1. How do you know the difference between allergies and COVID-19?
    1. It’s springtime and that means tree pollen allergies. Seasonal allergies are characterized by itchy/watery eyes, sneezing, post nasal drip, and nasal congestion/stuffiness. Two major signs of COVID-19 that are NOT consistent with allergies are fever and dry cough. Seasonal allergies can have a cough associated with post nasal drip; however, this will not be associated with a fever and should be improved with an antihistamine. If you sneeze, use tissue or elbow, not your hands unless you can immediately wash your hands.
  2. Why do we want to protect ourselves from sneezing and coughing?
    1. COVID-19 spreads by respiratory droplets. Transmission pathway begins as an infected patient coughs or sneezes onto their hands or surrounding surface. You then touch those surfaces, touch your face, and then the virus is able to get into your lungs by way of the mucus membranes in the mouth, nose or eyes.
  3. What am I doing as an ENT to protect myself?
    1. I wear a mask to see all patients. Lenox Hill hospital and others have mandated that everyone walking into the hospital must wear a mask. ENT and ophthalmologists are the highest risk specialties to get this virus because of the mode of transmission. We are more likely to get exposed. The virus harbors in the nasopharynx. Because of this, we limit nasal endoscopy and sinus debridement which commonly causes a sneeze or cough. I limit manipulation of the ear canals for ear wax because that also causes a cough. I have any patient who may sneeze or cough wear a mask before these procedures. N95 masks are only being recommended for specialists who are performing airway procedures on COVID-19 patients.
    2. I wash my hands according to CDC guidelines for 20 seconds with soap and water. If not available, I used hand sanitizer that is 60% alcohol – this concentration of alcohol disrupts the glycoprotein envelope and kills the virus. If the hands are visibly dirty, the dirt protects the virus from the alcohol; so always wash hands if dirty because the sanitizer won’t be as effective.
    3. Outside of the hospital, a stay-at-home mandate is in place in NYC for limited movement and social distancing at least 6 ft. We say 6 ft because a high-risk exposure is greater than 10 min within 6 ft, the distance that respiratory droplets can spread. I don’t ride elevators with others. I wash my hands as soon as I get home. I don’t touch the elevator buttons.
  4. How can my patients prepare and stay healthy?
    1. Mindset
      1. Work on your mindset with the premeditation of fear – what things do you fear and what can you do? As an ENT surgeon working in the ER, I fear getting sick and dying. How am I working through that? I talk to my family about my living will and I created a healthcare proxy so there is no confusion about my wishes and who is making decisions; I made sure that a family member is listed on all of my financial accounts so there is no chaos if they need access. It’s a very scary time but should the worst happen it won’t take me or my family by surprise.
      2. I understand that this will pass, as evidenced in China, where the virus originated. The curve will flattened and I will do my part. 
    2.  Medical
      1. AVOIDANCE. Use 6 ft social distancing if absolutely necessary to go out. Otherwise stay-at-home.
      2. Avoid calling 911 unless you have a true medical emergency that needs immediate attention.
      3. Healthy living – stay warm, limit alcohol, get plenty of sleep, some exercise, cook with foods high in Vitamin C, vegetables, elderberry syrup, and drink lots of water.
      4. Avoid all NSAIDS including ibuprofen, Advil, Aleve (naproxen)
      5. Avoid all oral steroids and nasal steroids if possible
      6. Scientists are working on antiviral medications, antibody infusions, rapid testing, effective protocols of hydroxychloroquine and azithromycin, remdesavir is rolling out, and 40+ compounds are being tested for vaccines.