key: cord-1006242-2fsp9jvx
authors: ZINE-EDDINE, I.; ELATIQI, O.; AITBENLAASSEL, O.; YAFI, I.; MAHROUCH, M.; GOUATRI, M.EL; SAHIBI, M.; BHIHI, A.; ELAMRANI, D.; BENCHAMKHA, Y.
title: A Moroccan Plastic Surgery Department approach during COVID-19 Pandemic
date: 2020-08-11
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2020.08.011
sha: 8897666114da779618ea6597028bd1d25a4bc7a1
doc_id: 1006242
cord_uid: 2fsp9jvx

COVID-19 pandemic is an obstacle for all health systems, especially in African countries. This paper shows how plastic surgery teams can adapt human resources and an efficient approach to provide the best care to our patients in this troubled time.

COVID-19 is a severe acute respiratory syndrome coronavirus (SARS-CoV-2). Originally identified in the city of Wuhan, in the Hubei province of central China, in December 2019, the virus has since spread rapidly across the world, on March 11, 2020, pandemic status was confirmed by the World Health Organization(1) new infections are rising exponentially as of MAY 15, 2020, there are over 4 621 414 confirmed cases worldwide (whose 6 652 in Morocco), with over 282 388 deaths attributed to the COVID-19 virus (2) . The strict lockdown and social distancing and restricted mobility started by March 20 in Morocco. A full reorganization of the health system was initiated countrywide, creating regional admission centers, specific testing departments within a COVID-19 pathway, and specialty hubs for continuous medical service. In this paper, we share our experience in managing plastic surgery patients during the COVID-19 pandemic at the Mohamed VI university hospital in Marrakech.

Early during the outbreak of the pandemic, the Marrakech-Safi region (4.5 million people) turned out to be one of the 3 most affected regions. As soon as the national lockdown was in force, extensive measures and departments remodeling was needed: Scheduled activity was stopped, and special COVID-19 pathways were created. Most departments were converted into COVID-19 facilities. Ibn tofail hospital, considered as an off-site hospital, was assigned to manage all non-COVID patients with urgent surgical pathology.

Concerning our plastic surgery department, it's a tertiary center managing acute infections, trauma, tumors and burns, as well as elective reconstructive procedures and research, it had to prioritize emergency work over elective work like recommended by The American College of Surgeons(3), and be prepared to continue with a reduced workforce. The focus on COVID-19 mustn't adversely affect the acute response needed to deal with plastic surgery emergencies. The staff is composed of 10 doctors and 16 nurses. Since the last week of March, we have modified the calls and the team has been split into two independent units: COVID-19 positive unit circuit with 5 doctors (50% of our team) and 6 nurses to assist the fight against COVID-19 and a non-COVID unit with 5 doctors and 10 nurses. Personal protective equipment (PPE) is provided by the hospital including N95 masks every 06 hours with a medical cap, a disposable overcoat, glasses, and overshoe.

Patients were either admitted directly or referred from regional hospitals (indirect admission). Before admission, patients residency is asked to see if it's a cluster or not, undergo medical history checking to look for any cough, shortness of breath, chills, sore throat, new loss of taste or smell and fever testing was a systematic procedure and if the patient had one of these criteria a CT-SCAN was made and the coordinator is called to make PCR test. Fortunately, we never had this situation. Telemedicine, clinical imaging, and symptom help us to carry out the operating program.

Admission was limited to a maximum of 2 patients per room, each room has 4 beds and we have a total of 8 beds dedicated to plastic surgery. Patient movement around the hospital is restricted. To reduce the length of stay by 30% from an average of 13 days last year to 10 days in this period, patients were admitted 24 to 48 hours before surgery. During hospitalization, only 1 visitor per day per patient was allowed for one-hour maximum. All wore surgical masks provided by the hospital (2 per day). During this period, 70% wore tumors (12 patients), 18% infections (3 patients), and 12% loss of substance (2 patients). The number of patients has decreased 50% compared to last year's data of the same period but the part of each type has been the same. The majority of tumors 57 % wore head and neck surgery (25% the face, 19% the scalp, and 13 % the Neck). The discharge was made early, and patients followed up over telemedicine to keep contact with our team. When necessary, the patient's consultation is realized with a doctor in the treatment room with all protective required equipment.

The COVID-19 Pandemic forces us to change operation room protocols. While achieving a reduced surgical load (6 surgeries a week) because of sharing the operation room with Ear, Nose and Throat (ENT) department. The operative team has been reduced. These cases are performed with three surgeons (one attending and two residents) which allows us to decrease the protective equipment used during a case.

Several changes in our clinical practice were made due to the COVID-19 pandemic, plastic surgery teams must adapt quickly because this pandemic is far from over, the sustainability of this system may be questionable for the long term, it has proven to be efficient in preserving the non-COVID status of the hospital so far, but for how long with exhausted teams.

Many cases cannot be postponed and some patients don't come to the hospital because they are scared to get infected in the hospital, we need to encourage and persuaded patients to consult and ensure providing safety precautions.

COVID-19) -events as they happen

050 Cases and 312,241 Deaths from COVID-19 Virus Pandemic -Worldometer

COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures

American College of Surgeons

We gratefully acknowledge all health workers in general and Mohamed VI University Hospital staff, in particular, to keep patients and society safe.

The authors declared no potential conflict of interest.

Not applicable