key: cord-0721964-frok1h35
authors: Bashar, Abul Hasan Muhammad; Hakim, Md Enamul; Rahman, Md Mokhlesur; Dey, Nirmal Kanti; Hasan, Minhazul; Islam, Md. Moynul; Jamil, Md. Saffait; Rahman, Md. Mushfiqur; Islam, Md. Faridul; Chandra Mandal, Naresh
title: Vascular Surgery Practice Guidelines during COVID-19 Pandemic in a Setting of High Work Volume against Limited Resources: Perspective of a Developing Country
date: 2020-09-02
journal: Ann Vasc Surg
DOI: 10.1016/j.avsg.2020.08.114
sha: 56b632d13f2f889bfb04768a0fbfa7f39f37c0c7
doc_id: 721964
cord_uid: frok1h35

OBJECTIVES: The situation of Covid-19 pandemic in the Indian subcontinent is worsening. In Bangladesh, rate of new infection has been on the rise despite limited testing facility. Constraint of resources in the healthcare sector makes the fight against Covid more challenging for a developing country like Bangladesh. Vascular surgeons find themselves in a precarious situation while delivering professional services during this crisis. With the limited number of dedicated vascular surgeons in Bangladesh, it is important to safeguard these professionals without compromising emergency vascular care services in the long term. To this end, we, at the National Institute of cardiovascular diseases and hospital (NICVD), Dhaka have developed a working guideline for our vascular surgeons to follow during the Covid-19 pandemic. The guideline takes into account high vascular work volume against limited resources in the country. METHODS: A total of 307 emergency vascular patients were dealt with in the first 4 Covid months (March through June, 2020) according to the working guideline and the results compared with the 4 pre-Covid months. Vascular trauma, dialysis access complications and chronic limb threatening ischemia formed the main bulk of the patient population. Vascular healthcare workers were regularly screened for Covid-19 infection. RESULTS: There was a 38% decrease in the number of patients in the Covid period. Treatment outcome in Covid months were comparable with that in the pre-Covid months except that limb loss in the CLTI patients was higher. Covid infection among the vascular healthcare professionals was low. CONCLUSION: Vascular surgery practice guideline customized for the high work volume and limited resources of NICVD was effective in delivering emergency care in during Covid-19 pandemic ensuring safety of the caregivers. Despite the fact that similar guidelines exist in different parts of the world, we believe that the present one is still relevant on the premises of a deepening Covid-19 crisis in a developing country like Bangladesh.

Introduction 56 We are living in an unprecedented time. An outbreak of the novel corona virus dubbed as Covid-close to 2500 making it one of the worst hit countries in Asia. Even with limited number of tests 78 being performed (10,000-15000/day), new infections in 24 hours are now consistently exceeding 79 3000. Test vs. case ratio has steadily increased since April, 2020 which now ranges between 21-80 25%. 6 Rate of infection is also increasing in neighboring India which has a population of nearly patients. Privately owned hospitals were also not allowed to treat known Covid patients in the 93 initial period. The idea behind such a strategy was to limit spread of infection in the community. Bangladesh is a small south-east Asian country which has drawn international attention in the 148 recent times for giving shelter to more than 1 million Rohingya refugees driven out from Our roster-based emergency services involving minimum number of HCW minimizes risk of 199 exposure. To further minimize this risk, we have brought in a few adjustments in our anesthetic 200 practices. Regional or loco-regional anesthesia is being preferred over general anesthesia with 201 endotracheal intubation whenever possible to reduce aerosol generation in the OT. Availability 202 of Personal protective equipment (PPE) has become a key issue for HCW worldwide. In At the National Institute of cardiovascular diseases and hospita, Dhaka, Bangladesh, we have developed a working guideline for our vascular surgeons to follow during the Covid-19 pandemic. The guideline takes into account high vascular work volume against limited resources of a developing country in the face of a worsening crisis that is likely to linger in the foreseeable future.

World Health Organization. Coronavirus disease (COVID19) pandemic

Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)