EditordThe 2019 novel coronavirus disease (COVID-19) pandemic has overwhelmed healthcare systems worldwide, profoundly impacting the lives of anaesthesiologists, intensivists, and nurses caring for the critically ill. Such high-acuity patient care imposes a significant physical and cognitive burden, which is further compounded by increased workloads, staffing deficiencies, and equipment shortages. Participation in aerosol-generating procedures and frequent direct patient contact may increase risk of infection. Government-imposed containment measures may lead to social isolation and restrict access to usual coping mechanisms. Exposure to contagion may also engender concerns from staff living with older people and young children. The previous severe acute respiratory syndrome outbreak of 2003 saw emotional exhaustion, anxiety, depression, and burnout afflicting healthcare workers. 1,2 Similarly, studies on healthcare workers from China and Italy have described stress-related anxiety and depression during the COVID-19 pandemic. 3,4 These studies did not specifically examine intensive care providers, who may constitute a highrisk subgroup. We sought to determine the prevalence and severity of psychological distress amongst anaesthesiologists and nurses working in ICUs during this pandemic, and identify potential risk factors. We also studied their main concerns, perceptions of pandemic preparedness, training adequacy, and staff protection. This observational, cross-sectional study was conducted at a 1240-bed tertiary academic medical centre in Singapore. During this pandemic, anaesthesiologists were rostered into ICUs in our hospital. Ethics approval was obtained from the institutional domain-specific review board (2020/00648) before commencement of the study. All anaesthesiologists (including trainees) and nurses working in ICUs were invited to participate with a one-time self-administered online questionnaire. The sampling period was June 11e15, 2020, during which Singapore saw 400 to 500 new cases daily, with a cumulative total exceeding 40 000 cases for a population of~5.8 million. Two survey completion reminders were issued. All participants completed a 46question, closed-ended, self-reporting questionnaire (Supplementary Appendix 1). No identifying information was collected. The anonymised questionnaire collected participant characteristics, medical history, and workplace characteristics, such as redeployment outside normal professional boundaries, direct COVID-19 patient care, workload during the pandemic,

Summary In December 2019, a cluster of atypical pneumonia cases were reported in Wuhan, China, and a novel coronavirus elucidated as the aetiologic agent. Although most initial cases occurred in China, the disease, termed coronavirus disease 2019, has become a pandemic and continues to spread rapidly with human‐to‐human transmission in many countries. This is the third novel coronavirus outbreak in the last two decades and presents an ensuing healthcare resource burden that threatens to overwhelm available healthcare resources. A study of the initial Chinese response has shown that there is a significant positive association between coronavirus disease 2019 mortality and healthcare resource burden. Based on the Chinese experience, some 19% of coronavirus disease 2019 cases develop severe or critical disease. This results in a need for adequate preparation and mobilisation of critical care resources to anticipate and adapt to a surge in coronavirus disease 2019 case‐load in order to mitigate morbidity and mortality. In this article, we discuss some of the peri‐operative and critical care resource planning considerations and management strategies employed in a tertiary academic medical centre in Singapore in response to the coronavirus disease 2019 outbreak.

COVID-19 was first identified in Wuhan, China and is caused by the novel coronavirus SARS-CoV 2. It has now spread rapidly to over 190 countries and territories around the world and has been declared a global pandemic by the World Health Organization. The virus is spread through droplet transmission and currently has a mortality rate of over 4% globally. The pediatric population has been found to be less susceptible to the disease with the majority of children having milder symptoms and only one pediatric death being reported globally so far. Despite this, strategies need to be put in place to prevent further spread of the virus. We present a summary of the general measures implemented at a large adult and pediatric tertiary hospital in Singapore (National University Hospital) as well as the specific strategies in place for the operating room and pediatric intensive care unit.

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