key: cord-0793731-5qvpryzf
authors: Griffin, M.F.
title: An Invited Commentary on: Emergency and Essential Surgical Healthcare Services during COVID-19 in Low- And Middle-Income Countries: a Perspective
date: 2020-06-09
journal: Int J Surg
DOI: 10.1016/j.ijsu.2020.06.009
sha: 73ebfd52acf4cf6fc9fca67d5e3a7632b77e4148
doc_id: 793731
cord_uid: 5qvpryzf

nan

Ma and colleagues 1 report on the impact of the Coronavirus (COVID-19) pandemic in lowand middle-income countries (LMICs), providing recommendations to mitigate the repercussions of COVID-19 and to prepare future communities for forthcoming crises. Worldwide COVID-19 has led to the indefinite postponement of surgery, limited surgical clinics and caused great demands on surgical healthcare resources. 2 It is clear, that even the most stable and robust surgical health care systems are struggling to cope with the everincreasing demands of COVID-19. 2 However, Ma et. al highlights the need to reflect on the even more profound impact that COVID-19 could have on the already strained and under resourced healthcare systems in LMICs. Ma et. al describes the potential impact of COVID-19 on LMICs including the difficulty in maintaining a surgical workforce, struggling with limited resources and being unable to protect the welfare of their surgical healthcare professionals. 1 During COVID-19, many healthcare systems have reallocated surgical staff to the emergency frontline and intensive care units (ITUS) to overcome the burden of the pandemic, providing surgical care only for emergency surgery. 2 Before, COVID-19, the Lancet Commission on Global surgery advised that to meet the global burden of surgical pathology, 100% of LMICs would need at least 20 surgical and anaesthesiologists per 100,000 population. 3 It is clear that deployment of surgical staff from the operating rooms in LMICs will have devastating consequences on maintaining emergency and essential surgical care delivery. 1 Coupled with the even less accessible personal protection equipment (PPE) in LMICs, the ability to maintain a surgical workforce further diminishes. 1 The need for specialist equipment including ventilators and ITU beds to treat those affected with COVID-19 effectively has been concern both in Europe and the United States. 2 However, Ma et al., emphasizes that in LMICs such resources are even more limited. 1 Recent studies show that LMICs Sub-African countries have less than 5 ICU beds per 100,000 population 4 , which is far less than overrun countries such as Italy with 12.5 beds per 100, 000 population. 5 Ma et al., outlines four key recommendations to potentially overcome the potential challenges in LMICs. 1 Firstly, ensuring a collective knowledge in the community will help prevent surges in COVID-19 cases including the importance of social distancing and understanding when to seek appropriate care. 1 Following surgical body guidelines to cancel elective procedures to free up space and surgical staff to aid in the pandemic. 2 To maximize their limited surgical workforce by ensuring they are adequately trained to treat patients with COVID-19. 1 Lastly, to take measures to protect their surgical providers by maximising PPE and considering innovative low-cost safe measures to re-use equipment. 1 In summary, while surgical healthcare is overwhelmed world-wide during the COVID-19 pandemic, it is particularly at risk in LMICs. 1 Maximising the LMICs limited surgical workforce through adequate PPE, cultural changes and focused training will be of vital importance to saving both patients and healthcare professionals. 1 

Invited Commentary, internally reviewed

Emergency and Essential Surgical Healthcare Services during COVID-19 in Low-And Middle-Income Countries: a Perspective

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