response here in Hong Kong
through the hospital authority system here.
And obviously, it's affected our daily lives
and also our daily practice here as well.
>> We're just about reaching the peak here
so we're very interested in hearing how you were impacted.
>> I think, within the hospital itself,
definitely it was a shock to begin with,
when we initially had this emergency response,
but I think very, very fortunately,
or unfortunately, we had SARS back in 2003.
So a lot of the staff here
actually went through that period of SARS in 2003,
and the institution also went through it in 2003.
So they had some responses of how to deal with it
based on those experiences from the past.
And so kind of efficiently,
they were able to develop guidelines to work through it.
We did have resource problems with PPE to begin with,
but that stabilized fairly quickly,
within two or three weeks after we cut down on clinics
and also elective operations.
>> Are the residents working with you in the hospital
or they continue to see patients
and perform surgeries with you?
>> So initially, our clinics were cut back by around 80%
and our operative time was similarly cut down
by about 60 to 70%.
And we were really just focusing
on doing oncological surgeries
and cutting down on elective surgeries.
We have not had to operate on any COVID-19 cases
that we know of at this point in time.
But obviously, there is a concern of PPE limitation,
so we can't have everybody in the operating room
at the same time, so there is that concern.
So they have had some, I think,
loss in terms of operative time and clinic time,
but we've tried to make up for that
and we've taken basically this time that we have
to focus on some other aspects.
So for example, quality improvement projects.
We've tried to do more of that during this period of time,
looking at research projects,
also having some teaching opportunities
from senior staff with the residents and the interaction.
So we're taking time to do more of that,
given everybody has a little bit more free time in a way,
while we cannot see further patients or operate.
>> So Jason, you wrote about PPE,
and you're one of the first to publish an article
in JAMA Otolaryngology.
Can you talk a little bit about protective measures
that you've instituted in your practice?
>> Yeah, so actually, all the ENT departments in Hong Kong
have something called the COC,
which represent basically the hospital authority,
which is the public hospitals in Hong Kong.
And they have a set of guidelines of PPE use
during our clinics operations or procedures,
particularly on clinics.
and essentially, if you're doing any procedures,
something simple as a flexible laryngoscopy,
the recommendation is a fit tested N95 mask
with gown, and goggles or face shield,
and we wear a hairnet as well, during that.
And for us here, everybody that sees clinic
does do flexible laryngoscopy.
So we have not, like some people,
designated one person to just do the procedure,
who will gear up in that way.
So all of us would wear this if we're in clinics,
and this would also apply,
we have a dedicated treatment room in our wards,
where we do all the bedside procedures as well
and they similarly wear the fit tested N95 mask,
a hairnet, a face shield, and gown as well.
And if they're not doing anything
that would really stimulate coughing or sneezing,
then we would recommend a surgical mask.
>> So Jason, you did not go through SARS,
but how did it impact the case distribution
and stage at which cancer patients presented at the hospital
and how do you perceive that impacting our clinical flow?
>> So that's a very, very good question.
They did publish, actually,
some data looking at the stage of disease
a year after SARS happened
and there was definitely a higher distribution
of higher stage disease during the year after SARS.
For me, what I've seen here anecdotally
just over the last couple of weeks,
I don't have data on this yet,
I think it's still too early,
but we've had a few patients which are delayed
and presented needing emergent airways
with laryngeal tumors or supraglottic tumors.
And even people with upper airway infection
or mandibular space abscesses presenting, I think, later,
requiring crush trachea use as well.
And that all happened in the span of two weeks,
where we had this spike in imported cases.
We have not had to do that in a while
and suddenly, we had three or four cases in one go.
>> Have you used telemedicine, Jason,
in terms of seeing some of these patients?
>> Our colleagues at another hospital
have started using telemedicine.
They're using it very, very selectively
and they basically identify the patients that they can see
or chat to over the phone on Zoom to do this.
But out of, I think, around 6,000 based patients,
they identified 20 to 30 patients.
There's obviously concern with privacy.
So the hospital authority,
the managers at the hospitals,
have some dedicated security to encrypt this work with zoom,
and also patient identification
to make sure we are seeing that patient,
through identification and their appointment slips as well.
And also, the consultations take longer with zoom,
in terms of setting it up with the identification methods
and the consultation, it's a little bit more cumbersome.
So it's definitely slower
than seeing the patients in our normal clinic.
The other thing we've also done
is set up set up drug refill clinics.
So for patients that are coming back
purely for a drug refill,
they'll go get a prescription and get that filled,
rather than having to see them in clinic.
So those are two aspects that we've done
to try and facilitate.
>> Jason, what was it like at its worst in Hong Kong?
>> I think at its worst, people were scared,
and people were really scrummaging for PPE.
You could not buy face masks,
you could not buy rice or toilet rolls
at the supermarkets to begin with, people were worried.
And if you walk into the hospital,
it's really was very, very quiet
and I've never seen it like that before.
And I think everybody was confused and a little lost.
But I think people here have behaved probably differently.
Culturally, they're very different.
Everybody wears masks
when they have upper respiratory symptoms.
And so they've been practicing the social distancing,
the hygiene, I think, very, very differently
from Europe and from US.
This a lot stemmed from SARS back in 2003, I think.
>> And in what way is it different than Europe?
>> So for example, if I'm on the ward here,
even before this all happened, before this pandemic,
we would all wear surgical masks
when we see patients on the wards.
And the outpatient clinic,
we would routinely wear gowns,
and masks, and gloves, surgical masks.
That's always been a routine since SARS 2003.
>> So Jason, where are you in the midst of this
public health crisis in Hong Kong, socially?
>> So right now, I think, we're happy.
We're hopeful at this point in time.
We've just been through, I think, hopefully,
our second wave, mainly imported cases
of COVID-19 in Hong Kong.
I mean, the last couple of days,
we've had zero community cases of COVID-19.
We just had a single digit imported cases of COVID-19.
And actually, over the past couple of weeks,
restaurants have been really limited.
They've separated so people can't sit
closer than two meters
and you can't have more than four people at a table.
All bars are closed, all cinemas, karaokes are closed.
But people are allowed to go out and walk about.
But if you go out to the streets,
you'll see people wearing masks.
And the typical hustle and bustle of Hong Kong
doesn't exist right now.
It's much quieter than you would expect
in the really highly densely populated area.
So people are practicing social distancing
and I think that will continue
for the foreseeable future here in Hong Kong,
as most of the people that are advising would say
that don't be happy,
don't lose social distancing.
Keep practicing it until you have 28 days
of no community cases.
So I think that's what everybody has in their mind
and is trying to practice going forwards socially.
>> What advice would you have for us, Jason?
>> I think social distancing has worked
very, very well for us here
and I think the mentality of what we've had here,
what we've been through;
hand hygiene, being careful gearing up and gearing down,
these simple things will help and will save lives.
>> Well, we really enjoyed talking to you.
Thank you very much for sharing your experience, Jason.
>> Thank you, Doctor Eisele.
Thank you, Carole.
>> Thank you, Jason, nice to see you.
>> Yeah, nice to see you. >> Stay safe.
>> Be well. >> You too, stay well.
>> Bye.