Challenges to delivering pediatric surgery services in the midst of COVID 19 crisis: experience from a tertiary care hos
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REVIEW ARTICLE
Challenges to delivering pediatric surgery services in the midst of COVID 19 crisis: experience from a tertiary care hospital of Pakistan Saqib Hamid Qazi1 · Ayesha Saleem1 · Areeba Nadeem Pirzada2 · La‑Raib Hamid2 · Sohail Asghar Dogar1 · Jai K. Das3 Accepted: 16 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Covid-19 pandemic has significantly challenged the healthcare delivery across the world. Surgery departments across the country responded to this challenge by halting all non-emergency procedures. This delay in diagnosis and management of surgical disease could result in significant mortality and morbidity among the most vulnerable population-the children. In this manuscript, we discuss the measures adopted as well as the challenges faced by the pediatric surgery department at Aga Khan University Hospital, Karachi (AKUH), Pakistan, which is a private, not-for-profit entity and providing optimum surgical care to the patients. We also underscore the need for global strategies for tackling such crisis. Keywords COVID-19 · Pediatric surgery · Challenges
Introduction On January 30th, 2020, the World Health Organization acknowledged a novel coronavirus (SARS-CoV-2) as a ‘public health emergency of international concern’ [1] and later declared coronavirus disease (COVID-19) a pandemic. The virus primarily affects the respiratory system and is transmitted between humans via respiratory droplets, secretions and direct contact [2]. The initial cases emerged in late December 2019, in Wuhan, Hubei Province of China [3]. As of July 9th, COVID-19 has infected more than 11.87 million people in more than 213 countries across the world and more than 545,000 people have lost their lives [4]. The disease is severe in elderly and people with underlying chronic diseases. The children though comprise a small fraction of the total people affected by COVID [5, 6], as a report of 73,214 covid-19 cases from the Chinese Center for Disease Control and Prevention showed that only 1–2% of the total cases were children under 19 years of age, in
* Saqib Hamid Qazi [email protected] 1
Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
2
Medical Student, Aga Khan University, Karachi, Pakistan
3
Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
contrast to 87% of the cases being adults aged 30–79 years [7]. The disease is also reportedly less severe in children [7, 8], with those infected experiencing mild symptoms characteristic of an acute respiratory tract infection [8]. However, in late April, reports of Kawasaki-like disease in COVID-19 positive children emerged, mostly in Europe and USA [9]. This has raised concerns surrounding the vulnerability of the children to the virus itself and its possible complications. The first two cases of COVID-19 in Pakistan were confirmed on February 26th, 2020 and both had recently travelled to Iran for pilgrimage. Pakistan had its first case of local d
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