Upper Airway Manifestations of SARS-CoV-2 Infection During New York City Omicron Wave: A Single-Institution Experience

ABSTRACT

Introduction: Studies have shown that COVID-19 viral glycoproteins bind to angiotensin-converting enzyme 2 (ACE2) receptors in the airway, causing downregulation of the ACE protein and leading to angioedema-like symptoms. Further, compared with previous variants, the Omicron variant of SARS-CoV-2 appears to replicate more readily in the upper airway than in the lungs. To our knowledge, this is the first case series to explore presentations involving the upper airway in patients with SARS-CoV-2 infection during the Omicron wave of the COVID-19 pandemic. Method(s) We reviewed a case series of adult patients who presented to a single New York City emergency department between December 2021 and January 2022 with acute upper airway symptoms that prompted otolaryngology consultation and who tested positive for SARS-CoV-2. Result(s) Between December 2021 and January 2022, there were at least 3 SARS-CoV-2-positive patients who presented to the New York-Presbyterian Hospital with upper airway conditions requiring evaluation by an otolaryngologist. Conditions included supraglottitis, tracheitis, and epiglottitis. Two patients had received the COVID vaccine;1 had not. One patient required intubation;2 were maintained on room air. One patient was admitted to the intensive care unit, 1 to the step-down unit, and 1 to the floor. Length of stay varied from 3 to 11 days, 1 for nonairway issues. All 3 had methicillinsusceptible/ methicillin-resistant Staphylococcus aureus nasal swabs;2 were positive. All had respiratory viral panels that were negative. One had a throat culture that was negative. All received antibiotics. Conclusion(s) To date, there have been no studies exploring the upper airway manifestations of SARS-CoV-2 infection in the Omicron wave. These data provide important clinical correlates that are highly relevant to otolaryngologists.