key: cord-0936584-y9i261ur
authors: Levy, Gal
title: Commentary: Preparation for pandemics prevents pandemonium
date: 2020-06-06
journal: J Thorac Cardiovasc Surg
DOI: 10.1016/j.jtcvs.2020.05.067
sha: d3af353b94a4bde3215a58231c9a0322f5fd714e
doc_id: 936584
cord_uid: y9i261ur

nan

See Article page 937.

Gal Levy, MD Healthcare crises are rare and far between. Not since the Spanish flu of 1918 has there been a pandemic as severe and worldwide as the Coronavirus Disease 2019. However, in 1918 the luxury of ventilators and intensive care unit was not accessible. Therefore, without a vaccine to protect against the infection or antibiotics to treat secondary infection, nonpharmaceutical interventions were implemented. The lessons of 1918 remind that isolation, quarantine, and good hygiene are paramount to minimize the spread of infectious organisms. 1 A century later, the world adjusts to another viral pandemic wreaking havoc on the universal healthcare system.

To accommodate the rapid influx of patients in distress, hospitals have had to incorporate massive adjustments, including redeployment of essential personnel, revision of department roles, and allocation of limited lifesaving resources. The impact on adult cardiac surgical practice and cardiovascular disease, and the prioritization of common cardiac surgical procedures are thoroughly reviewed in this article.

The effort placed forth by George and colleagues 2 in compiling this detailed and thorough composition regarding their preparation and execution of the Coronavirus Disease 2019 crisis resource allocation is commendable. The coordinated effort with leadership portrays how necessary it is to have system-wide agreement and planning across all levels of the institution. Their resource allocation reminds us of The New England Journal of Medicine recommendations for scarce resources, which was recently published. 3 The subjects addressed are relatable to anyone in the surgical practices. The visual representation in Figure 1 depicts nicely the risk stratification in all 3 phases of pandemic levels.

As surgeons, our focused interest is 2-fold: operative intervention and application of our skills to areas of need. George and colleagues 2 address their response to the reduction in operative volume and the adaptive transition into critical care management and procedures while still maintaining a core for emergency surgical activity. 

Uncertainty in emergency and the quickly evolving healthcare crisis can lead to chaos. Preparation strategies for the Coronavirus Disease 2019 pandemic provide purpose and direction for optimal outcomes.

Challenges and logistic solutions to address the implementation of massive redeployment, reorganization of team allocation, and overall complete restructuring of operating room and intensive care unit management are important to follow for future pandemics. George and colleagues 2 have started the conversation that should continue. How do we, as cardiothoracic surgeons, continue to provide care for the cardiovascular diseases that continue during a pandemic while balancing the needs of a new patient population? Discussions on this magnitude can and should continue well after the crisis abates to allow our specialty to continue to grow and evolve without depriving patients of necessary cardiovascular and thoracic care. The pandemic forced a seismic redistribution of priorities, resources, and identities. As these lessons were solidifying in New York City, all across the world our colleagues were making similar plans with one goal-how can WE best save lives?

The authors begin with stratifying cardiac surgery patients by acuity and reduced surgeries to less than 10% normal case volumes. This reduction created capacity for the patients with COVID-19 and allowed the application of the liberated resources of elective cardiac surgery to the severely ill patients with COVID-19. Professor and student alike were redeployed, according to ability, to the rosters of team-based care. Many cardiac surgeons became intensivists, others placed lines, and one became an intensive care unit nurse. 2 Targeted spaces, including operating rooms, were repurposed into much-needed patient areas. Skill-oriented teams were mated to these new "pods" to leverage the expertise of critical care resources. Focusing on providing safety for

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