ABSTRACT
The novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), first appeared in December 2019 and was declared a pandemic by the World Health Organization on March 11, 2020 (World Health Organization. WHO director-general's opening remarks at the media briefing on COVID-19—11 March 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19%2D%2D-11-march-2020. Accessed 2020). By September 9, 2020, 27.7 million cases and 0.9 million deaths were confirmed globally (Center for Systems Science and Engineering – Johns Hopkins Coronavirus Resource Center: COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. https://coronavirus.jhu.edu/map.html. Accessed 2020). This disease placed an unprecedented strain on healthcare systems around the world (Remuzzi and Remuzzi. Lancet. 395(10231):1225–8, 2020) and had a substantial effect on clinical practice across all surgical specialties, with neurosurgery being no exception (Bernstein. J Neurosurg. 2020:1–2. https://doi.org/10.3171/2020.4.JNS201031). Many hospitals implemented no-visitor policies and COVID-19 testing for all inpatients in order to prevent spread and protect patients and healthcare workers (Calderwood. Infect Control Hosp Epidemiol. 2020:1–9. https://doi.org/10.1017/ice.2020.303). To conserve beds, workforce, and valuable resources such as masks, gowns, and ventilators, surgeons had to restrict operations to emergency and essential interventions. Some neurosurgeons were redeployed to new intradepartmental roles, others lateralized to provide care for coronavirus patients. In order to limit in-person interactions and contagion, there was a surge in telehealth and digital innovation for remote monitoring and management. Research laboratories were closed for prolonged periods. Medical education and residency training were also substantially altered, with cancellation of many in-person events and a transformation to online meetings and educational sessions. In this chapter, we discuss the impact of COVID-19 on the global neurosurgery community with respect to clinical care, education, and research. While the pandemic has caused tremendous disruption in global neurosurgery already, there is hope that many of the lessons learned during this time have contributed to our resilience and preparedness for the future, be it a second wave of COVID-19 or a new unexpected challenge. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
ABSTRACT
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. METHODS: We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. RESULTS: We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. CONCLUSION: Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries.