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Impact of COVID-19 on ENT service delivery

Article-Impact of COVID-19 on ENT service delivery

Interview with Prof Dr Nirmal Kumar, President, ENT UK, Consultant Otolaryngologist-Head & Neck Surgeon, Director of Medical Education, Research Network Lead ENT, GM CRN, Honorary Professor, UG, Clinical Lead, Edge Hill University Medical School, Council Member, The Royal College of Surgeons of Edinburgh

Prof Dr Nirmal Kumar's team was among the first ones in the world to identify the loss of smell as a key COVID-19 symptom. In an interview with Daily Dose, he said that at Arab Health, he participated in a panel discussion that discussed the impact of COVID-19 on ENT. The panel also spoke about developing guidelines that can educate colleagues and clinicians worldwide and provide essential patient information. Excerpts: 

What has been the impact of COVID-19 been on ENT delivery?

We have come a long way in the year and a half since COVID-19 was first identified. In the early days, ENT clinicians were at the forefront, bearing the brunt of the exposure to the virus. At that time, we did not understand the implications. But with the help of guidelines, we ensured the protection for our members. One of the first things we did was to form a COVID-19 response team. We developed guidelines that allowed us to perform surgery safely and test the patients before operations. We started doing what we would term as urgent elective procedures and slowly moved into the elective that means the non-urgent routine operations too. Now, we are back to what we would call a nearly regular service with some changes that are perhaps for the better. The innovation in the delivery of services has been astounding. We are using more digital technologies such as telemedicine, as part and parcel, not in replacement. However, the doctor-patient relationship has to continue, and we need to examine the inside of the nose and throat or the ear. This can't be done in teleconsultation. Therefore, some parts have to revert to standard patient interaction. But some aspects have improved for the better.

For those who have suffered from the loss of taste or smell, how long does it take for them to recover fully? 

One of the acute symptoms of COVID-19 is the loss of sense of smell and taste. Sometimes it preceded other symptoms; sometimes, it was in addition to it. For the vast majority of these patients, 90 per cent of them lost their sense of smell and taste but recovered it within six weeks. Five per cent of them faced a delayed recovery between that was between six weeks to six months. The others developed what is being called as long COVID. This is a post-acute COVID syndrome, in which some patients suffer the debilitating effects of COVID six months after the diagnosis.

For example, if you are a vegetarian and don't eat fish, and if everything smells like fish, it can severely impact one's quality of life. Some patients also sense a burning sensation even when no smoke exists. In the past, we used to see such patients once in a blue moon. But COVID-19 has altered the way the nerve functions between the nose, where the nerve affects the virus and then the transmission of nerve impulses to the brain. That alteration sometimes lasts much longer than six months. This, of course, impacts mental health, and patients have reportedly even suffered from nightmares. 

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Prof Dr Nirmal Kumar

What impact is technology having in improving ENT patient outcomes today? 

In the UK, we are trying to work innovatively with clinicians about how we can see patients more optimally and triage patients with artificial intelligence tools. This will help to get the right patient to the right doctor at the right time and then do the procedure and discharge the patient safely. This will involve innovation using artificial intelligence technology and enhanced learning, which is a term we use for augmented or virtual reality. For example, if you're in the consulting room, you can get the patient's details, not just the X-rays or the scans and the information on a much more real-time basis. This will significantly advance the improvement of healthcare delivery.

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