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      Society of swallowing and dysphagia of Japan: Position statement on dysphagia management during the COVID-19 outbreak

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          Abstract

          On April 14, the Society of Swallowing and Dysphagia of Japan (SSDJ) proposed its position statement on dysphagia treatment considering the ongoing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

          The main routes of transmission of SARS-CoV-2 are physical contact with infected persons and exposure to respiratory droplets. In cases of infection, the nasal cavity and nasopharynx have the highest viral load in the body. Swallowing occurs in the oral cavity and pharynx, which correspond to the sites of viral proliferation. In addition, the possibility of infection by aerosol transmission is also concerning.

          Dysphagia treatment includes a broad range of clinical assessments and examinations, dysphagia rehabilitation, oral care, nursing care, and surgical treatments. Any of these can lead to the production of droplets and aerosols, as well as contact with viral particles. In terms of proper infection control measures, all healthcare professionals involved in dysphagia treatment must be fully briefed and must appropriately implement all measures. In addition, most patients with dysphagia should be considered to be at a higher risk for severe illness from COVID-19 because they are elderly and have complications including heart diseases, diabetes, respiratory diseases, and cerebrovascular diseases.

          This statement establishes three regional categories according to the status of SARS-CoV-2 infection. Accordingly, the SSDJ proposes specific infection countermeasures that should be implemented considering 1) the current status of SARS-CoV-2 infection in the region, 2) the patient status of SARS-CoV-2 infection, and 3) whether the examinations or procedures conducted correspond to aerosol-generating procedures, depending on the status of dysphagia treatment. This statement is arranged into separate sections providing information and advice in consideration of the COVID-19 outbreak, including “terminology”, “clinical swallowing assessment and examination“, “swallowing therapy”, “oral care”, “surgical procedure for dysphagia”, “tracheotomy care”, and “nursing care”. In areas where SARS-CoV-2 infection is widespread, sufficient personal protective equipment should be used when performing aerosol generation procedures.

          The current set of statements on dysphagia management in the COVID-19 outbreak is not an evidence-based clinical practice guideline, but a guide for all healthcare workers involved in the treatment of dysphagia during the COVID-19 epidemic to prevent SARS-CoV-2 infection.

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          et al. Comparisons of methods eliminating contaminants after oral care. -Preliminary study in healthy individuals-

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                Author and article information

                Contributors
                Journal
                Auris Nasus Larynx
                Auris Nasus Larynx
                Auris, Nasus, Larynx
                Published by Elsevier B.V. on behalf of Oto-Rhino-Laryngological Society of Japan Inc.
                0385-8146
                1879-1476
                23 July 2020
                23 July 2020
                Affiliations
                [a ]Department of Otolaryngology, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
                [b ]Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan
                [c ]Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
                [d ]Department of Rehabilitation, Japanese Red Cross Society Suwa Hospital, Suwa, Japan
                [e ]Department of Rehabilitation, National Center for Global Health and Medicine, Tokyo, Japan
                [f ]Department of Oral Medicine and Hospital Dentistry, Tokyo Dental College, Chiba, Japan
                [g ]The University of Tokyo Hospital, Rehabilitation Center, Tokyo, Japan
                [h ]Aichi Cancer Center, Nursing Department, Aichi, Japan
                [i ]Department of Otorhinolaryngology, Aichi Medical University, Aichi, Japan
                [j ]Department of Speech and Hearing Sciences, International University of Health and Welfare, and the Voice and Swallowing Center, Fukuoka Sanno Hospital, Fukuoka, Japan
                Author notes
                [* ]Corresponding author. ruu1025@ 123456yahoo.co.jp
                Article
                S0385-8146(20)30165-6
                10.1016/j.anl.2020.07.009
                7377736
                © 2020 Published by Elsevier B.V. on behalf of Oto-Rhino-Laryngological Society of Japan Inc.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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