key: cord-0941427-4hlazv35
authors: Abdul-Rahman, Abbas; Abdallah, Abbas; Yousif, Ali; Memon, Sara Fatima
title: Important considerations regarding the future management of Coronavirus (COVID-19)
date: 2020-05-05
journal: Int J Surg
DOI: 10.1016/j.ijsu.2020.04.083
sha: f835e9fbacdafe5ca29916097cc6e4c96a8d347c
doc_id: 941427
cord_uid: 4hlazv35

nan

Dear editor, A global effort to identify effective management options to deal with the Coronavirus Pandemic (COVID-19) is in full flow (1) . However, potential medications remain under investigation and vaccines are unlikely to be available in the short-term. As a result, current measures have largely centred around the introduction of strict public health policy. These have since proven to be an effective method of mitigating viral spread. However, with the steady stream of new evidence, important considerations must be made to restrict the harmful impact of the pandemic.

Lockdowns across the world continue to threaten the economic stability of nation states. As a result, governments have begun drawing their attention towards possible exit strategies. Models, such as that by Ferguson et al., look at the possible impact of various strategies on healthcare outcomes including ICU visits and mortality (2) . These models assume no risk of COVID-19 re-infection following initial recovery (2) . However, new evidence suggests that this may not be the case. A study from Wuhan in China found five cases of laboratoryconfirmed reactivations amongst a group of 55 patients previously known to have had the virus (3). The authors also found that there were no specific clinical characteristics to distinguish these patients from those who had been infected for the first time (3). The World Health Organisation (WHO) has also weighed in recently, warning that there remains a lack of evidence to suggest that antibodies to SARS-CoV-2 confers immunity to reinfection. This comes as a blow to countries such as the United Kingdom (UK) who have ordered millions of fast and cheap antibody tests (4) . These findings also undermine the potential merits of an 'immunity passport', a scheme that would help ease lockdown measures by lifting social distancing rules for those with 'proven' immunity. As a result, these details may complicate future governmental plans. They also highlight the importance of flexible mechanisms where public health-based decisions can be made quickly yet cautiously according to the latest evidence. This may explain why highly decentralised healthcare organisations such as that in Germany have been better able to cope with the pandemic.

In addition, whilst statistics focus on the direct impact of COVID-19 on global deaths, the substantial indirect impact of the virus on non-COVID-related health issues has largely been pushed aside. Doctors on the front-line have been taken aback by the unprecedented sharp decline in non-COVID emergency presentations to hospitals. Recent figures in the UK from the Office for National Statistics (ONS) show a significant increase in non-COVID deaths when compared to a similar time-period last year (5). Therefore, whilst intense focus on the pandemic will undoubtedly continue, appreciation for the wider impact of the virus on population health is vital. Additionally, whilst the ONS statistics highlight the short-term impacts on health, the long-term implications of the virus on morbidity and mortality rates remain to be seen. New plans must aim to reassure the general public and encourage hospital attendance for non-COVID causes where necessary. This could be done by providing clearer public guidance around when and when not to attend a hospital. Plans must also aim to mitigate the consequences of a reduction in healthcare quality and availability; innovative solutions that can provide optimal care whilst adhering to social distancing legislation will be necessary to overcome this.

In an ever-changing landscape, proactive efforts must be made to ensure that national policies -as well as individual patient management pathways -are driven by the most up-todate evidence. This, alongside an appreciation of the pandemic's impact through a wider lens, is needed to minimise unnecessary deaths in the short-and long-term future.

Provenance and peer review Not Commissioned, internally reviewed

Evidence Based Management Guideline for the COVID-19 Pandemic -Review article

Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand

Clinical characteristics of severe acute respiratory syndrome coronavirus 2 reactivation

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We, Mr Abdul-Rahman Abbas, Mr Abdallah Abbas, Mr Yousif Ali and Ms Sara Fatima Memon, do not report any conflicts of interest in the writing of this letter.

There were no sources of funding for this research.

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