key: cord-287129-g2zdv5dc authors: Sowerby, Leigh J.; Patel, Zara M. title: Reply to: Correspondence – International Registry of Otolaryngologist – Head and Neck Surgeons with COVID‐19 date: 2020-08-22 journal: Int Forum Allergy Rhinol DOI: 10.1002/alr.22689 sha: doc_id: 287129 cord_uid: g2zdv5dc nan 19". 1 We completely agree with all the limitations raised, as we had already raised them in the discussion of our own paper. What we apparently disagree on is the idea that accumulating knowledge from verified cases with contact tracing is somehow detrimental to our knowledge base and specialty. There has been an increasing fear surfacing across all scientific journals that data coming out of studies that are less robust than a randomized clinical trial is dangerous to our global scientific endeavor. This article is protected by copyright. All rights reserved. As Dr. Turner points out, the risk our specialty faces can be reduced with appropriate mitigation and use of personal protective equipment (PPE). Unfortunately, while access issues have abated in most developed countries, this continues to be a challenge on an international level. As we write this letter in reply, nineteen percent of all cases of COVID-19 reported in Mexico are in healthcare workers and our colleagues in Otolaryngology have not been spared. The risk of death for healthcare workers in Mexico is four times higher than in the United States and this is related and attributable to restricted access to PPE. 2 Sadly, some other countries are actively supressing case data and information, making the situation is even more dire -this data could not be included in our registry for fear of repercussions to the local representatives. One of the main aspirations of our registry was to help quantify situational risk and empower advocacy for proper PPE for those that do not have it -or at least to increase awareness around cases with potential risk so that whatever risk mitigation can be performed is done (i.e. Reverse draping the microscope during a mastoidectomy). Dr. Turner does an excellent job in summarizing the currently established risk for HCWs. He did not include a prospective observational study from the UK looking at 9,800 employees found that those working in COVID-facing areas had a higher rate than those elsewhere (21.2% vs. 8.2%). 3 The numbers reported for Canada also demonstrate the pitfalls of broad surveys while studying COVID-19. 4 While we agree that the disparate rates between HCWs and non-HCWs is mostly due to testing in the study by Schwartz et al, the substantially higher mortality rate in non-HCWs is because the vast majority of outbreaks were encountered in long-term care homes -80% of all Canadian deaths have been in long-term care residents. 5 While we support and amplify the caution that should be used when reading this type of data, we reject the idea that simply because the media or public figures may jump to conclusions before gathering all the evidence, means that all other physicians and scientists will do the same. We have more faith in our fellow otolaryngologists' ability to take the data in the context with which it is presented and simply add it to the growing knowledge base we are accumulating about this disease process and how best to continue safely practicing and operating within a pandemic. Sincerely, Letter to the Editor re: International Registry of Otolaryngologist -Head and Neck Surgeons with COVID-19. Int Forum All Rhinol Why the coronavirus is killing so many of Mexico's healthcare workers. The Guardian Differential occupational risks to healthcare workers from SARS-CoV-2: A prospective observational study COVID-19 infections among Healthcare Workers and Transmission within Households 81% of COVID-19 deaths in Canada were in long-term care -nearly double OECD average The authors have neither financial interests nor support to declare.