In response to the evolving COVID-19 pandemic, most governments and professional bodies recommended cancellation of elective surgery. The main elective treatments and procedures at the MDMI was also temporarily suspended as a similar approach. The staff and administration were preparing to convert the facility into a COVID treatment and isolation center.
This action was important to free up hospital bed capacity and ensure supplies of personal protective equipment (PPE), as well as to protect patients and health-care workers.
Severe COVID-19 is associated with a marked inflammatory and pro-thrombotic state. These pathological processes are exacerbated by surgery and immobilization, leading to a perfect storm detrimental to good postoperative outcomes. Furthermore, early data from China showed that older patients and those with comorbidities, particularly hypertension and diabetes, were most vulnerable to COVID-19. A similar demographic and clinical profile is typical of many types of surgery, and so there is probably a multiplicative risk process.
Most countries around the world that were facing high number of cases reported like the US, Spain, Italy, China, the health systems were all largely overwhelmed in the early stages of the COVID-19 pandemic. Staff training, PPE, intensive care unit (ICU) beds, and ventilators were often scarce or insufficient. Countries vary widely in terms of their capacity to respond to an outbreak of a novel infectious disease. Furthermore, there is a clear risk to hospital staff if infectious patients are not detected as early as possible.
Some elective (eg, Cancer surgery or Cesarean section) and most non-elective surgery must continue throughout any pandemic, and if the prevalence of COVID-19 is low and hospital resources are coping with demand for ward and ICU beds, more elective surgery can recommence. Globally, many governments and professional bodies are moving from a position of curtailment to reopening of elective surgery.
Surgery is an essential part of modern medicine, therefore additional risks during the COVID-19 pandemic have to be carefully considered. The MDMI has taken into consideration all necessary precautions to ensure the safety of the medical team and the patient recovery. The Surgeons and supportive staff have been extensively trained to handle Critical Care patients in the COVID pandemic.
