The urologist's role in the fight of COVID-19 pandemic: mandatory mindset shift on the frontline

Abstract

To the editor, Early in January 2020, we were living our regular lives. We are urologists at the "Hospital das Clínicas", University of Sao Paulo Medical School Clinical Hospital (HC-FMUSP), a 900-bed tertiary care facility inside an even wider and stronger health complex of 2.300 beds. Our Institution is responsible for about 350 highly complex monthly urological surgeries comprising all subspecialties in the field. We are inserted in the SUS (Sistema Único de Saúde), a unified health system with universal coverage created in 1990 (1). By the end of January 2020, we were attending crowded outpatient ambulatories, performing our usual surgeries, participating in the teaching of undergraduate students, teaching general surgery and urology residents, presenting scientific research in national and international scientific meetings. When the press released the first confirmed case of corona virus disease (COVID-19) in late December, 2019 by the previously named "Wuhan virus" (Hubei province in China), later renamed as SARS-CoV-2 (2), not even the most pessimistic of us could imagine the impact it would have on our lives. Not even when it was spotted that the virus spread was hidden from the World and that doctors who tried to disseminate the information out died of the disease. At worst, if the virus crossed oceans and continents to our country, the routine of clinicians working in emergency rooms and intensive care units could be affected. Important and influential individuals of our national medical and political society came to the public warning that there was nothing to fear or to worry about. They told, we believed. Those who lived to see April 2020 realized how naive we had been. Italy fell and the whole World kneeled together with the Mediterranean country. "No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less" (3). How can the wisdom of a 17th century man be so contemporary? Perhaps because true wisdom is beyond time. While Italy was bleeding, here in Brazil most of our surgeries started to be postponed and the outpatient clinics to be rescheduled based on international and national urological societies recommendations (4). Academic meetings were canceled indefinitely. One by one, all the familiar aspects of our lives were taken away from us. Whilst we could still get together in the cafes, we were astonished. What´s next? Heartbreaking videos came from all over the World: first Italy, then Spain, England, and finally the United States. Great nations with robust health care systems took a hit like they have never seen before, at least not since the World War II. The context of a locally Chinese isolated crisis was rapidly dissipated into thin air. Thunders of war were quickly moving in our direction. It was real, surreal, and we did not plan for it. On March 24, the state of Sao Paulo officially announced social isolation. Cancelation of all sports events. Empty streets. Parks with closed gates. Children and ...

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