COVID-19: Effect on gastroenterology and hepatology service provision and training: Lessons learnt and planning for the future

Abstract

In late 2019, reports arose of a new respiratory disease in China, identified as a novel coronavirus, severe acute respiratory syndrome coronavirus 2. The World Health Organisation named the disease caused by the virus ‘coronavirus disease 2019 (COVID-19)’. It was declared a pandemic in early 2020, after the disease rapidly spread across the world. COVID-19 has not only resulted in substantial morbidity and mortality but also significantly impacted healthcare service provision and training across all medical specialties with gastroenterology and Hepatology services being no exception. Internationally, most, if not all ‘non-urgent’ services have been placed on hold during surges of infections. As a result there have been delayed diagnoses, procedures, and surgeries which will undoubtedly result in increased morbidity and mortality. Outpatient services have been converted to remote consultations where possible in many countries. Trainees have been redeployed to help care for COVID-19 patients in other settings, resulting in disruption to their training - particularly endoscopy and outpatient clinics. This has led to significant anxiety amongst trainees, and risks prolongation of training. It is of the utmost importance to develop strategies that continue to support COVID-19-related service provision, whilst also supporting existing and future gastroenterology and Hepatology services and training. Changes to healthcare provision during the pandemic have generated new and improved frameworks of service and training delivery, which can be adopted in the post-COVID-19 world, leading to enhanced patient care.

Outcomes of incoming and outgoing second opinions from a UK liver transplant centre

“…Having a standardised uniform inter-LT centre process for STCOs between units may be an area for exploration especially in the era of evolving LT indications and transplanting clinically sicker patients. The advent of telemedicine recently in the COVID-19 pandemic 9 also may be used for such patients with remote MDTs now embedded features of UK clinical practice. This may speed up referral times and timely decision making.…”

COVID-19: Has the Liver Been Spared?

“…The COVID-19 pandemic has substantially impacted solid organ transplantation, including the temporary inactivation of waitlist candidates who tested positive for SARS-CoV-2 infection with a consequent suspension of transplant activity, except for extremely super-urgent cases [ 180 , 181 ]. The first pandemic wave caused a reduction in organ donation compared to the same period in the previous year, as demonstrated by the 25% decrease in liver transplants reported by the United Network for Organ Sharing (UNOS) [ 182 ] and also later confirmed in a large population-based study across 22 countries worldwide, which showed an overall reduction in liver transplants of 11% [ 183 ].…”

“…Additionally, the COVID-19 pandemic also had a disruptive effect on the training of hepatologists, gastroenterologists, radiologists, and other medical personnel, due to the redeployment and cancellation of educational activities. Following the pandemic outbreak, in fact, elective procedures were drastically interrupted leading to a significant gap in medical education and decreased physical and emotional well-being of trainees [ 180 , 215 ]. Moreover, global shortages of personal protective equipment and the attempt to minimize the risk of infection led to restricting staffing for procedures and excluding “non-essential persons” as fellows.…”

“…Moreover, global shortages of personal protective equipment and the attempt to minimize the risk of infection led to restricting staffing for procedures and excluding “non-essential persons” as fellows. The small outpatient residual volume during the COVID-19 outbreak and the frequent unavailability of training mentors who had tested positive for SARS-CoV-2 further contributed to an increase in trainees concerning attaining the program requirements and maintaining their procedural skills [ 180 ]. According to a recent European survey, in fact, the majority (84.5%) of gastroenterology trainees reported a high impact on training activities by COVID-19, whose residual activities mainly concerned urgent endoscopies and oncologic patients [ 216 ].…”

Getting by With Less: How to do More With Less Staff After COVID-19?

“…All levels of support staffing from medical office administrators to nurses have been affected by the pandemic (1)(2)(3). The virus itself has led to waxing and waning of the workforce as individuals are either infected or exposed (4).…”