key: cord-0964631-fbp9rr5z
authors: Coppola, Alessandro; Coppola, Roberto
title: An Invited Commentary on: Optimizing response in surgical systems during and after COVID-19 pandemic: lessons from China and the UK – Perspective. Zheng Liu (IJS-D-20-00464)
date: 2020-05-19
journal: Int J Surg
DOI: 10.1016/j.ijsu.2020.05.048
sha: 7535b4507e136d52d542124e94865783e3e5e853
doc_id: 964631
cord_uid: fbp9rr5z

nan

Optimizing response in surgical systems during and after COVID-19 pandemic: lessons from China and the UK -Perspective. Zheng Liu (IJS-D-20-00464) Liu and colleagues (1) reported on the surgical measures adopted at the beginning of the Coronavirus (COVID-19) pandemic. The initial core of this battle against the Sars-Cov2 epidemic explosion was the complete closure of the hospital for routine access of the surgical patients and a strict triage of all the patients needing urgent surgical care. Due to this firm position, no patient with fever or other possible COVID-19 related symptoms were admitted to the hospital for scheduled surgery. Many of the wards of the hospitals were converted from the surgical departments to COVID-19 facilities, completely isolated and dedicated to these patients. Also, a dedicated health care staff (HCS) was created. Outpatient visits were limited only to urgent cases. In Italy, these measures were carefully implemented from March 2020, since the beginning of the pandemic and now are improved day after day following international experiences in this topic. In our institution, the Campus Bio-Medico University of Rome, Italy, at the begging of the COVID-19 pandemic, a Task Force (TF) was explicitly created for drawing an internal protocol taking effort from the evidence arriving worldwide. Liu, in his paper (1), stated that only emergency surgery should be the priority for the admission in a hospital; this statement is correct but can lead to some misunderstanding. As reported by the American College of Surgeons, continuation of 'elective' surgical care have to be frequently evaluated and adapted if needed, based on the impact of the COVID-19 pandemic on local resources. (2) Besides, in our experience, we can report that in a situation where entire hospitals were used for COVID-19 patients, there is a non-negligible role of the other hospitals in continuing surgery for the needs of the community. Medically-Necessary, Time-Sensitive (MeNTS) Procedures is a recent term coined by the University of Chicago, which reflects a comprehensive scoring system that was developed and implemented considering patient, disease, and procedure-related factors when scheduling surgery (3). MeNTS could be a valid tool to face the problematic differences between elective, urgent, and emergent procedures more than the common sense of the terms. Improving the screening with temperature measures, oxygen saturation, swab, and eventually chest CT scan were the most useful measures adopted for patients admitted for surgeries. In cases with potential exposure to COVID-19, the patients were admitted to the insulation until the screening tests were negative. Nowadays, we are not able to calculate COVID-19 cancers-related deaths. As reported by the authors (1), the shift to different treatment protocols and the delay of surgeries were strategies adopted in some centers. We are in strong disagreement with these strategies. How reported by different international surgical societies (4-5) cancers should be considered like life-threatening diseases and changing treatment protocols or postponing surgery should be adopted only in really selected cases. Another critical point is the safety of the HCS. HCS must be provided with Personal Protection Equipment (PPE) during the whole course of their ward, outpatient clinic, or operating room activities. A useful strategy to overcome the lack of PPE can be reducing the number of staff on duty. Promoting forms of smart working, in particular involving residents, for research activities allows at the same time to preserve PPE and decrease the risk of contagion among HCS.

As the dynamic scenario of the COVID-19 pandemic continues to evolve, decisions regarding the screening test, alternative strategies improving outpatients services, and perfection of surgery indications remain individualized in the context of patients, providers, institutional factors, and available resources. A tremendous effort must be adopted to avoid a new spread of COVID-19, increasing all the prevention knowledge learned in the first period of the pandemic.

Provenance and peer review Invited Commentary, internally reviewed

Optimizing response in surgical systems during and after COVID-19 pandemic: lessons from China and the UK -Perspective

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Medically-Necessary, Time-Sensitive Procedures: A Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic

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