Should the endoscopic restrictions during COVID-19 pandemic remain unchanged?

(Background) Endoscopic procedures are interventions that have been defined as carrying a high-risk of infection with COVID-19. Most endoscopy units restrict their activity based on pre-endoscopic diagnosis. (Objective) To determine the consequences of endoscopic restrictions as a result of the COVID-19 pandemic and their impact on digestive cancer diagnosis. (Design) A comparison of upper digestive endoscopies and colonoscopies with gastrointestinal cancers diagnosed between three endoscopic centers, two of which restricted their procedures and one that did not but performed the procedures under a strict protocol. (Setting) A retrospective analysis was performed collecting data between 15 March 2019 and 15 August 2020. Two-factor ANOVA and a Tukey's a posteriori test were used as statistical tests. (Main outcome measures) There was variation in gastrointestinal cancer diagnosis between 2019 and 2020, considering the endoscopic procedures performed each year. (Result) There was a significant decrease in the total endoscopic procedures performed between 2019 and 2020 (p < 0.001), the result of reduced testing at the two centers (p < 0.001) with pre-endoscopic restrictions, which was not compensated for by a slight increase in procedures at the center without restrictions (p = 0.139). Regarding the total cancers diagnosed, while a significant decrease was observed for the two centers with pre-endoscopic restrictions (p = 0.007), a significant increase was registered in the center that maintained its endoscopic productivity (p < 0.001). After 851 procedures (537 upper digestive endoscopies and 314 colonoscopies) there was no evidence of COVID-19 infection in the endoscopic staff. (Conclusion) Endoscopic restrictions based on preendoscopic diagnosis should be reassessed in consideration of local pandemic situations, and a balance should be sought between COVID-19 infection risk and the detrimental delay of potential cancer diagnosis.

After COVID 19 we will be as always, but in a different way. Plot continuities to erect a milestone

The milestone category that is frequently used to refer to the COVID 19 pandemic is called into question to propose that the use of this category is rather what generates a distinction between a past time or a before and a future time or an after. It is proposed that the possibility that this has been erected as a milestone is given by processes that are maintained both globally and locally, even though what allows the appearance of unprecedented events for the Chilean health system is precisely the need to articulate its actions and markedly neoliberal rationalities with global logics. It is specified in the penetration of technological and biopolitical frameworks in the ways of life of the population worldwide and in the notions regarding how to live, and in the colonial matrix of knowledge /power that is at the base of the historical conception of the world system.