General thoracic surgery services across Asia during the 2020 COVID-19 pandemic

Abstract

The COVID-19 pandemic of 2020 posed an historic challenge to healthcare systems around the world. Besides mounting a massive response to the viral outbreak, healthcare systems needed to consider provision of clinical services to other patients in need. Surgical services for patients with thoracic disease were maintained to different degrees across various regions of Asia, ranging from significant reductions to near-normal service. Key determinants of robust thoracic surgery service provision included: preexisting plans for an epidemic response, aggressive early action to "flatten the curve", ability to dedicate resources separately to COVID-19 and routine clinical services, prioritization of thoracic surgery, and the volume of COVID-19 cases in that region. The lessons learned can apply to other regions during this pandemic, and to the world, in preparation for the next one.

Understanding the practice of thoracic surgery during the COVID-19 pandemic

“…Experience from Asian thoracic surgeons has shown that in many countries, there was a drop in non-neoplastic thoracic operations and malignancy and lung transplant had the highest priority [4].…”

“…If a COVID-19-positive patient or strongly suspected patient has to be operated, it should be done in an exclusive operating room, preferably with negative pressure. Personal protective equipment must be worn as per protocol and extra personnel should not be allowed inside the operating room [4,9]. There is no definite evidence on coronavirus; however, there are isolated reports showing that viruses may survive in surgical smoke created by electrosurgical instruments [15,16].…”

“…There is no definite evidence on coronavirus; however, there are isolated reports showing that viruses may survive in surgical smoke created by electrosurgical instruments [15,16]. To minimize the surgical smoke, a suction device should be used and an electrosurgical instrument should be set at a lowest effective power [4,6]. For surgery in non-COVID-19 patients, the infectiousness potential has to be assessed and PPE as per hospital infection prevention control practices has to be used.…”

“…The Ministry of Health and Family Welfare of India has published a detailed guideline that should be followed [17]. The Japanese thoracic surgeons have suggested that surgeons fully equipped with PPE have considerable physical and mental fatigue and should try to reduce the operating time as much as possible and consider a change of personnel during surgery [4]. This is an important observation which requires due attention to shape our future surgical practice.…”

“…The National Health Service (NHS) in the UK has witnessed forced unprecedented transformation, resulting in radical alterations to services [5]. Similar thoughts have been expressed by the Asian Cardiovascular and Thoracic Annals [4] with reports of thoracic services maintained from "significant reduction to near normal service." Based on these observations, the Indian Journal of Surgery [6] has suggested developing new protocols and practices when services are resumed.…”