We are in uncharted territory as a South African surgical community. The COVID-19 outbreak has been declared a global pandemic by the WHO and our South African President has appropriately responded by declaring a “national state of disaster” in order to activate national procedures.
Many university and state hospitals in South Africa have already responded by postponing non-urgent, elective surgery and reducing undergraduate programs. Although no one is entirely sure how this disease will impact South Africa we need to be cognisant and prepared for what may happen. International/supernumerary registrars have been advised to consult their embassies and return home if needed. National meetings are being postponed for the next few months.
Part of the thought-process behind this is to expand the “ventilator capacity” using theatres as disaster-ICU’s. The second aspect is to release non-ICU staff who have training in basic ICU to assist with caring for the expected increase in ICU patients.
We as surgeons will be faced with normal emergency operations where we might have reduced levels of post-operative care. This will place us in positions where we have to use ward level instead of ICU.
We will need to operate on patients who are isolated for suspected or proven COVID-19. The current advice for surgery is limited. There is no current advice on whether laparoscopy or open surgery is of greater risk. Anaesthetic procedures will need to be changed. Theatre cleaning procedures may have to be modified. The use of personal protective equipment is essential for all healthcare personnel involved in the operation including surgeons, anaesthetists and theatre nursing professionals.
Endoscopy is another important area for surgeons. SAGES have published important guidelines that ASSA supports.
Social distancing, hand washing and environmental management are all key to managing this pan epidemic. As surgeons, we may not be front-line in this disease but we may (with appropriate training) also all be asked to become “covidiologists” if required to assist.
ASSA will endeavour to keep the surgical community updated as this information is constantly and rapidly changing.
Download the statement here.