key: cord-0707735-deisqgmw authors: Bashir, Mohamad; Moughal, Saad title: Cardiovascular Disease and Surgery Amid COVID-19 Pandemic date: 2020-04-28 journal: J Vasc Surg DOI: 10.1016/j.jvs.2020.04.479 sha: 3314f2068191b5bcff6e7a107157b9a212404e40 doc_id: 707735 cord_uid: deisqgmw nan China. Reports summed it up to a group of affected patients who were vendors or dealers at the 23 local Huanan Seafood market. Hence, WHO initiated a strategic process to identify, track down 1 affected individuals and report on their early assessment. Since then, the infectivity, virulence, 2 and spread of this initially unknown but later identified through genomic sequencing, 3 microorganism was unprecedented. 4 The devastation and transmission throughout different parts of the world are unprecedented. 5 Fatalities are on the rise worldwide and most affected areas have shifted since the start of the 6 outbreak. The UK government initiated stringent strategies and lockdown to halt the spread of 7 this virus, yet its early to decide whether or not those measures instigated are effective. 8 European nations have been inflicted with the devastation caused by COVID-19, similarly to 9 China and Southeast Asia. The UK's healthcare system is battling to restrain not only the extent 10 of the virulence of this virus but also the case fatalities and outcomes. The reports are up-heaving 11 and government lockdown is uncertain, the future is uncertain however, one thing is certain; 12 backlashes and staggering results are on the rise. Our knowledge of COVID-19 is still evolving rapidly, and this review aims to discuss the 14 healthcare impact sieved from the whole spectrum of this pandemic and focused on vascular 15 disease and surgery, implication on health economics, strategic assessment and future outlooks 16 for this prevailing situation. It reflects on limited measures taken to hat progression of disease 17 within the health sector and the potential effect that this virus might have in the future. It's imperative to identify patients that can develop complications should they get infected with 19 Covid 19. Amongst the high risk profile patient group are commonly the elderly, the 20 immunocompromised, those with IHD, men, and smokers appear to be at greater risk of infection 21 (8,9). However, although those characteristics are amongst the demographical characteristics are 22 pertinent features to vascular patients that we deal with on a daily basis (10), there is an 23 indubitable effect that Covid 19 can implore on the cardiovascular patients per se and on the 1 conduct of service operation and performance. One strong feature that can be culpable for 2 destabilising cardiovascular -Covid 19 infected population is the potential acceleration in 3 inorganic calcium deposit destabilisation leading to myocardial infarction, myocarditis and heart 4 failure. Another superimposed factor that can change outcomes reportedly that we deal with on and scenarios with bacterial respiratory tract infection, hence, it is prudent yet inevitable that 20 antibiotics will be prescribed for many regardless. There are no approved therapies for COVID-19 just yet and scattered unsolicited trials have 22 titrated our current understanding of how to tackle this disease. Hence, prescribing antibiotics in 23 4 those patients with known comorbidities cannot be excluded e.g. COPD exacerbations with 1 purulent sputum or when radiological evidence of pneumonia. However, it imperative that a 2 tailored decision process toward lab workup might not be sensitive navigating an unknown 3 terrain with COVID 19 is a challenge. 4 Such that, demographic, clinical, laboratory and radiological differences between patients who 5 were and were not admitted to the intensive care unit have yet to be conclusive in our cohort of 6 patients. There is no current study to delineate the structural changes that coronavirus can impact our 9 population cohort and give if any will be in the future. Those studies will have limited resources 10 and numbers of patients in these studies will be relatively small and infer nothing substantial to 11 teach current and future generations. 12 In addition to what has been mentioned above, the clinical characteristics of patients who died 13 are scarce. No vaccine or specific antiviral treatment for COVID-19 has yet been shown to be 14 effective, hence supportive therapeutics to ameliorate and protect multi-organ function is crucial 15 (13) . The changing clinical terrain and our ability to reconnoitre the surface is limited. The truth to the matter is that we are unable to yet comprehend the scale of this effect on the 12 health sector, to say the least. The reduction in taskforce due to COVID lockdown and social 13 isolation has impacted the running of financial output precisely. Staffing and capacity to care for patients. For many of the elements presented above, it is difficult to predict how a specific power would 5 be used in a specific context, and therefore monetized costs would be hard to assess and evaluate 6 until the cloud has dispersed. The fight against this disease and its spectral elusive outcomes are yet to unravel. The inclusive 10 totality of repercussions on our patients' cohorts will be delineated in the immediate future post 11 COVID era. What is certain is that patient's quality service provisions will be affected at a 12 multitude of levels. The pertinent objectives are to save as many as possible and save ours, to say 13 the least, to live the restructuring phase and the aftermath. 14 15 Severe 17 acute respiratory syndrome-related coronavirus: The species and its viruses -a statement of the 18 Pathogenesis, 20 and Control of COVID-19. Viruses COVID-19, SARS and MERS: 22 are they closely related? Incubation period of 2019 novel coronavirus (2019-2 nCoV) infections among travellers from Wuhan, China The Incubation Period 6 of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation 7 and Application Understanding Herd Immunity. Trends 9 Immunol Population Diversity and Collective Interactions during Influenza Virus 11 Infection Are patients with hypertension and diabetes mellitus at 13 increased risk for COVID-19 infection? Clinical features of patients infected 15 with 2019 novel coronavirus in Wuhan, China Endothelial Cell Dysfunction and the Pathobiology of 17 Clinical and 19 virological data of the first cases of COVID-19 in Europe: a case series Procalcitonin to 22 initiate or discontinue antibiotics in acute respiratory tract infections Surviving Sepsis 2 Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 3 2019 (COVID-19) Clinical characteristics of 113 deceased patients with coronavirus disease 5 2019: retrospective study