key: cord-1029910-c1krlejx
authors: José Antonio, Soriano Sánchez; Tito, Perilla; Marcelo, Zenteno; Alvaro, Campero; Claudio, Yampolsky; Mauro, Loyo Varela; Manuel Eduardo, Soto García; José Alberto Israel, Romero Rangel
title: EARLY REPORT ON THE IMPACT OF COVID-19 OUTBREAK IN NEUROSURGICAL PRACTICE AMONG MEMBERS OF THE LATIN AMERICAN FEDERATION OF NEUROSURGICAL SOCIETIES
date: 2020-05-07
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.04.226
sha: 43ef042fcbf0489e4bc145bec0a44bdc48916903
doc_id: 1029910
cord_uid: c1krlejx

Abstract Background The COVID-19 pandemic has caused severe economic consequences by local governmental measures to contain the outbreak1 We provide insight on the impact that healthcare restriction has made on neurosurgical activity in Latin Iberoamerica. METHODS: We performed an internet-based survey among Presidents and Members of the Societies of the Latin American Federation of Neurosurgical Societies (FLANC). We blindly analyzed information about local conditions and their impact on neurosurgical praxis using SPSS® software. Results Information came from 21 countries. Sixteen Society Presidents reported having suspended regular activities, and differing local scheduled congresses, fourteen reported mandatory isolation by government, and four instituted a telemedicine project. Four-hundred eighty-six colleagues, mean age 49 years, reported a mean 79% reduction in their neurosurgical praxis. Seventy-six percent of neurosurgeons had savings to self-support for 3-6 months, if restrictions are long lasting. Conclusions Stopping activities among Societies of the FLANC, together with a drop of 79% of neurosurgical praxis, adds to deficits in provider´s protection equipment and increasing demand for attention in the healthcare systems; representing a huge financial risk for their sustainability. Neurosurgeons should involve in local policies to protect health and economy. Telemedicine represents an excellent solution, avoiding another pandemic of severe diseases across all-specialties as non-essential care can turn essential if left untreated. Financial support and ethics code review is needed to battle this new disease, designated the occupational disease of the decade, that continues to struggle the healthcare systems. Times of crisis are times of great opportunities for humanity to evolve.

Society, and Four Extracontinental European Societies, whose primary languages (Spanish, 51 Portuguese, Italian and French) derive from Latin 6 . In other words, the FLANC jointly 52 represents the neurosurgical workforce of Latin Iberoamerica. By using the FLANC as a 53 platform, we aimed to provide an insight on the socioeconomic impact that healthcare 54 restriction has made on Latin Iberomerican neurosurgical practice as a baseline to 55 understand the potential financial burden it will imply (especially to other physicians 56 involved in non-essential treatment) in terms of sustainability if these measures are to be 57 overcome) this crisis. 59 60 61 METHODS 62

We performed an electronic internet-based survey among the members of the Latin 64

American Federation of Neurosurgical Societies on a single day to obtain information in a 65 historically early stage on the COVID-19 Outbreak in Latin Iberoamerica. As information 66 changes abruptly from day to day in the pandemic we consider that transverse studies are 67 mandatory to pose a baseline to compare the impact of health policies on economy. We 68 collected information on an 18-item electronic questionnaire directed to the Presidents of 69 the Societies of the FLANC (Table 1 ) to obtain precise information on outbreak condition 70 and governmental dispositions in each country, as well as information related to societal 71 activities and COVID-19 infection incidence among local neurosurgeons. We used another 72 14-item questionnaire for (neurosurgeons) members of the FLANC ( Chile 3% (13); Uruguay, and El Salvador 2% (11) each; Spain 2% (9); Panama, and 118 Dominican Republic 2%, (8) each; USA, Haiti, Honduras, Nicaragua and Venezuela <1% 119 each (3, 2, 2, 2 and 1 responses respectively). The mean age of colleagues was 49.29 (min. The medical praxis has also been affected, as the World Health Organization has 181 recommended reducing activity with the advance of epidemy in local countries to provide 182 essential care to give the best use of resources to contain the outbreak and reduce infection 183 rates 5 . Neurosurgery as a specialty has adopted these measures and has emitted 184 recommendations to properly classify and select patients requiring emergent treatment 185 during triage (whether COVID is non-suspected, suspected, denied, or confirmed) 11-15 . Our 186 results demonstrate the dramatic consequences that these measures have provoked in 187 neurosurgical practice, whether in the public or private, reaching rates as high as 80% in 188 most of the countries. This fact proves right the estimates of the ILO 10 , given that 17% of 189 neurosurgeons in public health care system are suffering a degree of unrefunded work (8% 190 partial reduction in salary, and 9% not receiving payment) as early as two elapsed months 191 since the starting of the COVID-19 epidemic in Latin Iberoamerica on February 9 th , 192 2020 16 . 193 194 We are most concerned about the sustainability of medical practice in neurosurgery as for 195 that of many other specialties, having lesser percentages of essential-care. We agree with 196 both, government decisions and WHO recommendations, in that containing measure must 197

remain, yet, we also agree with ILO as many jobs are to be lost if this situation is to be 198 billion investment is to be given in this first round to Argentina, Ecuador Paraguay Haiti, 211

Dominican Republic, Panama, and Bolivia 21 . This investment will help to strengthen the 212 public health system and policies aiming to identify new cases and to prepare for increased 213 levels of demand 21 . We hope this help continue to be provided to the rest of Latin America, 214 and increasing project be directed to patients at risk as well as to physicians. This 215 population has demonstrated to be at increased risk of morbidity, mortality but also to 216 psychological distress by burnout and dealing with the disease 22 in a scare security health 217 system, too, as COVID-19 is considered the new occupational illness in the decade 23 . 218

On the other hand, we must remain ethics for everyone needing medical care, whether 220 COVID-19 related or non-COVID-19 related, as Kim et al. recognized, we are living 221 through truly novel times; however, ethical principles must remain the same 24 . It is our 222 belief and our best wisdom that current technology permits us to develop information as 223 fast as never before, we must take this advantage that our predecessor did not have in 224 previous pandemics. We have the opportunity to change the medical practice for the good 225 of humanity, providing care even if physically apart, but joint in mind, as we all juried the 226 hypocritic judgment 25 . Relying on providing essential care will ultimately affect the health 227 of the whole humanity, driving to another pandemic of increasing essential care needs by 228 suboptimal treatment (if any) of the non-essential care morbidities. As the natural course of 229 illnesses describes, non-treatment provides increasing complications that ultimately impact 230 health 26-29 . Suboptimal treatment can theoretically turn non-essential care pathologies into 231 essential care pathologies at an exponential growth rate, as massive or even more, than 232 COVID-19 Pandemic. Besides, keeping the usual healthcare of patients would prove 233 against physicians self-right to preserve health, especially when protection equipment 234 recommendations by WHO are not satisfied 30 . Our results show that neurosurgeons must 235 acquire this equipment in a relation of 55% of self-investment, not to imagine if we were to 236 attend the full spectrum of pathologies in the COVID-19 outbreak. Hopefully, 237

Telemedicine brings the opportunity to deliver health care to some extent, at least as for 238 non-essential care 2,14,31 , avoiding the complications and counter effects of no-treatment. It 239 will also aid in reactivate medical praxis and contribute to the economy for sustaining a 240 long-lasting pandemic. Telemedicine can help people to preserve jobs (or create new 241 ones 19 ), economy, and health to counterattack the struggling financial crisis that has been 242 held in the present and will affect the future for the many years to come. 243

We also appeal to respect physicians' jobs and rights, as this pandemic has turned into a 245 which hunters pandemic too. Frustration and long waiting times are known causes that led 246 to increase aggression from patients to healthcare providers 32 . The fear of COVID-19 has 247 pushed people to take irrational measures to prevent infection from healthcare providers 33 .

In Mexico, we have witnessed direct aggression to nurses on public transport, with people 249 covering them with Chloride 34 Rationality and respect must prevail to health care providers; 250 we must search for local government policies that protect healthcare workers from 251 aggressions too. 

Pandemic: Bold Public Health Leadership, Rapid Innovations, and Courageous 286

On the Coronavirus (COVID-19) Outbreak and the Smart City 288 Network: Universal Data Sharing Standards Coupled with

294 5. WHO. Operational Guidance For Maintaining Essential Health Services During An 295 16

America: The implications of the first confirmed case in Brazil

Covid-19: why is the UK 332 government ignoring WHO's advice?

COVID-19: learning from experience

Hilsenrath PE. Commentary Ethics and Economic Growth in the Age of COVID 19 : 337 What Is a Just Society to Do ?

Covid-19 : UK government writes off £ 13 . 4bn of hospital debts to 339 ease pressures

World Bank's Response to Covid-19 (Coronavirus) In Latin America & 341 Caribbean

Factors Associated With Mental Health Outcomes Veterans Affairs

Por miedo a coronavirus, bañan con cloro y bajan de camiones a 377 enfermeras en Jalisco

We want to express our most sincere acknowledgments to the following colleagues and friends… Juan José Maria Mezzadri Argentine Neurosurgery Association