COVID Cleft: A national evaluation of cleft care operating through the COVID-19 Pandemic in the United Kingdom

Background/Purpose: COVID-19 fundamentally changed cleft teams' ability to care for their patients. This study aims to study;1) the effect of COVID-19 on elective surgery timings and outcomes;2) preoperative screening and isolation protocols;3) the impact of operating with personal protective equipment (PPE). Methods/Description: Between the start of the first UK lockdown in March 2020 and April 2021 operative details from 651 cleft procedures performed in eight UK centres were entered into a secure REDCap database. Results: 651 records were entered (59% male, 41% female). 9% patients had a known syndrome. Operations were as follows: cleft palate repair (40%), unilateral cleft lip repair +/- vomer flap (23%), alveolar bone grafting (16%), secondary speech surgery (10%), fistula repair (3.7%), lip revision (1%) and rhinoplasty (1%). 39% of surgical cases were deemed delayed compared to normal protocol timings, with 80% of the delays attributable to COVID. Mean age at initial cleft lip repair was 230 days exceeding a previous representative mean of 137 days as well as breaching the UK national standards for upper age limit of 183 days. Mean age at cleft palate repair was 387 days compared to the UK national standard for upper age limit of 396 days, and previous representative mean of 320 days. 81% of patients undertook some form of pre-operative isolation;47% isolated for two weeks. COVID screening was performed in the 72 hrs prior to surgery in 89% of patients and 13% of parents/carers. Only one patient had a positive test. 69% surgeons wore an FFP3 (N99) mask to operate, and 64% of cases involved difficulty during the operation as a result of the PPE;most commonly communication difficulties (45%). No patients developed COVID in the early post-operative period. Conclusions: This data demonstrates that initial cleft lip and palate repair in the UK has been delayed as a direct result of the COVID-19 pandemic. Secondary surgery has been significantly affected and efforts will need to be made at national level to provide capacity to catch up. Isolation and testing protocols for COVID-19 vary from unit to unit, but appear safe. Routine cleft surgery can safely continuing through the pandemic, as long as appropriate infection control measures are followed and resources allow.

The RCS England COVID-19 Surgical Research Group: early findings and lessons to influence surgical practice.

INTRODUCTION: Surgeons and allied professionals have been quick to respond to the need for evidence during the COVID-19 pandemic. The Royal College of Surgeons of England (RCS England) has provided formal recognition, support and guidance to all members of its interdisciplinary collaborative COVID Research Group (RCS CRG). We describe research conducted by members of this group, initial findings and lessons for clinical practice so far. METHODS: Members of the more than 50 projects included so far in the RCS CRG portfolio were invited to provide a summary of their project and findings to date. The 26 summaries received were collated and broad themes identified to produce this summary document. RESULTS: Wide-ranging projects have been conducted by members of the RCS CRG, rapidly yielding crucial insights into the behaviour of the SARS-CoV-2 pathogen, its impact on patients and staff, the challenges it presents to surgical practice and investigation into methods to adapt and overcome such challenges. CONCLUSIONS: The response of the surgical research community to COVID-19 has been rapid and well-organised. Early establishment of a formal network under the auspices of RCS England has assisted efficient research collaboration and delivery, while avoiding academic duplication between groups. This has led to a high research output, directly informing and substantially influencing practice throughout and beyond the pandemic.

The dispersion of spherical droplets in source-sink flows and their relevance to the COVID-19 pandemic.

In this paper, we investigate the dynamics of spherical droplets in the presence of a source-sink pair flow field. The dynamics of the droplets is governed by the Maxey-Riley equation with the Basset-Boussinesq history term neglected. We find that, in the absence of gravity, there are two distinct behaviors for the droplets: small droplets cannot go further than a specific distance, which we determine analytically, from the source before getting pulled into the sink. Larger droplets can travel further from the source before getting pulled into the sink by virtue of their larger inertia, and their maximum traveled distance is determined analytically. We investigate the effects of gravity, and we find that there are three distinct droplet behaviors categorized by their relative sizes: small, intermediate-sized, and large. Counterintuitively, we find that the droplets with a minimum horizontal range are neither small nor large, but of intermediate size. Furthermore, we show that in conditions of regular human respiration, these intermediate-sized droplets range in size from a few µm to a few hundred µm. The result that such droplets have a very short range could have important implications for the interpretation of existing data on droplet dispersion.