Personal protective equipment for surgeons during COVID-19 pandemic: systematic review of availability, usage and rationing

NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy

ABSTRACT

Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.

Eco-Friendly and COVID-19 Friendly? Decreasing the Carbon Footprint of the Operating Room in the COVID-19 Era

Surgery is one of the most energy-intensive branches of healthcare. Although the COVID-19 pandemic has reduced surgical volumes, infection control protocols have increased the ecological footprint of surgery owing to the extensive use of personal protective equipment, sanitation, testing and isolation resources. The burden of environmental diseases requiring surgical care, the international commitment towards environmental sustainability and the global efforts to return to the pre-pandemic surgical workflow call for action towards climate-friendly surgery. The authors have searched the peer-reviewed and gray literature for clinical studies, reports and guidelines related to the ecological footprint of surgical care and the available solutions and frameworks to reduce it. Numerous studies concede that surgery is associated with a high rate of energy utilization and waste generation that is comparable to major non-medical sources of pollution. Recommendations and research questions outlining environmentally sustainable models of surgical practices span from sanitation and air quality improvement systems to the allocation of non-recyclable consumables and energy-efficient surgical planning. The latter are particularly relevant to infection control protocols for COVID-19. Paving the way towards climate-friendly surgery is a worthy endeavor with a major potential to improve surgical practice and outcomes in the long term.

Rapid In Situ Thermal Decontamination of Wearable Composite Textile Materials

Pandemics stress supply lines and generate shortages of personal protective equipment (PPE), in part because most PPE is single-use and disposable, resulting in a need for constant replenishment to cope with high-volume usage. To better prepare for the next pandemic and to reduce waste associated with disposable PPE, we present a composite textile material capable of thermally decontaminating its surface via Joule heating. This material can achieve high surface temperatures (>100 °C) and inactivate viruses quickly (<5 s of heating), as evidenced experimentally with the surrogate virus HCoV-OC43 and in agreement with analytical modeling for both HCoV-OC43 and SARS-CoV-2. Furthermore, it does not require doffing because it remains relatively cool near the skin (<40 °C). The material can be easily integrated into clothing and provides a rapid, reusable, in situ decontamination method capable of reducing PPE waste and mitigating the risk of supply line disruptions in times of need.

Effects of Mask Reuse on the Oropharyngeal, Skin, and Mask Microbiome

BACKGROUND

Face masks have been critical in the coronavirus disease 2019 (COVID-19) pandemic, but supplies were sometimes limited and disposable masks contribute greatly to environmental waste. Studies suggest that filtration capacity is retained with repeated use, and surveys indicate many people reuse surgical masks. However, the impact of mask reuse on the host is understudied.

METHODS

We applied 16S rRNA gene sequencing to investigate the bacterial microbiome of the facial skin and oropharynx of individuals randomized to wearing fresh surgical masks daily versus masks reused for 1 week.

RESULTS

Compared to daily fresh masks, reuse was associated with increased richness (number of taxa) of the skin microbiome and trend towards greater diversity, but no difference in the oropharyngeal microbiome. Used masks had either skin-dominant or oropharynx-dominant bacterial sequences, and reused masks had >100-fold higher bacterial content but no change in composition compared to those used for 1 day.

CONCLUSIONS

One week of mask reuse increased the number of low-abundance taxa on the face but did not impact the upper respiratory microbiome. Thus, face mask reuse has little impact on the host microbiome, although whether minor changes to the skin microbiome might relate to reported skin sequelae of masking (maskne) remains to be determined.

CAM Based Fine-grained Spatial Feature Supervision On Surgical-PPE: A New Dataset For Surgical PPE Kit Presence Detection

In the wake of Covid pandemic, usage of surgical PPE kit by surgeons has become essential. Since reliable localization of human joints is necessary for automated understanding of surgeons activity, the first step is surgical PPE kit detection. While there exist reported works on industrial PPE kit detection, task of surgical PPE kit detection has hardly been explored. To facilitate this, we construct "Surgical-PPE" dataset with 1150 Non-PPE instances and 2656 surgeon wearing PPE kit instances. In this work, we also propose a two-stage transfer learning based end-to-end training methodology. Novelty lies in (a) novel "Surgical-PPE" dataset to detect if surgeon is wearing PPE kit or not, (b) proposed supervised contrastive combined loss function for stage-1 training, (c) proposed spatial context aware combined loss function for stage-2 training. We qualitatively illustrate the improvement of HiResCAM and XGrad-CAM explanations for the proposed methodology. We also qualitatively illustrate that feature embeddings of same class are pulled closer together compared to feature embeddings of different classes on the proposed multi-stage training methodology, using T-SNE plots. We benchmark the performance of popular existing network architectures along with the proposed methodology on "Surgical-PPE" dataset. Using proposed methodology, we achieve peak accuracy of 97.63%, precision of 97.66%, recall of 97.63%, F1-score of 97.64%, JI of 95.41% and FPR of 2.5%. We report improvement by 1.7% in terms of FPR and 2% in terms of JI compared to second best performing model (ResNext50(CE)). Owing to the proposed training methodology, an improvement of 2.62% in terms of FPR and 5% in terms of JI was observed.Clinical relevance- To understand the OT activity of the surgeon in third-person perspective, it is important to determine whether or not, the surgeon is wearing PPE kit. Hence surgical PPE kit presence detection becomes the first step towards automated surgical video analysis.

Ethical analysis examining the prioritisation of living donor transplantation in times of healthcare rationing

The transplant community has faced unprecedented challenges balancing risks of performing living donor transplants during the COVID-19 pandemic with harms of temporarily suspending these procedures. Decisions regarding postponement of living donation stem from its designation as an elective procedure, this despite that the Centers for Medicare and Medicaid Services categorise transplant procedures as tier 3b (high medical urgency-do not postpone). In times of severe resource constraints, health systems may be operating under crisis or contingency standards of care. In this manuscript, the United Network for Organ Sharing Ethics Workgroup explores prioritisation of living donation where health systems operate under contingency standards of care and provide a framework with recommendations to the transplant community on how to approach living donation in these circumstances.To guide the transplant community in future decisions, this analysis suggests that: (1) living donor transplants represent an important option for individuals with end-stage liver and kidney disease and should not be suspended uniformly under contingency standards, (2) exposure risk to SARS-CoV-2 should be balanced with other risks, such as exposure risks at dialysis centres. Because many of these risks are not quantifiable, donors and recipients should be included in discussions on what constitutes acceptable risk, (3) transplant hospitals should strive to maintain a critical transplant workforce and avoid diverting expertise, which could negatively impact patient preparedness for transplant, (4) transplant hospitals should consider implementing protocols to ensure early detection of SARS-CoV-2 infections and discuss these measures with donors and recipients in a process of shared decision-making.

The impact of COVID-19 on plastic and reconstructive surgery in China: A single-centre retrospective study

BACKGROUND

This study aimed to investigate the volume of plastic surgery operations in a large public hospital and figure out the changes in the related factors associated with Coronavirus Disease 2019 (COVID-19) and identify the potential problems.

METHODS

We created a survey and collected clinical data from 1 January 2018 to 31 December 2020. Information on procedure time, patient gender, patient age, and procedure type was collected from the database. The data were analysed using IBM SPSS Statistics for Windows, version 25.0.

RESULTS

A total of 10,827 patients were admitted to our department. The total number of patients decreased by 21.53% in 2020 (3057 cases) than the same period in 2019 (3896 cases). The total number of aesthetic procedures decreased by 34.17% in 2020 than that in 2019. However, restorative procedures in 2020 (2013 cases) only decreased by 12.86% than that in 2019 (2310 cases). The percentages of women amongst patients who underwent aesthetic procedures were 91.75%, 92.18%, and 90.71% in 2018, 2019, and 2020, respectively. Most of the patients in these three years were aged 20-29 years.

CONCLUSIONS

The plastic surgery industry is experiencing the effects of the unprecedented COVID-19 pandemic worldwide. COVID-19 was quickly brought under control, and the plastic surgery industry developed rapidly in China because of the active, timely, and accurate implementation of epidemic prevention strategies.

Infection control of COVID-19 in operating theaters in a designated hospital for specified infectious diseases in Japan

At the beginning of the COVID-19 pandemic in 2020, many hospitals around the world recommended stopping elective surgery as a precaution to stop the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The number of elective surgeries was reduced in Japan due to several waves of the pandemic. This work describes the management of COVID-19 and actual polymerase chain reaction (PCR) screening in operating theaters at the National Center for Global Health and Medicine (NCGM), a designated hospital for specified infectious diseases in Japan. The following three steps for COVID-19 infection control were taken to maintain the operating theater: i) Do not bring COVID-19 into the operating theater, ii) Infection control for all medical staff, and iii) Surgical management of surgical patients with COVID-19. We introduced checklists for surgical patients, simulations of surgery on infected patients, screening PCR tests for all surgical patients, and use of a negative pressure room for infective or suspected cases. We determined the flow and timing of surgery for patients with COVID-19. However, many aspects of COVID-19 infection control measures in the operating theater are still unclear. Therefore, infection control measures require further advances in the future to manage new infections.

The Role of Telemedicine in the Management of Patients with Chronic Diseases in Primary Care During the COVID-19 Pandemic

Introduction:The COVID-19 pandemic has rapidly spread to many countries and has led various primary healthcare services of chronic diseases to be neglected and only partially be replaced by telemedicine services. This study aims to investigate the role of telemedicine in the management of patients with noncommunicable diseases in primary health care during the COVID-19 pandemic. Method: A narrative review of the literature was carried out through searching the PubMed and Google Scholar databases. Results: From the initial stages of the pandemic, several scientific medical societies issued guidelines which urged citizens and health personnel to adopt digital means in the provision of regular chronic care as much as possible. The significant benefits of the telemedicine sessions partially only filled the gap of the deferred chronic care. On the other hand, many barriers need to be addressed in order to achieve an equitable and high-quality implementation of telemedicine services. Conclusion:The widespread application of telemedicine and self-monitoring was brought about by the COVID-19 pandemic and currently, they have become common ways of managing non-communicable diseases in primary health care. Innovations introduced need to be maintained and integrated into conventional traditional practices, so that health systems are more resilient to future public health emergencies.

Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study

Background

International efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub.

Methods

Twenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis.

Results

Four key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals.

Discussion

Our findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.

Exploring primary healthcare practitioners' experiences regarding the coronavirus disease 2019 (COVID-19) pandemic in KwaZulu-Natal, South Africa

BACKGROUND

The coronavirus disease 2019 (COVID-19) has spread rapidly around the world since the initial outbreak in Wuhan, China. With the emergence of the Omicron variant, South Africa is presently the epicentre of the COVID-19 pandemic in sub-Saharan Africa. Healthcare workers have been at the forefront of the pandemic in terms of screening, early detection and clinical management of suspected and confirmed COVID-19 cases. Since the beginning of the outbreak, little has been reported on how healthcare workers have experienced the COVID-19 pandemic in South Africa, particularly within a low-income, rural primary care context.

METHODS

The purpose of the present qualitative study design was to explore primary healthcare practitioners' experiences regarding the COVID-19 pandemic at two selected primary healthcare facilities within a low-income rural context in KwaZulu-Natal, South Africa. Data were collected from a purposive sample of 15 participants, which consisted of nurses, physiotherapists, pharmacists, community caregivers, social workers and clinical associates. The participants were both men and women who were all above the age of 20. Data were collected through individual, in-depth face-to-face interviews using a semi-structured interview guide. Audio recordings were transcribed verbatim. Data were analysed manually by thematic analysis following Tech's steps of data analysis.

RESULTS

Participants reported personal, occupational and community-related experiences related to the COVID-19 pandemic in South Africa. Personal experiences of COVID-19 yielded superordinate themes of psychological distress, self-stigma, disruption of the social norm, Epiphany and conflict of interest. Occupational experiences yielded superordinate themes of staff infections, COVID-19-related courtesy stigma, resource constraints and poor dissemination of information. Community-related experiences were related to struggles with societal issues, clinician-patient relations and COVID-19 mismanagement of patients.

CONCLUSION

The findings of this study suggest that primary healthcare practitioners' experiences around COVID-19 are attributed to the catastrophic effects of the COVID-19 pandemic with the multitude of psychosocial consequences forming the essence of these experiences. Ensuring availability of reliable sources of information regarding the pandemic as well as psychosocial support could be valuable in helping healthcare workers cope with living and working during the pandemic.

Recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic: a scoping review

OBJECTIVE

To map the recommendations for hospitalised patient safety in the context of the COVID-19 pandemic.

DESIGN

Scoping review using the method recommended by the Joanna Briggs Institute.

DATA SOURCES

Databases: Medline, SCOPUS, EMBASE, ScienceDirect, LILACS, CINAHL and IBECS; grey literature platform: Google Scholar; and 11 official websites of leading healthcare institutions were searched on 27 April 2021 and updated on 11 April 2022.

ELIGIBILITY CRITERIA

We included documents that present recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic, published in any language, from 2020 onwards.

DATA EXTRACTION AND SYNTHESIS

Data extraction was performed in pairs with consensus rounds. A descriptive analysis was carried out to present the main characteristics of the articles. Qualitative data from the extraction of recommendations were analysed through content analysis.

RESULTS

One hundred and twenty-five documents were included. Most papers were identified as expert consensus (n=56, 44.8%). Forty-six recommendations were identified for the safety of hospitalised patients: 17 relating to the reorganisation of health services related to the flow of patients, the management of human and material resources and the reorganisation of the hospital environment; 11 on the approach to the airways and the prevention of the spread of aerosols; 11 related to sanitary and hygiene issues; 4 about proper use of personal protective equipment and 3 for effective communication.

CONCLUSIONS

The recommendations mapped in this scoping review present the best practices produced so far and serve as a basis for planning and implementing good practices to ensure safe hospital care, during and after COVID-19. The engagement of everyone involved in the care of hospitalised patients is essential to consolidate the mapped recommendations and provide dignified, safe and quality care.

The challenges of health volunteers management in COVID19 pandemic in Iran

PURPOSE

The use of volunteers is one of the approaches to capacity building, preparedness and the response of the health system in disasters. Appropriate management of volunteers during disasters and emergencies is essential. This study aimed to explain the challenges of volunteer management in the Pandemic COVID-19 in Iran.

DESIGN/METHODOLOGY/APPROACH

Qualitative research was conducted using the content analysis based on the Graneheim method. The participants' selection was done based on purposeful sampling and theoretical sampling until data saturation. Direct field observation and 26 interviews were applied to collect data.

FINDINGS

Four categories and 15 sub-categories emerged to describe the challenges of volunteer management during the COVID-19 crisis including policymaking barriers (including legal barriers, insurance and support coverage and risk governance), managerial barriers (including planning, coordinating and organizing, training and awareness, command and leadership and information management and documentation), socio-cultural barriers (personal safety attitude and culture, attitudes and expectations of the community and perspectives on volunteers) and executive-operational barriers (monitoring and evaluation, cost and needs assessment).

ORIGINALITY/VALUE

It is essential to increase managers', officials' and volunteers' perceptions of COVID19 risk through education and information. Preparing a database for volunteers' information, including non-governmental organization and governmental organization volunteers, planning for needs assessment, establishing a mechanism for recruiting volunteers and using their capacities and appropriate organizing, tracking and monitoring of volunteers can be among effective strategies.

The use of a surgical helmet system with a high-efficiency particulate air filter as possible protection equipment during the coronavirus disease 2019 pandemic: a double-blinded randomized control study

PURPOSE

The rapid spread of coronavirus disease 2019 (COVID-19) has increased the use of personal protective equipment. The purpose of this study was to investigate whether a commercially available sterile surgical helmet system (SSHS) can be considered protective against COVID-19 and therefore safe for use.

METHODS

A double-blinded randomized controlled study was performed to investigate the efficacy of the ViVi® SSHS with a high-efficiency particulate air filter called HFD Hood (THI, Total Healthcare Innovation GmbH, Feistritz im Rosental, Austria) to protect against respiratory droplets. Forty recruited participants were divided into two different groups. The SSHS was tested using a validated qualitative test for respirator masks through saccharin or placebo solutions based on random allocation into two cohorts. Saccharin droplets are a validated surrogated marker for any elements of viral size, such as coronaviruses. A positive report of sweet taste after saccharin exposure was suggestive of ViVi® SSHS inefficacy in protection against droplets.

RESULTS

One participant out of 21 (4.8%) reported positive for taste within the placebo cohort, while five out of 19 (26.3%) reported positive for taste within the saccharin cohort upon testing. Two out of 21 (9.5%) participants reported positive for taste within the placebo cohort, and two out of 19 (10.5%) reported positive for taste within the saccharin cohort upon retesting. There were no statistically significant differences between the saccharin and placebo groups in either the test or retest measurements (p = 0.085 and p = 1.000, respectively).

CONCLUSIONS

This study demonstrates that the ViVi® SSHS equipped with HFD Hood protects against respiratory droplets, increasing protection against several microorganisms, including the virus that causes COVID-19, allowing surgeons to carry out procedures on COVID-positive patients in a more comfortable and safer way.

Additive manufacturing (3d printing) in response to a pandemic: Lessons learned at the children's hospital of Philadelphia

The COVID-19 pandemic produced unprecedented challenges to healthcare and medical device manufacturing (e.g. personal protective device and replacement part shortages). Additive manufacturing, 3D printing, and the maker community were uniquely positioned to respond to these needs by providing in-house design and manufacturing to meet the needs of clinicians and hospitals. This paper reviews the pandemic response of Children's Hospital of Philadelphia CHAMP 3D Lab, a point-ofcare3D printing team that supports clinical and research projects across the hospital network. The CHAMP team responded to a variety of COVID-19 healthcare needs including providing protective eyewear and ventilator components, creating a transport hook, and designing a novel transparent facemask. This case series details our response to these needs, describing challenges experienced and lessons learned in overcoming them so that others may learn from our experiences. Challenges to responding to the pandemic included the need to handle urgent pandemic related requests in addition to our standard fare. This required us to not only expand our capacity without additional resources, but also to develop a system of prioritization. Specific changes made included: streamlining workflows, identifying safety review processes, and developing/enlisting a network of collaborators. Further, we consider how to transition to a future, post-pandemic world without losing the cohesive drive of emergency-induced innovation. This paper aims to share what we have learned and to encourage both teams currently engaged in the printing community and those looking to join it.

Can patients with asymptomatic SARS-CoV-2 infection safely undergo elective surgery?

Current or recent infection with SARS-CoV-2 increases the risk of perioperative morbidity and mortality. Consensus guidelines recommend delaying elective major surgery after acute SARS-CoV-2 infection for 7 or 8 weeks. However, because of the growing backlog of untreated surgical disease and the potential risks of delaying surgery, surgical services may be under pressure to reduce this period. Here, we discuss the risks and benefits of delaying surgery for patients with current or recent SARS-CoV-2 infection in the context of the evolving COVID-19 pandemic, the limited evidence supporting delays to surgery, and the need for more research in this area.

COVID-19: A health-care worker’s perspective

The coronavirus disease 2019 (COVID-19) pandemic took the world by surprise in 2020, rapidly overwhelming our societies, economies, and health-care systems. The health-care workers (HCWs), hospital administrators, government leaders, and public health officials all rushed to coordinate and contain its global spread. Early on, it became clear that the virus was highly contagious and had a longer latent (yet transmissible) period when compared with previous pandemics. During the early dynamics in Wuhan, China, the basic reproductive number (R₀) was 2.2–2.7, suggesting a doubling time of the number of infected persons of 6–7 days. The spread of the disease has been further exacerbated by limitations in testing and medical supplies, disconcerting guidelines, conflicting media information, and whether policies are instituted and enforced to attempt to “flatten the curve” as well as the timeliness of health-related political efforts. At the same time, a swarming number of fast-track publications and interventions overwhelmed frontline HCWs with excessive and misrepresented study conclusions that needed to be implemented at the bedside. Some high-profile publications were even retracted limiting further therapeutic options. Facing these uncertainties, HCWs have been battling with immense physical and psychological stress from a surge of clinical work, staff shortage, bed crunch, potential lack of personal protective equipment and drugs, and profound ethical conflicts. Above all, HCWs grapple with the risks that exposure to the virus could have not only for themselves but for their families. The International Council of Nursing reported an estimate of 230,000 infected HCWs and over 600 nurses died based on information collected on 30 countries from national nursing associations, government figures, and media reports in June 2020. In this chapter, we explore the multitude of challenges confronting the frontline providers during this COVID-19 pandemic.

Aging of 3D Printed Polymers under Sterilizing UV-C Radiation

In the context of the COVID-19 pandemic, shortwave ultraviolet radiation with wavelengths between 200 nm and 280 nm (UV-C) is seeing increased usage in the sterilization of medical equipment, appliances, and spaces due to its antimicrobial effect. During the first weeks of the pandemic, healthcare facilities experienced a shortage of personal protective equipment. This led to hospital technicians, private companies, and even members of the public to resort to 3D printing in order to produce fast, on-demand resources. This paper analyzes the effect of accelerated aging through prolonged exposure to UV-C on mechanical properties of parts 3D printed by material extrusion (MEX) from common polymers, such as polylactic acid (PLA) and polyethylene terephthalate-glycol (PETG). Samples 3D printed from these materials went through a 24-h UV-C exposure aging cycle and were then tested versus a control group for changes in mechanical properties. Both tensile and compressive strength were determined, as well as changes in material creep properties. Prolonged UV-C exposure reduced the mechanical properties of PLA by 6-8% and of PETG by over 30%. These findings are of practical importance for those interested in producing functional MEX parts intended to be sterilized using UV-C. Scanning electron microscopy (SEM) was performed in order to assess any changes in material structure.

Moral distress amid COVID-19: A frontline emergency nurse's perspective

ABSTRACT

ED nurses are at high risk for developing moral distress during the COVID-19 pandemic. Predisposing factors include limited resources, inadequate staffing, PPE shortages, and caring for vulnerable populations. This article explores personal and organizational strategies to help nurses cope with moral distress.

BJS commission on surgery and perioperative care post-COVID-19

BACKGROUND

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence.

METHODS

In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them.

RESULTS

BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training.

CONCLUSION

The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.

Development and validation of technologies suitable for the decontamination and re-use of contaminated N95 filtering facepiece respirators in response to the COVID-19 pandemic

Background

Coronavirus disease 2019 (COVID-19) has brought significant challenges to society globally, particularly in the area of healthcare provision. A pressing need existed in protecting those tasked with delivering healthcare solutions during the COVID-19 crisis by providing solutions for preserving adequate supplies of effective personal protective equipment (PPE).

Aim

To evaluate and validate available methods for the decontamination of N95 filtering facepiece respirators (FFRs) while maintaining functionality during re-use.

Methods

Multiple low-temperature steam and vaporized hydrogen peroxide (VHP) technologies were assessed for inactivation of Mycobacterium spp. and feline calicivirus (employed as representatives of the contamination challenge).

Findings

Virus (≥3log₁₀) and Mycobacterium spp. (≥6log₁₀) inactivation was achieved on various types of N95 FFRs using an array of heat (65–71^oC), humidity (>50% relative humidity) and VHP without affecting the performance of the PPE.

Conclusion

The methods have been validated and were authorized by the US Food and Drug Administration under a temporary emergency use authorization. Based on the findings, opportunities exist for development and deployment of decontamination methods made from simple, general purpose materials and equipment should a future need arise.

Rapid redesign and effect on clinical workload of a supra-regional burns and plastic surgery service during the COVID-19 pandemic

Introduction

In March 2020, South Wales experienced the most significant COVID-19 outbreak in the UK outside of London. We share our experience of the rapid redesign and subsequent change in activity in one of the busiest supra-regional burns and plastic surgery services in the UK.

Methods

A time-matched retrospective service evaluation was completed for a 7-week “COVID-19” study period and the equivalent weeks in 2018 and 2019. The primary aim of this study was to evaluate plastic surgery theatre use and the impact of service redesign. Comparison between study periods was tested for statistical significance using two-tailed t-tests.

Results

Operation numbers reduced by 64% and total operating time by 70%. General anaesthetic cases reduced from 41% to 7% (p<0.0001), and surgery was mainly carried out in ringfenced daycase theatres. Emergency surgery decreased by 84% and elective surgery by 46%. Cancer surgery as a proportion of total elective operating increased from 51% to 96% (p<0.0001). The absolute number of cancer-related surgeries undertaken was maintained despite the pandemic.

Conclusion

Rapid development of COVID-19 SOPs minimised inpatient admissions. There was a significant decrease in operating while maintaining emergency and cancer surgery. Our ringfenced local anaesthetic Plastic Surgery Treatment Centre was essential in delivering a service. COVID-19 acted as a catalyst for service innovations and the uptake of activities such as telemedicine, virtual MDTs, and online webinars. Our experiences support the need for a core burns and plastic service during a pandemic, and show that the service can be effectively redesigned at speed.

Medical students during the COVID-19 pandemic: Considerations and arguments on their clinical engagement

During the recent COVID-19 pandemic, the clinical exposure of medical students has been hindered while the impact on medical education is under investigation. The potential negative impact of medical students on transmission rates, along with the shortages of Personal Protective Equipment (PPE), their lack of proper training, and their limited ability to work independently, give rise to reasonable concerns regarding their involvement in pandemic management. Nevertheless, the heavy workload could soon provoke severe deficiencies in the frontline medical workforce. Hence, the possibility of covering gaps in human resources by effectively deploying students should not be rejected in advance. Additionally, a pandemic poses a valuable learning opportunity for high-quality medical education. The aim of this commentary is to present a discussion with supporters and opponents of medical student engagement in the pandemic management and their involvement in placements requiring physical contact with patients. We also attempt to elucidate the necessary conditions for the students' possible involvement in clinical settings.

From outbreak of COVID-19 to launching of vaccination drive: invigorating single-use plastics, mitigation strategies, and way forward

The unforeseen outbreak of the COVID-19 epidemic has significantly stipulated the use of plastics to minimize the exposure and spread of the novel coronavirus. With the onset of the vaccination drive, the issue draws even more attention due to additional demand for vaccine packaging, transport, disposable syringes, and other allied devices scaling up to many million tonnes of plastic. Plastic materials in personal protective equipment (PPE), disposable pharmaceutical devices, and packaging for e-commerce facilities are perceived to be a lifesaver for the frontline healthcare personnel and the general public amidst recurring waves of the pandemic. However, the same material poses a threat as an evil environmental polluter when attributed to its indiscriminate and improper littering as well as mismanagement. The review not only highlights the environmental consequences due to the excessive use of disposable plastics amidst COVID-19 but also recommends mixed approaches to its management by adopting the combined and step-by-step methodology of adequate segregation, sterilization, sanitization activities, technological intervention, and process optimization measures. The overview finally concludes with some crucial way-forward measures and recommendations like the development of bioplastics and focusing on biodegradable/bio-compostable material alternatives to holistically deal with future pandemics.

Impact of enhanced personal protective equipment on surgeon workload and intraoperative patient outcomes

This work shows the need for targeted improvement to mitigate communication challenges associated with use of enhanced personal protective equipment. The data provide reassurance to surgeons and patients that there is no negative impact on surgeon workload or patient outcomes from use of enhanced personal protective equipment in the operating theatre.

Brachial Plexus Injury Surgical Service in Time of Coronavirus Disease 2019 Pandemic Experience from a Single Tertiary Orthopaedic Hospital in Indonesia

BACKGROUND: Brachial plexus injury (BPI) is one of the most devastating nerve injuries to the extremities. BPI in adults is an increasingly common clinical problem due to road traffic accident. Injury patterns, the timing of surgery, priority on the recovery of function, and patient’s understanding about the expectations of the prognosis are things that are important to consider before deciding on surgical management. The coronavirus pandemic coronavirus disease 2019 (COVID-19) has significantly affected all sectors, one of which is a surgical practice both in terms of medical personnel and equipment, also patient perceptions of hospital services. AIM: This study will analyze epidemiological data on BPI patients who underwent surgery during the COVID-19 pandemic. METHODS: A retrospective descriptive study of BPI profile in Prof. Soeharso Orthopedic Hospital before (2019) and during (2020) the COVID-19 pandemic. Demographic data, the total number of surgery, type of surgical procedure, and patient origin were collected. We compared to the same period in 2019 before pandemic started. RESULTS: In the data obtained from patients treated or undergoing BPI surgery before pandemic (March 1, 2019 to December 31, 2019) and during the pandemic (March 1, 2020 to December 31, 2020), Indonesia first confirms case was on March 2, 2020, until today. There were 51 and 43 cases, respectively. Panplexal type before the pandemic there were 27 patients (52%), and during the pandemic were 20 patients (46%), the upper type before: during the pandemic was 24 (48%): 23 (54%), and lower type 0 cases. Primary reconstruction before: during the pandemic was 26 (55%): 27 (62%) case, and secondary reconstruction before: during the pandemic was 25 (49%): 16 (38%) case, respectively. CONCLUSION: COVID-19 pandemic has no significant effect in the term of the number of BPI surgery performed. Better outcome in BPI surgery is influenced by the timing of the operation, therefore primary reconstruction remains the main choice for BPI patients with safety concern or health protocols. Pre-operative screening applied in our hospital includes laboratory examination, chest radiograph, and polymerase chain reaction swab test. Surgical personnel using personal protective equipment such as protective suit, face shield, google, shoes and medical mask during the COVID-19 pandemic. Patients with significant axon loss and limited clinical recovery are considered “urgent”, as surgery should be performed within 6 months or sooner (depending upon the distance to recipient’s muscle) to avoid irreversible muscle atrophy and degradation of motor endplates.

Effects of SARS-CoV-2 on the Practice of Otolaryngology

OBJECTIVES

Otolaryngologists in Texas have been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. Executive orders and professional recommendations have changed the way otolaryngologists practice. The objective of the study was to determine the effect of COVID-19 on otolaryngologists in the state of Texas.

METHODS

We surveyed the Texas Association of Otolaryngology to evaluate burnout, research output, and ability to respond to the pandemic. We also looked at the effect of Texas governmental executive orders GA-09 and GA-15 on work hours and patient load.

RESULTS

Our survey showed no significant difference in personnel contracting COVID-19 with perception of adequate personal protective equipment (P = 0.203), population density (P = 0.445), or type of practice (P = 0.763). The phenomenon of "pandemic burnout" was prevalent, with prolonged uncertainty the primary contributing factor for burnout caused by the pandemic.

CONCLUSIONS

The response to COVID-19 and the course of the pandemic are continuing to evolve and may play a significant role in how otolaryngologists practice and on their well-being during the pandemic.

Innovation in a Time of Crisis: A Systematic Review of Three-Dimensional Printing in the COVID-19 Pandemic

The coronavirus (COVID-19) global pandemic resulted in the breakdown of traditional supply chains responsible for providing essential equipment to hospitals and personal protective equipment (PPE) for health and social care workers. The three-dimensional (3D) printing community has responded to emerging need by recognizing shortages across health care systems and providing innovative solutions in real time, circumventing short-term global supply issues. A systematic review was undertaken to investigate the role of 3D printing in the COVID-19 pandemic in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE, EMBASE, and World Health Organization (WHO) COVID-19 databases. Newspaper and internet article sources were identified using the NEXIS media database. All studies and articles on the application of 3D printed solutions during the peak of the COVID-19 pandemic were included. The literature search identified 26 related articles, and 13 studies met inclusion criteria and were suitable for full-text review. One thousand two hundred and one unique digital media articles were identified; after removal of duplicates and screening of headlines for the inclusion and exclusion criteria, 460 articles were suitable for full-text review. The cross-collaboration between the 3D printing community and health care systems has aided in the provision of innovative solutions to combat the COVID-19 crisis. The applications for 3D printing ranged from oxygenation equipment to noninvasive and invasive ventilatory parts and innovative solutions for infection control and quarantine hubs. This review has identified that 3D printing technology has made the biggest contribution to the production of PPE in particular face shields, mirroring the areas of greatest shortage and need. Additive manufacturing has played a pivotal role in aligning disciplines in engineering, science, and medicine for the greater good. We have witnessed the rapid reconfiguration of traditional supply chains to circumvent global shortages, while making advancements in effort to limit the impact of this and future pandemics.

SARS-CoV-2 pandemic-induced PPE and single-use plastic waste generation scenario

The SARS-CoV-2 pandemic has demonstrated both positive and negative effects on the environment. Major concerns over personal hygiene, mandated and ease in lockdown actions and slackening of some policy measures have led to a massive surge in the use of disposable personal protective equipment (PPE) and other single-use plastic items. This generated an enormous amount of plastic waste from both healthcare and household units, and will continue to do so for the foreseeable future. Apart from the healthcare workers, the general public have become accustomed to using PPE. These habits are threatening the land and marine environment with immense loads of plastic waste, due to improper disposal practices across the world, especially in developing nations. Contaminated PPE has already made its way to the oceans which will inevitably produce plastic particles alongside other pathogen-driven diseases. This study provided an estimation-based approach in quantifying the amount of contaminated plastic waste that can be expected daily from the massive usage of PPE (e.g. facemasks) because of the countrywide mandated regulations on PPE usage. The situation of Bangladesh has been analysed and projections revealed that a total of 3.4 billion pieces of single-use facemask, hand sanitizer bottles, hand gloves and disposable polyethylene bags will be produced monthly, which will give rise to 472.30 t of disposable plastic waste per day. The equations provided for the quantification of waste from used single-use plastic and PPE can be used for other countries for rough estimations. Then, the discussed recommendations will help concerned authorities and policy makers to design effective response plans. Sustainable plastic waste management for the current and post-pandemic period can be imagined and acted upon.

[Validity of SARS-CoV-2 swabs taken preoperatively in children]

BACKGROUND

 Due to the limited compliance, the technically correct collection of a pooled nasopharyngeal swab is significantly more difficult in children. Especially during operations in the area of the upper respiratory tract, there is a significantly increased risk of infection with COVID-19 for everyone present in the operating room. The aim of the study is to analyze the validity of SARS-CoV-2 swabs taken preoperatively under suboptimal conditions.

MATERIAL AND METHODS

 Retrospective comparison of the PCR results of SARS-CoV-2 swaps taken preoperatively and intraoperatively from 62 children in the period from April to November 2020. Median age was 4.49 years. The PCR diagnosis was carried out one or two days preoperatively (in the case of emergency interventions on the same day) and again intraoperatively using a pooled nasopharyngeal swab.

RESULTS

 All 62 preoperatively taken swabs were negative. Deviating from the preoperative test result, one intraoperatively obtained swab was positive.

CONCLUSIONS

 Due to limited compliance, a correct preoperative swab technique (preanalytics) cannot always be assumed for children. Sufficient protective measures for everyone present in the operating room are therefore imperative. Intraoperative test should be considered if the the preoperative test was performed under difficult conditions.

The ongoing impact of COVID-19 on adult cardiac surgery and suggestions for safe continuation throughout the pandemic: a review of expert opinions

Objectives:

To establish the impact of the COVID-19 pandemic on adult cardiac surgery by reviewing current data and use this to establish methods for safely continuing to carry out surgery.

Methods:

Conduction of a literature search via PubMed using the search terms: ‘(adult cardiac OR cardiothoracic OR surgery OR minimally invasive OR sternotomy OR hemi-sternotomy OR aortic valve OR mitral valve OR elective OR emergency) AND (COVID-19 or coronavirus OR SARS-CoV-2 OR 2019-nCoV OR 2019 novel coronavirus OR pandemic)’. Thirty-two articles were selected.

Results:

Cardiac surgery patients have an increased risk of complications from COVID-19 and require vital finite resources such as intensive care beds, also required by COVID-19 patients. Thus reducing their admission and potential hospital-acquired infection with COVID-19 is paramount. During the peak, only emergencies such as acute aortic dissections were treated, triaging patients according to surgical priority and cancelling all elective procedures. Screening and 2-week quarantine prior to admission were essential changes, alongside additional levels of PPE. Focus was on reducing length of stay and switching to day-cases to reduce post-operative transmission risk, whilst several hospitals adopted ‘hot’ and ‘cold’ operating theatres for covid-confirmed and covid-negative patients.

Conclusions:

This paper suggests a ‘CARDIO’ approach for reintroducing elective procedures: ‘Care, Assess, Re-Evaluate, Develop, Implement, Overcome’; prioritising the mental and physical health of the workforce, learning from and sharing experiences and objectively prioritising patients to improve case load.

Family Presence for Critically Ill Patients During a Pandemic

Family engagement is a key component of high-quality critical care, with known benefits for patients, care teams, and family members themselves. The COVID-19 pandemic led to rapid enactment of prohibitions or restrictions on visitation that now persist, particularly for patients with COVID-19. Reevaluation of these policies in response to advances in knowledge and resources since the early pandemic is critical because COVID-19 will continue to be a public health threat for months to years, and future pandemics are likely. This article reviews rationales and evidence for restricting or permitting family members' physical presence and provides broad guidance for health care systems to develop and implement policies that maximize benefit and minimize risk of family visitation during COVID-19 and future similar public health crises.

SARS-CoV-2, surgeons and surgical masks

The exact risk association of coronavirus disease 2019 (COVID-19) for surgeons is not quantified which may be affected by their risk of exposure and individual factors. The objective of this review is to quantify the risk of COVID-19 among surgeons, and explore whether facemask can minimise the risk of COVID-19 among surgeons. A systematised review was carried out by searching MEDLINE to locate items on severe acute respiratory syndrome coronavirus 2 or COVID-19 in relation to health care workers (HCWs) especially those work in surgical specialities including surgical nurses and intensivists. Additionally, systematic reviews that assessed the effectiveness of facemask against viral respiratory infections, including COVID-19, among HCWs were identified. Data from identified articles were abstracted, synthesised and summarised. Fourteen primary studies that provided data on severe acute respiratory syndrome coronavirus 2 infection or experience among surgeons and 11 systematic reviews that provided evidence of the effectiveness of facemask (and other personal protective equipment) were summarised. Although the risk of COVID-19 could not be quantified precisely among surgeons, about 14% of HCWs including surgeons had COVID-19, there could be variations depending on settings. Facemask was found to be somewhat protective against COVID-19, but the HCWs’ compliance was highly variable ranging from zero to 100%. Echoing surgical societies’ guidelines we continue to recommend facemask use among surgeons to prevent COVID-19.

Present cum future of SARS-CoV-2 virus and its associated control of virus-laden air pollutants leading to potential environmental threat - A global review

The world is presently infected by the biological fever of COVID-19 caused by SARS-CoV-2 virus. The present study is mainly related to the airborne transmission of novel coronavirus through airway. Similarly, our mother planet is suffering from drastic effects of air pollution. There are sufficient probabilities or evidences proven for contagious virus transmission through polluted airborne-pathway in formed aerosol molecules. The pathways and sources of spread are detailed along with the best possible green control technologies or ideas to hinder further transmission. The combined effects of such root causes and unwanted outcomes are similar in nature leading to acute cardiac arrest of our planet. To maintain environmental sustainability, the prior future of such emerging unknown biological hazardous air emissions is to be thoroughly researched. So it is high time to deal with the future of hazardous air pollution and work on its preventive measures. The lifetime of such an airborne virus continues for several hours, thus imposing severe threat even during post-lockdown phase. The world waits eagerly for the development of successful vaccination or medication but the possible outcome is quite uncertain in terms of equivalent economy distribution and biomedical availability. Thus, risk assessments are to be carried out even during the post-vaccination period with proper environmental surveillance and monitoring. The skilled techniques of disinfection, sanitization, and other viable wayouts are to be modified with time, place, and prevailing climatic conditions, handling the pandemic efficiently. A healthy atmosphere makes the earth a better place to dwell, ensuring its future lifecycle.

Personal protective equipment for reducing the risk of COVID-19 infection among health care workers involved in emergency trauma surgery during the pandemic: An umbrella review

BACKGROUND

Health care facilities in low- and middle-income countries are inadequately resourced to adhere to current COVID-19 prevention recommendations. Recommendations for surgical emergency trauma care measures need to be adequately informed by available evidence and adapt to particular settings. To inform future recommendations, we set to summarize the effects of different personal protective equipment (PPE) on the risk of COVID-19 infection in health personnel caring for trauma surgery patients.

METHODS

We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. Systematic reviews of experimental and observational studies assessing the efficacy of PPE were included. Indirect evidence from other health care settings was also considered. Risk of bias was assessed with the AMSTAR II tool (Assessing the Methodological Quality of Systematic Reviews, Ottawa, ON, Canada), and the Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267).

RESULTS

Eighteen studies that fulfilled the selection criteria were included. There is high certainty that the use of N95 respirators and surgical masks is associated with a reduced risk of COVID-19 when compared with no mask use. In moderate- to high-risk environments, N95 respirators are associated with a further reduction in risk of COVID-19 infection compared with surgical masks. Eye protection also reduces the risk of contagion in this setting. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide, or dry heat is effective and does not affect PPE performance or fit.

CONCLUSION

The use of PPE drastically reduces the risk of COVID-19 compared with no mask use in health care workers. N95 and equivalent respirators provide more protection than surgical masks. Decontamination and reuse appear feasible to overcome PPE shortages and enhance the allocation of limited resources. These effects are applicable to emergency trauma care and should inform future recommendations.

LEVEL OF EVIDENCE

Review, level II.

Psychological and occupational impact of the COVID-19 pandemic on UK surgeons: a qualitative investigation

BACKGROUND

The COVID-19 pandemic represents the greatest biopsychosocial emergency the world has faced for a century. The pandemic has changed how individuals live and work, and in particular, frontline healthcare professionals have been exposed to alarming levels of stress.

OBJECTIVE

The aim of this study was to understand the professional and personal effects of COVID-19 pandemic on surgeons working in the UK National Health Service (NHS).

SETTING

Surgical departments in the NHS.

DESIGN

Between May and July 2020, as part of an ongoing study, we asked surgeons two open-ended questions: 'What challenges are the COVID-19 crisis currently presenting to you in your work and home life?' and 'How is this stress affecting you personally?' Thematic analysis was used for the qualitative data. Responses to the second question were also categorised into four groups reflecting valence: positive, neutral, mildly negative and strongly negative.

RESULTS

A total of 141 surgeons responded to the survey and the results indicated that 85.8% reported that they were generally negatively affected by the COVID-19 pandemic, of which 7.8% were strongly affected in a negative way. Qualitative thematic analysis identified four key themes from responses relating to the impact of the pandemic: (1) changing and challenging work environment as a result of COVID-19; (2) challenges to professional life and development; (3) management of change and loss in the respondents' personal lives; (4) emotional and psychological impacts.

CONCLUSION

The results highlighted the substantial emotional and psychological effects of the COVID-19 pandemic on surgeons' mental health, particularly in relation to fear and anxiety, loss of motivation, low mood, stress and burnout. There is an urgent need for workplace support and mental health interventions to help surgeons cope with the difficulties they face during the ongoing COVID-19 pandemic.

The impact of SARS-CoV-2 infection on the surgical management of colorectal cancer: lessons learned from a multicenter study in Spain

OBJECTIVE

the aim of the study was to analyze the management of colorectal cancer (CRC) patients diagnosed with CRC or undergoing elective surgery during the period of the SARS-CoV-2 pandemic.

MATERIAL AND METHODS

a multicenter ambispective analysis was performed in nine centers in Spain during a four-month period. Data were collected from every patient, including changes in treatments, referrals or delays in surgeries, changes in surgical approaches, postoperative outcomes and perioperative SARS-CoV-2 status. The hospital's response to the outbreak and available resources were categorized, and outcomes were divided into periods based on the timeline of the pandemic.

RESULTS

a total of 301 patients were included by the study centers and 259 (86 %) underwent surgery. Five hospitals went into phase III during the peak of incidence period, one remained in phase II and three in phase I. More than 60 % of patients suffered some form of change: 48 % referrals, 39 % delays, 4 % of rectal cancer patients had a prolonged interval to surgery and 5 % underwent neoadjuvant treatment. At the time of study closure, 3 % did not undergo surgery. More than 85 % of the patients were tested preoperatively for SARS-CoV-2. A total of nine patients (3 %) developed postoperative pneumonia; three of them had confirmed SARS-CoV-2. The observed surgical complications and mortality rates were similar as expected in a usual situation.

CONCLUSIONS

the present multicenter study shows different patterns of response to the SARS-CoV-2 pandemic and collateral effects in managing CRC patients. Knowing these patterns could be useful for planning future changes in surgical departments in preparation for new outbreaks.

Assessing Barriers Faced by Surgeons While Providing Surgical Care During the COVID-19 Pandemic in Pakistan: An Online Cross-Sectional Study

Background

The COVID-19 pandemic is not only affecting public health, but it is also impairing the specialized surgical care services in the hospitals. The present study aimed to assess the barriers faced by the surgeons while performing surgical procedures during the COVID-19 pandemic.

Methods

A cross-sectional, web-based survey was conducted from September 10 to October 14, 2020. The study population consisted of surgeons practicing in Kpk, Pakistan. Descriptive statistics and binary logistic regression analysis were used to analyze the data.

Results

A total of 292, out of 543, surgeons participated in the study (response rate: 59.6%). The younger surgeons (25–30 years) considered the lack of policies and practices regarding exposure to COVID-19 patients as a significant barrier to their practice. The surgeons practicing in private hospitals considered themselves at a higher risk while providing surgical care to the COVID-19 patients. The non-cooperation of the patients was the main barrier in delivering surgical care services.

Conclusion and Recommendation

The current study highlighted the barriers to the surgeons while providing surgical care to patients in the current pandemic. The most pronounced barriers to the surgeons were the lack of policies regarding exposure to COVID-19 and practice and non-cooperation of the patient. To address these barriers, it is recommended that health regulatory agencies of Pakistan should implement strict infection control practices to ensure the safety of surgeons and allied healthcare staff during the COVID-19 pandemic.

Resource requirements for reintroducing elective surgery during the COVID-19 pandemic: modelling study

Background

The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled.

Methods

This was a modelling study using Hospital Episode Statistics data (2014–2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals.

Results

A total of 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 – 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million.

Conclusion

As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.

COVID-19 preparedness: capacity to manufacture vaccines, therapeutics and diagnostics in sub-Saharan Africa

OBJECTIVE

The COVID-19 pandemic is a biosecurity threat, and many resource-rich countries are stockpiling and/or making plans to secure supplies of vaccine, therapeutics, and diagnostics for their citizens. We review the products that are being investigated for the prevention, diagnosis, and treatment of COVID-19; discuss the challenges that countries in sub-Saharan Africa may face with access to COVID-19 vaccine, therapeutics, and diagnostics due to the limited capacity to manufacture them in Africa; and make recommendations on actions to mitigate these challenges and ensure health security in sub-Saharan Africa during this unprecedented pandemic and future public-health crises.

MAIN BODY

Sub-Saharan Africa will not be self-reliant for COVID-19 vaccines when they are developed. It can, however, take advantage of existing initiatives aimed at supporting COVID-19 vaccine access to resource-limited settings such as partnership with AstraZeneca, the Coalition for Epidemic Preparedness and Innovation, the Global Alliance for Vaccine and Immunisation, the Serum Institute of India, and the World Health Organization's COVID-19 Technology Access Pool. Accessing effective COVID-19 therapeutics will also be a major challenge for countries in sub-Saharan Africa, as production of therapeutics is frequently geared towards profitable Western markets and is ill-adapted to sub-Saharan Africa realities. The region can benefit from pooled procurement of COVID-19 therapy by the Africa Centres for Disease Control and Prevention in partnership with the African Union. If the use of convalescent plasma for the treatment of patients who are severely ill is found to be effective, access to the product will be minimally challenging since the region has a pool of recovered patients and human resources that can man supportive laboratories. The region also needs to drive the local development of rapid-test kits and other diagnostics for COVID-19.

CONCLUSION

Access to vaccines, therapeutics, and diagnostics for COVID-19 will be a challenge for sub-Saharan Africans. This challenge should be confronted by collaborating with vaccine developers; pooled procurement of COVID-19 therapeutics; and local development of testing and diagnostic materials. The COVID-19 pandemic should be a wake-up call for sub-Saharan Africa to build vaccines, therapeutics, and diagnostics manufacturing capacity as one of the resources needed to address public-health crises.

The role of three-dimensional printing in coronavirus disease-19 medical management: A French nationwide survey

Objectives

Coronavirus disease-19 (COVID-19) has spread worldwide and poses various challenges to healthcare services. The limited supply of medical and personal-protective equipment has affected the ability of many countries to respond to the crisis. Three-dimensional printing (3DP) is well suited to addressing these shortages. We assessed the medical role of 3DP during the COVID-19 outbreak in hospitals in France.

Design

Retrospective survey.

Setting and intervention

We included and questioned all French level-1 and -2 COVID-certified centers.

Participants

One hundred and thirty-eight COVID-certified centers were contacted across France: 38 (27.5 %) level 1 and 100 (72.5 %) level 2 centers. The analysis focused on 133 centers (96.37 %), among which 98 (73.68 %) used 3DP.

Main outcome measures

The primary endpoint was the number of pieces printed in 3D. The secondary endpoints were the mode, type, and benefits of 3DP.

Results

The total number of pieces printed in 3D nationwide was 84,886: 76,000 pieces of individual protective equipment (IPE) (89.53 %), 6335 pieces of biomedical equipment (7.47 %), and 2551 prototypes (3.01 %). In 91 cases (92.85 %), 3DP was performed using external printers. The pieces 3D-printed by the various centers helped around 6109 patients and protected around 41,091 caregivers.

Conclusions

3DP produced more than 84,000 pieces at 98 centers, helped more than 6000 patients, and protected more than 41,000 caregivers. Therefore, 3DP played a major role in medical aid during the COVID-19 outbreak in France.

Continuing cancer surgery through the first six months of the COVID-19 pandemic at an academic university hospital in India: A lower-middle-income country experience

Background

The novel coronavirus pandemic (COVID‐19) hinders the treatment of non‐COVID illnesses like cancer, which may be pronounced in lower‐middle‐income countries.

Methods

This retrospective cohort study audited the performance of a tertiary care surgical oncology department at an academic hospital in India during the first six months of the pandemic. Difficulties faced by patients, COVID‐19‐related incidents (preventable cases of hospital transmission), and modifications in practice were recorded.

Results

From April to September 2020, outpatient consultations, inpatient admissions, and chemotherapy unit functioning reduced by 62%, 58%, and 56%, respectively, compared to the same period the previous year. Major surgeries dropped by 31% with a decrease across all sites, but an increase in head and neck cancers (p = .012, absolute difference 8%, 95% confidence interval [CI]: 1.75% — 14.12%). Postoperative complications were similar (p = .593, 95% CI: −2.61% — 4.87%). Inability to keep a surgical appointment was primarily due to apprehension of infection (52%) or arranging finances (49%). Two COVID‐19‐related incidents resulted in infecting 27 persons. Fifteen instances of possible COVID‐19‐related mishaps were averted.

Conclusions

We observed a decrease in the operations of the department without any adverse impact in postoperative outcomes. While challenging, treating cancer adequately during COVID‐19 can be accomplished by adequate screening and testing, and religiously following the prevention guidelines.

Coronavirus disease 2019 (COVID-19) induced waste scenario: A short overview

The COVID-19 pandemic and lockdown situation have shown both positive and negative effects on the environmental aspects. With an unprecedented rate the different types of waste volume have up surged along with the COVID-19 contamination rate. As the situation has mandated people as well as the most infected persons to stay at home, the amount of generated hazardous waste is 3.40 kg that can be expected daily from each infected person. China and other countries have seen a massive increment in the hazardous waste generation (about 600 % increase in Hubei province) amount. While dealing with this sudden increase in waste amount, the conventional incineration facilities have been outstripped and waste management industry is facing an immense pressure over handling hazardous waste generated from COVID-19 infected patients. Alongside with the hazardous waste volume, single-use plastic items and personal protective equipment (PPEs) have induced a new type of "PPE pollution" in the land and aquatic environment. The current review provides a countrywide waste generation amount, estimated using the infected number of cases for some selected countries. In contrast with the poor waste management noticed during this pandemic, some suggested approaches towards a better waste management service and future implications of waste management are discussed with viable consideration for the waste workers.

Strategies for Optimizing the Use of PPE During Surgery in COVID-19 Pandemic: Rapid Scoping Review of Guidelines

Personal protective equipment (PPE) plays a fundamental role in the prevention of spread to Health Care Professionals (HCP) ; especially in a surgical setting. This scoping review of surgery guidelines was performed to appraise the quality of appropriate PPE recommendations and propose a strategy to optimize the PPE usage. This rapid scoping review of guidelines on surgery during COVID-19 was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol. Important databases were searched from January 1, 2020 to July 31, 2020, for relevant studies produced by a national/international academic association/organization, in English literature, using relevant keywords. Quality of evidence was graded according to GRADE guidelines. The searches yielded a total of 1725 studies, out of these 41 guidelines on surgery during COVID-19 matching with pre-defined criteria were evaluated. The level of evidence was uniformly rated "low," as assessed by GRADE guidelines and recommendations provided by them were mostly non-specific covering a narrow range of items. The crucial issue of optimization of PPE was not addressed at all. Economic implications demand optimization of PPE and conservation of resources. A simple decision-making algorithm addressing all the limitations of guidelines can be constructed, which allows HCPs to safeguard themselves and at the same time optimize/ conserving resources.

The impact of COVID-19 on hand therapy practice

BACKGROUND

Hand therapists and health care providers across the spectrum have been profoundly impacted by COVID-19. Greater insight and information regarding how practitioners have been affected by this unparalleled pandemic is important.

PURPOSE

Survey research was performed to examine the impact of the COVID-19 pandemic on hand therapy practice.

STUDY DESIGN

Online survey research.

METHODS

Four constructs guided the development of the survey: psychosocial and financial impact; safety practice patterns; changes in current practice patterns; use of telehealth. The survey was distributed to members of the American Society of Hand Therapists from April 14, 2020 through May 4, 2020. Descriptive demographic data were obtained. Frequencies were examined using ChiSquare, correlations were examined using Spearman Correlation Coefficient, and means were compared via independent t-test.

RESULTS

A total of 719 members responded to the survey. Eighty-six percent of therapists reported feeling more stress than they did prior to the COVID-19 pandemic. This level of stress was similar across ages, practice settings, financial stability or instability, and geographical settings. Older therapists (r_s = 0.04) and those that practiced longer (r_s = 0.009) felt more comfortable with in-person treatment. Ninety-eight percent of therapists reported a decrease in caseload. Postoperative cases (P= .0001) and patients ages 19-49 were more likely to receive in-person treatment (P= .002). 46% of therapists reported providing telehealth services. Nontraumatic, nonoperative cases (P= .0001) and patients aged 65 or older were more likely to receive telehealth services (P= .0001). Younger therapists (r_s = 0.03) and therapists working in outpatient therapist owned, outpatient corporate owned, and outpatient academic medical centers (X² [4, N = 637] = 15.9463, P= .003) were more likely to utilize telehealth.

CONCLUSION

Stress was felt globally among hand therapy clinicians regardless of financial security or insecurity, age, practice area, or geographical setting. Therapists saw a drastic decrease in caseloads. In-person caseloads shifted primarily to postoperative cases.

STUDY DESIGN

Web based survey.

Pharmacological Prophylaxis and Personal Protective Equipment (PPE) Practices in Gynecological Cancer Surgery During COVID-19 Pandemic

Purpose

In the absence of vaccine, proper use of personal protective equipment (PPE) is the most important strategy to protect healthcare workers against COVID-19 infection. The recommendations on pharmacological prophylaxis against COVID-19 infection are controversial. The aim of current study was to assess PPE practices during surgery on COVID-19 negative gynecological cancer patients and use of pharmacologic prophylaxis by clinicians practicing gynecologic oncology.

Methods

We disbursed a survey questionnaire through various social media platforms among clinicians practicing gynecologic oncology. The survey consisted of 37 questions divided into five subgroups evaluating demographic details, use of pharmacological prophylaxis against COVID-19, preoperative COVID-19 screening protocol, details on PPE usage and associated discomfort, if any.

Results

Two hundred twenty oncologists from 13 countries responded to the survey. Pharmacological prophylaxis was being used by 85 (38.6%) respondents; most common agent was hydroxychloroquin (HCQ) by 24.5% respondents. Routine preoperative screening for COVID-19 was performed by 214 (97.3%) respondents. Some degree of discomfort during surgery due to PPE use was reported by 170 (77.3%) respondents, which was moderate to severe in 73 (33.2%) respondents. Most common difficulties associated with face mask/shield were problems in communication (69.5%) and breathing (58.1%). Eye protection was associated with poor visibility, fogging and headache. Unusual fatigue attributed to PPE use was experienced by 143(65%) respondents.

Conclusion

Use of pharmacological prophylaxis against COVID-19 is controversial and the same is reflected in our survey. Most respondents adhered to PPE use despite experiencing some physical discomfort.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40944-021-00500-4.