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Opinions of Wednesday, 27 May 2020

Columnist: Francis Abantanga

Impact of coronavirus on surgeries worldwide


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Coronavirus started in the latter parts of 2019 in Wuhan City of China. Soon the disease spread from China and engulfed some European countries, especially Italy and Spain. Currently, countries in Europe, America and Africa are recording very frightening infection rates, with very high daily mortalities.

COVID-19 pandemic has led to major destruction of routine economic activities globally. A significant proportion of health workers who are managing patients during this pandemic have experienced depressive symptoms.

It is feared that the depressive symptoms will persist one year after the outbreak. Studies show that those health care workers who fear contagion and fear infecting their families, friends, and colleagues, feel stigmatized, and some have considered resigning from their jobs.

Similar concerns are springing up about the mental health, psychological adjustment, and recovery of health care workers who are treating and caring for patients with COVID-19.

During this period of COVID-19 pandemic, hospitals have reduced elective surgeries in the interest of patients and staff so that will be able to support the wider hospitals’ response to COVID-19.

The CovidSurg Collaborative, a research network which focuses on the impact of COVID-19 on surgical care, has projected that, based on a 12-week period of peak disruption to hospital services due to COVID-19, 28.4 million elective surgeries worldwide have been cancelled or postponed in 2020.

This projection is based on a modelling study published in the British Journal of Surgery. The study indicates that each additional week of disruption to hospital services will be associated with a further 2.4 million cancellations of surgeries.

The researchers of CovidSurg collaborative collected detailed information from surgeons across 359 hospitals in 71 countries on plans for cancellation of elective surgeries. This data was then statistically modelled to estimate totals of cancelled surgeries across 190 countries.

The researchers project that, worldwide, 72.3% of planned surgeries would be cancelled during the peak period of COVID-19 related disruption. Most cancelled surgeries will be for non-cancer conditions.

Orthopedic procedures will be cancelled most frequently, and it is expected that 6.3 million orthopedic surgeries will be cancelled worldwide over a 12-week period. It is also projected that, globally, 2.3 million cancer surgeries will be cancelled or postponed.

In Ghana, hospitals have cancelled most elective surgeries for 12 weeks. It is estimated that this will result in 14,549 cancelled surgeries, including 1,405 cancer procedures.

These cancellations will create a backlog that will need to be cleared after the COVID-19 disruption ends. If, after the disruption ends, the hospitals increase the number of surgeries performed each week by 20% compared to pre-pandemic activity, it will take 11 months, one week (45 weeks) to clear the backlog. However, each additional week of disruption will lead to the cancellation of an extra 1,212 surgeries, significantly extending the period it will take to clear the backlog.

From the publication by the British Journal of Surgery, Stephen Tabiri, Professor of Surgery in the School of Medicine and Health Sciences, University for Development Studies and a Consultant General Surgeon at the Tamale Teaching Hospital, who led CovidSurg Collaborative project in Ghana concluded that “Elective operations have been cancelled in all hospitals during the COVID-19 pandemics across the nation. This has increased disease burden among citizens”.

In the publication, Prof. Tabiri further observed that most cancer patients will deteriorate well before the pandemic is over, and hospitals will also lose significant income due to the cancellation of surgeries to support the wider hospital response to COVID-19.

Also, in the publication, Prof. Tabiri said “these cancellations will place a heavy burden on the hospitals, patients and society at large. He urged hospital managers to develop a robust recovery plan well in advance of the day the pandemic is declared over. “It is incumbent on policy makers in Ghana to include the hospitals in the proposed stimulus financial package for the hospitals”, Prof. Tabiri suggested in the publication.

Professor Francis Atindaana Abantanga, Dean of School of Medicine and Health Sciences at the University for Development Studies, Tamale, who also participated in the research project said the publication’s recommendations that each additional week of disruption of work in our hospitals increases the number of cancelled surgeries significantly.

According to Prof. Abantanga, “clearing the backlog of surgeries after COVID-19 pandemic will require all stakeholders working together to support patients and healthcare facilities.

The authors of this article will like to caution that the world should prepare itself and adopt policies that will enable them to handle huge backlog of surgeries when the impact of COVID 19 declines.

In Ghana, the Ministry of Health and the Ghana Health Service should consider drawing up a comprehensive plan to handle post COVID-19 surgeries.
Collaboration of all stakeholders would be useful in handling this situation.

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