Priorities, actions and risks in the COVID-19 pandemic: a flash SoMe survey among surgical oncologists.

OBJECTIVES: Corona virus-induced disease 19 (COVID-19) pandemic has globally affected the surgical treatment of cancer patients and has challenged the ethical principles of surgical oncologists around the world. Not only treatment but also diagnosis and follow-up have been disrupted. METHODS: An online survey was sent through Twitter and by the surgical societies worldwide. The survey consisted of 29 closed-ended questions and was conducted over a period of 24 days beginning in March 26, 2020. RESULTS: Overall, 394 surgical oncologists from 41 different countries answered the questionnaire. The predominant guiding principle was "saving lives" 240 (62%), and the different aspects of lock-down found hence large support (mean 7.1-9.3 out of 10). Shut-down of elective surgery and modification of cancer care found a mean support of 7.0 ± 3.0 and 5.8 ± 3.1, respectively. Modification of cancer care longer than two weeks was considered unacceptable to 114 (29%) responders. Hundred and fifty six (40%) and 138 (36%) expect "return to normal" beyond six months for surgical practice and cancer care, respectively. CONCLUSIONS: Surgical oncologists show strong and long-lasting support for lock-down measures aiming to save lives. The impact of the pandemic on surgical oncology is perceived controversially, but the majority was forced already now to accept what is inacceptable for many of their colleagues.

The American College of Surgeons Response to the COVID-19 Pandemic (Part III): Leadership in a Time of Crisis.

The response of the American College of Surgeons (ACS) to the COVID-19 pandemic was vigorous and effective because it had mature programs in surgical quality and health policy and advocacy, the legacy of decades of work by its officers and leaders and its current executive director, David Hoyt. Hoyt had the foresight to institute a digital communications platform upon which the College collected data for its clinical programs and conducted many of its meetings. Through internet portals, online communities, and social media it broadcasted news and information to the membership. When the global COVID-19 pandemic struck, the College was able to quickly mobilize its leaders and scientific experts to disseminate credible information, recommend protocols to maintain patient and provider safety in operating room environments, provide a rational scheme of prioritization of urgent surgical operations, and a sensible means of resumption of normal surgical practice. As the financial impact of the outbreak on surgical practice became apparent, the ACS represented the interests of surgeons in the White House, Capitol, federal agencies, and governors' mansions and statehouses. In an interview by Steven Wexner, a member of the ACS Board of Regents, Hoyt described the response of the ACS to an unprecedented threat to the surgical care of patients in the country and the world. His story demonstrates the legacy of credibility and professionalism built by decades of principled leadership of generations of officers and Regents of the College, and his own example of effective leadership in crisis.

The American College of Surgeons Response to the COVID-19 Pandemic (Part I): Cancer Care, COVID-19 Registry, Surgeon Wellness.

From the onset of the COVID-19 global pandemic of 2020, the American College of Surgeons has been a leader in disseminating reliable information on the nature of the crisis and assuring quality of surgical care during the enforced lockdown of inpatient and outpatient care.

The American College of Surgeons Response to the COVID-19 Pandemic (Part II) : Advocacy and Public Policy.

From the onset of the COVID-19 global pandemic of 2020, the American College of Surgeons (ACS) has been a leader in disseminating credible information on the clinical and scientific aspects of the disease. As governmental regulations enforced the closure of hospitals and operating rooms to elective surgical cases as part of its "shelter-in-place" public lockdown policies, the ACS brought specialty societies together to create guidelines to protect patients and preserve surgical quality. Federal agencies made available financial aid programs to mitigate the economic impact of the outbreak. The division of advocacy and health policy of the ACS made certain that the interests of surgeons and their patients were served. Steven Wexner, member of the Board of Regents of the ACS interviewed the medical directors of the division, Frank Opelka in quality and health policy, and Patrick Bailey in advocacy, for their stories of how the College responded to the many health and public policy issues that came before Congress and governmental agencies during the pandemic.

Lessons Learned and Experiences Shared From the Front Lines: United Kingdom.

This is the second installment of a series of interviews, conducted by the senior author (S.D.W.) and the American College of Surgeons (ACS), that feature international leaders in surgery telling of the challenges they faced during the global COVID-19 pandemic. The disease arrived in the United Kingdom with devastating effects within a few weeks of its spread to Western Europe from China. In Oxford, Professor Neil Mortensen used his position as the President-elect of the Royal College of Surgeons of England to help coordinate efforts among the 4 Royal Colleges in the United Kingdom (his own, London, Edinburgh, and Ireland) to mobilize and retrain surgeons for duty helping to support in the critical care of patients with respiratory illness from the virus. In London, Lord Ara Darzi, a colon and rectal surgeon and leading innovator in minimally invasive surgery, underwent re-education himself in respiratory care to help his medical colleagues. As a member of the House of Lords involved in matters regarding the National Health Service as former Parliamentary Undersecretary of Health, he facilitated legislative measures to increase the physician workforce necessary to meet the demand for skilled personnel. Professor Mortensen and Lord Darzi have been recognized as honorary fellows of the ACS for their contributions to surgery. "Lots of people do not think it can possibly happen to them", Professor Mortensen said, "Our experience is that it will happen to you, and you cannot be prepared enough. Preparation, preparation, preparation is what you need to do."

Lessons Learned and Experiences Shared From the Front Lines: Milan and Madrid.

Under the aegis of the American College of Surgeons (ACS), the senior author (SDW), a member of the Board of Regents of the ACS, interviewed 3 of his international colleagues in colon and rectal surgery who found themselves dealing with a flood of patients from the COVID-19 pandemic. Each was in a "hot spot" where the outbreak overwhelmed the capacities of the hospitals. Professor Antonino Spinelli of Milan dealt with the sudden increase in COVID-19 patients that threatened to push all other emergencies and urgent cancer cases aside. Providers lacked the personal protective equipment to be adequately safe in the environment. In Madrid, Dr Julio Mayol recounted how 10%-15% of the workers in his hospital were incapacitated by the virus, many of them doctors providing direct care to patients. The disease is so prevalent that all emergency patients are treated as though they have the infection. Having practices in Saudi Arabia and Spain, Dr Delia Cortés-Guiral saw how the former country controlled the epidemic through a strict lockdown of travel and closure of holy pilgrimage sites and social gatherings. In contrast, upon her return to her native country, she experienced the near-breakdown of the health care system by the suddenness of the outbreak. "There are now no specialists now, she says." All of the specialties are treating COVID-19 patients and all of us are learning at the same time how to deal with this disease."It is a nightmare now here in Spain".