COVID-19 Pandemic and Its Impact on Neurosurgery Practice in Malaysia: Academic Insights, Clinical Experience and Protocols from March till August 2020

Abstract

The newly discovered coronavirus disease 2019 (COVID-19) is an infectious disease introduced to humans for the first time. Following the pandemic of COVID-19, there is a major shift of practices among surgical departments in response to an unprecedented surge in reducing the transmission of disease. With pooling and outsourcing of more health care workers to emergency rooms, public health care services and medical services, further in-hospital resources are prioritised to those in need. It is imperative to balance the requirements of caring for COVID-19 patients with imminent risk of delay to others who need care. As Malaysia now approaches the recovery phase following the pandemic, the crisis impacted significantly on neurosurgical services throughout the country. Various emergency measures taken at the height of the crisis may remain as the new normal in the provision of neurosurgical services and practices in Malaysia. The crisis has certainly put a strain on the effective delivery of services and as we approach the recovery era, what may have been a strain may prove to be a silver lining in neurosurgical services in Malaysia. The following details are various measures put in place as the new operational protocols for neurosurgical services in Malaysia.

How has the COVID-19 pandemic impacted clinical care and research in Neuro-Oncology?

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“…(52)(53)(54)(55)(56)(57)(58) One centre found that patients who utilised telemedicine appointments had more stable brain tumours than patients who attended in-person appointments (40). Studies have suggested that telemedicine is suitable for Neuro-oncological examination of non-critical patients,(3,22,59,60) reducing the need for in-person visits. Examination may be improved by the presence of a caregiver and appropriate staff training (61).…”

Treatment Patterns and Outcomes of Patients with Grade 4 Glioma Treated with Radiation during the COVID-19 Pandemic

“…Patients with glioma are especially vulnerable to potential side effects from COVID-19 due to a tendency towards older age, increased risk of functional impairment due to neurocognitive decline, and increased use of corticosteroids thereby causing further immunosuppression and greater susceptibility to infections [ 6 , 7 ]. COVID-19 infection during the early stages of the pandemic was also known to have neurological sequelae, with CNS infection hypothesized to be mediated via angiotensin-converting enzyme receptors present on endothelial, glial, and neuronal cells [ 8 ]. It was therefore also suspected that due to having a pre-existing injury to the brain, patients with glioma were more susceptible to the neurologic side effects of COVID infection [ 9 ].…”