key: cord-0946010-c9u5dmf8 authors: Grasso, Giovanni; Munakomi, Sunil title: Neurosurgical Practice at the Time of COVID-19 date: 2020-05-08 journal: World Neurosurg DOI: 10.1016/j.wneu.2020.04.092 sha: 8f6acf2fdd5ab6927ab76d0360f5b79d8575ea06 doc_id: 946010 cord_uid: c9u5dmf8 nan evidence of extrapulmonary disease with cardiac involvement seen in almost 74% of these cohort groups. 4 The characteristic computed tomography chest scan findings include bilateral ground-glass opacities, whereas the hyaline membrane and interstitial thickening are the pathognomonic histologic changes identified in the disease. 5 Although fever is considered the hallmark of the onset of COVID-19 and strictly body temperature screening protocols have been adopted in most parts of the world, a study has revealed that only 43.8% of patients had a fever on admission. 6 Another alarming issue is the report of more than 3300 health care workers confirmed with COVID-19 as of early March. 7 The main means of virus propagation is through airborne transmission via respiratory droplets that remain aloft on the surface for a long period, thereby underscoring the rationale for strict adherence to social distancing. The strong mitigation and timely implementation of lockdown are of paramount importance to halt public movements and thereby prevent an upsurge in the disease counts. After the increase in the caseloads, many hospitals have reshaped their face and turned into makeshift facilities for rapid testing and management of infected individuals. Containment and intensive care management with proning and protective lung ventilation are the pivotal steps in the critical care management plan. 8 In this dire scenario, the lack of ventilators has paved the way for noninvasive ventilation solutions reveling an unprepared health system, lacking adequate personal protective equipment, with frontline health workers courageously committed to fighting a war with no ammo. The spotlight on COVID has overshadowed other health threats in which treatments are at risk for conventional management. Neurosurgery also has been left crippled by this pandemic. Most of the elective surgeries have already been canceled. Although the incidence of road traffic accidents might have decreased, owing to the lockdown, the neurosurgeons still need to plan emergent care for patients with cardiovascular accidents, acute hydrocephalus, and tumors with impending herniation. Moreover, all of their patients are at risk for finding available beds in intensive care units, and for those in the intensive rehabilitation unit, the discharge from hospital is almost difficult. The study from Italy has provided a framework for creating an emergency task force and creating focused treatment hubs. 9 They have implemented transfer of needful patients into these hubs either primarily or through secondary transport from the peripheral spokes. Most of the urgent neurosurgical procedures can be performed by a strict number of operators. The clinical situations defined as neurosurgical emergencies are cerebral hemorrhage, acute hydrocephalus, brain tumor with a forthcoming risk of intracranial hypertension, traumatic brain and spinal cord injury, and spinal cord compression. 9 Also, a direct neurosurgical involvement in the management of infected patients cannot be excluded because of the recent evidence of acute brain hemorrhage observed in patients with COVID-19. 10 Another aspect to be of concern in neurosurgery is pertaining to the continuation of residency programs. To date, most of the academic educational activities have been halted and residents from various specialties, including neurosurgery, have been reassigned to the new COVID wards. In this unforeseeable scenario, remote education, telementoring, virtual teaching, cloud learning, and virtual rounds are valuable alternative models for continuing education and preventing the sense of isolation and depression that is sweeping over the weeks. The current toll in the global front can be a mere snapshot of this unfathomable onslaught. There needs to be judicious use of health resources for ramping up our quest to conquer COVID-19. Till we have redemption of this "Pandora's Box," there is the utmost need to implement proactive steps and to be a trusted portray of the health information rather than being "infodemic." This is the time we the neurosurgeons realize the importance of simple hand washing and infection control adherence while managing our patients. This is the time we keep ourselves safe for WORLD NEUROSURGERY -: ---, -2020 www.journals.elsevier.com/world-neurosurgery the upcoming surge in the elective neurosurgical cases. This is the time to prepare ourselves for the probable task shifting among task force and the front lines to manage the unprecedented surge in the critical patient with COVID-19. This is the time to make ingenious efforts to limit this pandemic to avoid frustrating the sacrifice of the lost health workers. A pneumonia outbreak associated with a new coronavirus of probable bat origin Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor Influence factors of death risk among COVID-19 patients in Wuhan, China: a hospital-based case-cohort study Clinical pathology of critical patient with novel coronavirus pneumonia (COVID-19) China Medical Treatment Expert Group for Covid-19 COVID-19: protecting health-care workers Intubation and ventilation amid the COVID-19 outbreak: Wuhan's experience Neurosurgery during the COVID-19 pandemic: update from Lombardy COVID-19-associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features 1878-8750/$ -see front matter ยช