Precautions for Intubating Patients with COVID-19

To the Editor: The major challenges in managing patients with the novel coronavirus disease (COVID-19) are bilateral pneumonia and acute respiratory distress syndrome. Many patients with COVID-19 will be in critical condition and will need intubation. Human-to-human transmission has been confirmed, and the virus has spread across the world. Based on current real-time reports, there are 78,962 confirmed COVID-19 cases, with 7,952 patients still in critical condition as of February 28, 2020. Many have been intubated and many remain to be intubated. The problem is that the viral load in the airway is probably very high and is very contagious. This poses significant risks for these who are performing intubation. Anesthesia providers play a vital role in providing in-hospital intubation. However, they generally do not deal with patients with such highly contagious disease. The safety of the patient and the individuals who are involved in the intubation requires special consideration and precautions. Multiple articles related to the precautions of intubation in the perioperative settings have recently been published. Some are empirical recommendations from institutions outside of the epicenter of COVID-19. Here we present our updated first-hand experiences focusing on the safety of the patients and providers performing intubation in an extreme situation from the epicenter of COVID-19, Wuhan, China. As shown in figure 1, three medical providers, who are volunteers from Shanghai and Qingdao, traveled to Wuhan to assist with patients there.