key: cord-1020057-n3xs96h5
authors: Ataullah, A.H.M.; Rahman, Sabrina; Rahman, Md Moshiur; Agrawal, Amit; Moscote-Salazar, Luis Rafael
title: Neurosurgical Challenges in the Second Wave of COVID-19; a Global Pandemic
date: 2021-05-27
journal: International journal of surgery open
DOI: 10.1016/j.ijso.2021.100356
sha: 43e6ddb33d8dbffa58583ac15d31e99fb3f9a54d
doc_id: 1020057
cord_uid: n3xs96h5

nan

Dear Editor, The Neurosurgery team and another department face challenges in COVID-19's second wave. In this COVID-19 pandemic, the number of patients seeking neurosurgical care and interventions has declined globally, which has affected academic activities. A statistically significant decrease of approximately 33.6% in acute referrals and about 55.6% in the number of operations conducted during COVID-19. [1] This is comparable to the published literature in which 226 respondents from more than 60 countries identified a reduction of more than 50%. [2] In a report, the overall number of surgeries conducted by the Neurosurgery Department decreased dramatically by 63.38%, but during this pandemic, the proportion of minor cases increased from 19.72% to 30.77%. The proportion of spinal cases also decreased from 27.11% to 18.27%, but the proportion of cranial cases rose from 72.89% to 81.73%. [3] Many neurosurgical trainees were redeployed to COVID-19 wards as part of restructuring the capability release facilities for coping with COVID-19. [4] This, coupled with the fact that fewer exercises were undertaken, indicated a decline in opportunities for training. In 2020, neurosurgical case volume in all neurology programs declined 75%, and interestingly 90% increased research time. [5] While the first wave caught us totally off guard, the second wave finds us trained with operational protocols [6] , most importantly, understanding the extent of diffusivity for the operators. Since aerosols transmit this virus, surgical procedures have been documented using unfavorable pressure suction rooms. [7] Given strategies to protect patients and healthcare staff, there was a global agreement to restrict "elective" neurosurgical operations and interventions. [8] With recent changes in the situation, departments of neurosurgery worldwide should be prepared for the anticipated rise in operation volume and should plan the operation schedule reasonably and coordinate medical resources. According to a recent report of Wuhan and data provided by Lesheng et al., there was a substantial increase in the number of patients to the neurosurgical department during and after lockdown and an increase in the number of operations. [9] Despite the difficulties, there is a need to retain the capacity to treat patients needing emergency neurosurgical management. A particular operating area for SARS-CoV-2 positive patients or suspected cases should also be built and the surgical SARS-CoV-2 non-intensive care unit based on the recommendation from international surgical societies.

[10] We must ensure safe neurosurgical procedures during the second wave of COVID-19 and be more cautious.

This study did not receive any funding or financial support.

Studies on patients or volunteers require ethics committee approval and fully informed written consent which should be documented in the paper.

Authors must obtain written and signed consent to publish a case report from the patient (or, where applicable, the patient's guardian or next of kin) prior to submission. We ask Authors to confirm as part of the submission process that such consent has been obtained, and the manuscript must include a statement to this effect in a consent section at the end of the manuscript, as follows: "Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request".

Patients have a right to privacy. Patients' and volunteers' names, initials, or hospital numbers should not be used. Images of patients or volunteers should not be used unless the information is essential for scientific purposes and explicit permission has been given as part of the consent. If such consent is made subject to any conditions, the Editor in Chief must be made aware of all such conditions. Even where consent has been given, identifying details should be omitted if they are not essential. If identifying characteristics are altered to protect anonymity, such as in genetic pedigrees, authors should provide assurance that alterations do not distort scientific meaning and editors should so note.

Not applicable.

Please specify the contribution of each author to the paper, e.g. study concept or design, data collection, data analysis or interpretation, writing the paper, others, who have contributed in other ways, should be listed as contributors.

All authors contributed equally to the paper, e.g. study concept or design, data collection, data analysis or interpretation and writing the paper.

The World Medical Association's Declaration of Helsinki 2013 states in article 35: 'Every research study involving human subjects must be registered in a publicly accessible database before recruitment of the first subject'. Editors of IJSO require that all types of research studies involving human participants should be registered prospectively but failing that retrospectively. There are many places to register your research, and you can choose which is the most suitable for your needs:

•https://www.clinicaltrials.gov/for all human studiesfree •http://www.chictr.org.cn/index.aspxfor all human studiesfree •https://www.researchregistry.com/for all human studiescharge •https://www.isrctn.com/for all human studiescharge •Prosperofor systematic reviewsfree •There are many national registries approved by the UN that can be found here Elsevier does not support or endorse any registry. Once registered, you will need to submit your assigned Unique Identifying Number (UIN) from your registration body as a mandatory part of your submission.

Not applicable.

The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish

Neurosurgery and coronavirus: impact and challengeslessons learnt from the first wave of a global pandemic

Potential association between COVID-19 mortality and healthcare resource availability. The Lancet Global health

Effect of coronavirus disease 2019 pandemic on case volume, spectrum, and perioperative coronavirus disease 2019 incidence in neurosurgical patients: An experience at a tertiary care center in India

COVID-19 and neurosurgical training and education: an Italian perspective

Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of 8 Programs

Workflow management for COVID-19 patients needing an urgent neurosurgical procedure

Impact of the COVID-19 Pandemic on Emergency Department Visits -United States

Preparedness and guidelines for neurosurgery in the COVID-19 era: Indian perspective from a tertiary care referral hospital

The Impact of COVID-19 on the Neurosurgery Department During and After the Lockdown of Wuhan

The authors have no potential conflict of interest.J o u r n a l P r e -p r o o f