COVID-19 Discussion

By Alison Shamwana | Started 30th Apr 2020

INTRODUCTION BY MARTIN SMITH, IHPBA PRESIDENT

Follow this link to read the introduction by our President, Professor Martin Smith.

COVID-19 Video Diaries

Dr Giovanni Marchegiani
 
Dr Kito Fusai
 
Dr Dejan Radenkovic

 

Doctor P. Jagannath

Chief of Surgical Oncology at SL Raheja Hospital, Lilavati Hospital (Mumbai)

Close call followed by a long week...

We had started cancer surgeries despite 80% beds being earmarked for COVID. I strongly believed and wrote many times that non-Covid patients like Cancer patients are actually suffering due to lockdown. We had a set protocol of Covid test, HRCT thorax and then admit for surgery.

I had this sense of ‘invincible bravado’ that my family disapproved. But the sick had to be cared for, so it was surgeries with PPEs and protocols.

Two weeks ago we did a standard procedure on an elderly lady. On the third postop day in ICU, I found the lady coughing. By some instinct, I asked for a throat swab though she tested negative before surgery.

It was Saturday late evening and my registrar phoned frantically “Sir, she tested positive”. My heart sank. How many people were exposed? Surgeons, anesthetists, nurses, ward boys and ICU staff were all part of contacts. All of us were scheduled for throat swab on Monday. CEO phoned up advised all of us to ‘self quarantine’.

My resident and the ICU registrar tested positive. So there was spread.

Then it really hit me. How do I self quarantine? My 93 year old father stays with me and I need to take care of his needs on a daily basis. What about my family? Mind raced in multiple angles. What if the test is positive? Frantic search and calls for medication to be taken. Its no longer an academic search.

Rationality is pushed back. Science is any how confusing . I have been on HCQ like most of my colleagues.

Take another dose said my colleague. Done and what else?

Gargle with hot water, spirulina, Ivermectin. What else? Homeopathy? The suggestions are endless.

There is no downside risk, so take it. Quick order to the chemist for drugs. I did not tell my father. ‘The hospital has asked us to be careful’ was the line.

As luck would have it, the lab phones, saying that the particular batch of tests did not go well. Holy smokes, what now?

Don’t worry Sir, tomorrow we will run it again, say the lab.

What I am going to do tonight???

Then you start developing vague symptoms. Body is aching. Is there fever? No. How about SpO2. Fortunately there is pulse oxy at home. Reassured that the reading is fine.

Next day the Lab says test is negative. Partial relief. As we need to test again after 4 days. Too soon in the illness, RT PCR can be negative. Isolation continues.

So agonizing wait for the fourth day testing. Every morning and evening, taste the food and smell. Oh fine I can still smell and taste. In some that can be an early symptom.

Finally the second test also comes negative.

Such relief. I cannot describe the racing thoughts in the longest week of my life. Waiting anxiously, imaginary symptoms, scenarios that flash through. Looking for any information that can help.

I can well imagine what patients, family and the contacts go through.

Then it happened to a close friend and his family. They too went through the same anxiety, logistic nightmare and worry on the uncertain course. Relieved that all are well.

I no longer have the sense of ‘invincibility’.

We are fortunate to move along and be safe. Thank God for the same.

I will never push my luck and will be extra careful.

I can only tell you and ask you to be super careful. Then the panic can be avoided.

…. Tomorrow, the beginning of new day in a surgeon’s life

 

What next after the close call ??

 As I said earlier, I had a close call but all tests turned out negative. Some well wishers and my family were naturally anxious. They asked me to go slow. “You are 60+ and worked for more than three decades, why don’t you go easy now?” It is a sound advice but I’ll tell you a couple of real life stories which shaped my decision. I am using real names because they are real heroes. 

Dr. Prabhu Desai is our popular Chest Physician. When COVID patients started pouring in, they all need the services of a chest physician. There are so many people scared of donning the PPE suit. Dr. Prabhu Desai literally had to go in sometimes six times with PPEs to see patients and plan the treatment.

 Many of the chest physicians, nurses and residents were exposed and turned COVID +ve. One day I was distressed to learn that Dr. Prabhu Desai is admitted to the hospital. I messaged him and in his remarkable positive way he said, “No problem, I am fine. I felt I should just get into the hospital for safety. Even now I am treating patients remotely in the COVID ward.

 “Can you also help a good friend of mine from Hyderabad?” 

He said “Sure, let me talk to him”. 

This is the spirit of a dedicated professional. He was always positive even on Remdesivir and in a week’s time he was discharged, only to continue to help patients from all over.

The same is the story with our Infectious Diseases Specialist, ICU In-charge, Cardiologists, many residents and nurses. These are the people who not only had COVID, came out of it and were willing to get back to the hospital to help more patients. Even my resident Dr.Webster beat Covid 19 and appendicitis to be back on duty in “Covid ward”.

Then there is Sr. Mary. We were happy to welcome her back to the OR after 2 week battle with COVID. I was getting ready for surgery I said, “Sister, why don’t you take rest?” She said “No, I am absolutely fine, I will wash up for surgery”. 

 Then she quietly comes up to me and says, “Sir, I have antibodies +ve. If anybody needs plasma I am ready to give as a plasma donor.” I was amazed. 

Yes, some of the doctors are staying back home, maybe there are some co-morbid conditions and it is advisable for them to stay back but those who are otherwise fit, there is no reason to shy away.

 I love my work. 

I am passionate about surgery,

I want to take care of patients. 

It gives me a sense of purpose in my life.

 I cannot trade it for any kind of retirement, at this point, as long as I am physically fit.

 I had promised my family that I will go slow, that I would not operate for a month. But soon I had to break my promise. I couldn’t say ‘no’ to a young man who drove all the way from Agra for 2 days for a surgery only by me, nor could I refuse a patient of jaundice who needed urgent surgery- complex Whipple's and came in specifically for my help. 

Yes, we will take precautions, we will do everything possible to safeguard ourselves and the our family and our hospitals.

So here I am back at work, ready to do what I always cherish, “Surgery for cancer patients”.

Michelle L de Oliveira - President of the UEMS HPB Board of Examination:

Follow this link to read an explanation by Michelle L de Oliveria, President of the UEMS HPB Board of Examination) on the impact of the COVID-19 crisis on the late 2020 examinations, the wider impacts to the HPB surgical education system, and how the HPB syllabus may need to change in response.

Orlando Torres: Being an HPB surgeon during the COVID-19 era.

Follow this link to read Dr Orlando Torres’ account of how COVID-19 impacted not only his professional, but also personal life.
 

AHBPA Webinar on COVID-19

Follow this link to view the AHPBA Webinar on COVID-19 and HPB Surgery.  This is a very useful discussion, but please note that it took place on 17 April so data provided in the webinar and the Q&A should be viewed in light of a rapidly changing landscape.

Impact of the coronavirus pandemic on the role of HPB surgeons in Tongji Hospital, Wuhan, China

This report [link] by Lin Chen, Zhi-yong Huang and Xiao-ping Chen describes how HPB surgeons in the Tongji Hospital of Wuhan, at the epicentre of the coronavirus outbreak in China, were called upon to assist in the fight against coronavirus, and the strategies adopted to successfully deliver HPB service to the most severely affected COVID-19 patients and others during the last four months.

Being an HBP Surgeon during COVID19 times

Follow this link to read a report by Fabio Ausania, Hospital Clínic de Barcelona, on the impact COVID-19 has had in Catalonia.

Delivery of HPB surgery during the COVID-19 pandemic:  an European-African HPB Association Survey

Watch this presentation by Anita Balakrishnan of the results of the above survey to which many of you will have contributed:

 

A paper is also being published in HPB, you can view the full text here

Please use the discussion board below if you have any questions for the authors on the survey or results.

GROUND RULES

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Comments (11)
  • Palepu Jagannath 5th May 2020

    (3)

    Learning to live in Covid 19 era
    India has enforced stringent lock down on its 1.6 Billion people for the last 6 weeks.
    Fortunately we have done well so far. The graph clearly shows that the numbers in India are not overwhelming.The curve is flatter but we have not yet seen down trend.
    total no of deaths - countrywise
    However this comes with huge economic loss. saving 'lives and livelihoods' is important.
    We need to also accept that life is not going to be same. New "Social behaviour and social responsibility  are necessary".
    Here's the blog on "Learning to live in Corona era'. https://www.linkedin.com/pulse/learning-live-post-corona-era-dr-p-jagannath
  • (2)

    Dear colleagues,

    My name is Tihomir Georgiev, an HPB surgeon from Spain.

    As the pandemic progresses, I am more and more concerned about those patients that have recently passed a COVID-19 pneumonia with some residual chest X-ray changes, that already have at least one negative PCR test and, being asymptomatic for more than 2-3 weeks, are to undergo an elective HPB surgery.

    The available protocols do not consider the possibility the patient continues being infective even after negative PCR test and, at least in my institution, the current protocol do not recommend any additional protective measures when operating on such patients.

    Would you be so kind to share your personal experience and opinion on whether you would use PPE during a complex liver resection in such patient or you could consider the patient definitely non infective (being asymptomatic and SARSCOV2 PCR negative).

    Thank you 

  • DEBANSHU BHADURI 7th May 2020

    (1)

    Dear Tihomir

    My name is Debanshu Bhaduri, and I am a surgical oncologist from Maharashtra, India, the state hit hardest by COVID 19 in this country. I can share my department's policy with you and I hope it is of some use. 

    We have not shut oncology services even a single day at our institute even though India has, and is witnessing the most stringent lockdown in the history of the planet (so I am informed). As a charitable institute with moderate funding, PPE acquisition  is a perpetual conundrum. Since the outbreak, major surgical procedure numbers have abated just a bit because of the logistics involved in reaching the hospital (for patients and their care givers). However, as testing and 'window period' period dilemmas continue, and with several of our staff struck with the virus, we treat each and every patient undergoing surgery or in house as positive for COVID 19 regardless of test conclusions. Accordingly, protective measures are taken for all patients undergoing surgery. 

    I am happy to inform you that thus far my team and I are virus free and the policy seems to be working. We have also been lucky enough to have performed major HPB surgery on just one patient who had a prior history of COVID 19. There was no flare up of symptoms during the perioperative period. 

    In our non HPB patients, we have not yet encountered a single COVID positive patient (all patients are tested prior to admission), but we continue to follow a policy of "a high degree of suspicion" universally.

  • Prashant Bhangui 11th May 2020

    (1)

    Dear Prof Orlando, yours is a heartwarming tale of how a "family" of specialists and a young doctor with a young son has demonstrated the courage to fight this deadly virus that has created havoc for us, our patients, and the whole medical and social system worldwide!! Life has ceased to be the same for more than 3 months now, but the important thing is to keep going, and stay positive!! All the best to you and your family my friend, and ...LETS KEEP THE FAITH!!!

    We at Medanta, in Delhi-NCR India are continuing to operate on our HPB cancer patients with prior RT-PCR Testing (with/without preop CT Chest as indicated), and also transplanting urgent/semi urgent end stage liver disease patients, trying our best to keep our patients and ourselves safe, in these difficult times. But the logistics are overwhelming to say the least!!

  • Alison Shamwana 18th May 2020

    (0)

    The IHPBA COVID-19 REGISTRY will help members understand the consequences of COVID on HPB services worldwide.

    For full background & to REGISTER YOUR CENTRE / get a password: medscinet.com/Covidihpba/ 

    Real-time results:

    https://www.medscinet.com/Covidihpba/about.aspx?lang=1

    Contributors may access a more detailed dashboard.

  • Prasad Wagle 6th Jun 2020

    (0)

  • Prasad Wagle 6th Jun 2020

    (0)

    Let me begin by giving my best wishes to my good friend Dr Orlando Torres & his family for having recovered well from COVID .

    As you would be aware India & in particular Mumbai are in the throes of COVID currently, probably peaking as i write this.

    India currently is trying to wriggle out of the lockdown enforced on March 22. Not only has the economy been brought to its knees but even routine surgical services have been hampered greatly as the focus currently like elsewhere is on the Pandemic.

    I would like to confess & not sheepishly that HPB work has plummeted since the enforced lockdown. The reasons as i see it are primarily due to patient reluctance to come to a COVID facility & secondary from the Surgeons viewpoint point of not burdening the already crunched resources. Working long hours in a claustrophobic PPE would be a distant third, though i am certain things will be better over time.

    I would also like to draw attention to the COVID registry. I have registered for the same though i would like to mention as a rule we are not operating COVID positive HBP related work & perhaps rightly so as recent studies have indeed shown higher perioperative morbidity & mortality. 

    Let me end this piece wishing all my HPB colleagues a safe 2020 & looking forward meeting my friends in Melbourne early next year.

  • Åsmund Avdem Fretland 7th Jun 2020

    (0)

    Dear colleagues, 

    In Oslo, Norway we are now running HPB surgery almost as normal. We are also getting patients in who has had COVID19 and who recovered well. I guess many of you have operated patients like that now. Any good advice for us? Did anyone encounter unexpected complications? 

    Best regards, 

    Åsmund

  • Alison Shamwana 24th Jun 2020

    (0)

    NEW CONTENT ADDED

    A presentation by Anita Balakrishnan explains the results of the E-AHPBA survey on delivery of HPB surgery during the COVID-19 pandemic to which many members contributed.

    There is also a link to the full-text manuscript detailing the findings of the survey which will be published in HPB journal.

  • Alison Shamwana 7th Jul 2020

    (1)

    NEW CONTENT ADDED

    Read Dr P Jagannath's vivid and powerful account of his recent brush with COVID-19, and what he describes as "the longest week of my life".

  • Alison Shamwana 10th Jul 2020

    (1)

    In "What next after the Close Call?", Dr Jagannath's personal and inspiring follow up to his article on the COVID-19 outbreak in his hospital clearly illustrates how much front line medical staff are prepared to give in providing care to those struck down by this virus.

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