Should nasogastric tube insertion during the COVID-19 pandemic be considered as an aerosol-generating procedure?

Nasogastric tubes are used frequently in surgical patients for bowel decompression, provision of enteral nutritional support and preventing aspiration of gastric contents. There is no conclusive research into the risk of COVID-19 transmission associated with nasogastric tube insertion, although evidence from the severe acute respiratory syndrome outbreak appears to suggest that there is no increased risk of transmission. However, close contact with a COVID-19 patient, especially those displaying respiratory symptoms, is likely to increase the risk of transmission. Nasogastric tube insertion requires increased time spent at a patient's bedside and can also cause pharyngeal irritation, resulting in coughing. In addition, the nasogastric tube can expose the healthcare worker to potentially infectious saliva. Therefore, there is a clear need for increased evidence regarding the risk of transmission associated with nasogastric tube insertion, to ensure that such risks can be mitigated.