Guiding Principles for Cancer Surgery during the COVID-19 Pandemic
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CASE REPORT
Guiding Principles for Cancer Surgery during the COVID-19 Pandemic S. V. S. Deo 1 & Sunil Kumar 1 & Naveen Kumar 1 & Jyoutishman Saikia 1 & Sandeep Bhoriwal 1 & Sushma Bhatnagar 2 & Atul Sharma 3
# Indian Association of Surgical Oncology 2020
Introduction COVID-19 pandemic had an unprecedented adverse impact on health care services globally. This pandemic had started in the Wuhan city of China where the first case was reported on 31st December 2019 [1, 2] and on 11th March 2020 the World health organization (WHO) had declared it as a global pandemic and as a public health emergency of international concern [3]. Within a short span of 3 months a significant proportion of different geographic regions of the world are facing the impact of COVID-19 pandemic [4–6]. Government of India has imposed a nationwide lockdown from 24th March 2020 to contain the spread of coronavirus infection. The pandemic has caused major disruption of health care services both in high income and low and middle income countries with limited resources. The challenges faced by health care sector include, caring for critical COVID-19 patients in hospitals resulting in massive diversion of critical hospital resources, caring for non COVID-19 patient population with medical and surgical emergencies and last but not the least - protecting health care providers (HCP) and implement new infection control protocols. In most of the hospitals worldwide, surgeons are operating only on patients with life threatening emergencies and postponing majority of elective surgical cases. The challenges surgical community facing include screening for COVID status, protection of HCP, judicious use of limited personal protective equipment (PPE) and other hospital resources.
* S. V. S. Deo [email protected] 1
Department of Surgical oncology, BRA-IRCH, All India Institute of Medical Sciences, New Delhi 110029, India
2
Department of Onco-Anasthesia, All India Institute of Medical Sciences, New Delhi, India
3
Department of Medical oncology, All India Institute of Medical Sciences, New Delhi, India
Major factors that will guide surgical practice in the current scenario are stage of COVID-19 pandemic in a particular country / region and availability of health care resources. Most of the countries are now reaching the stage of community spread of COVID-19 infection with a huge number of potential asymptomatic carriers and significant number of critical COVID-19 patients. Based on the COVID-19 status of the region/hospital and availability of health care resources American College of Surgeons (ACS) has proposed 3 different phases that a health care setup can encounter. Phase 1 - Semi-urgent settings (Preparation phase): The disease is not in the rapid escalation phase and institutions have adequate resources such as hospital and ICU beds, ventilators and manpower to cater the services. Phase 2 - Urgent settings: Limited availability of resources due to increased number of COVID-19 patients. Phase 3- Hospitals are over burdened with COVID-19 patients and
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