Tag Archive for: COVID-19

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Coming out of lockdown safely – A view from China

How our lives have changed. Over two months ago we published a popular blog on the effect of COVID-19 on our surgical practice (https://www.bjuinternational.com/bjui-blog/covid-19-and-urology/). In many ways it informed us as to what to do during challenging times to keep our patients safe.

As we gradually take careful steps out of lockdown, our minds are focused on the most important of all words – SAFETY. 

While every nation will have differences and nuances, the principles of learning from each other, remain the same as they did when lockdowns started.

I am not surprised by new and ever changing information about the disease almost every day and see international collaboration as a powerful and positive tool in this situation.

With this in mind I requested our friends from Italy, China, Germany and New Zealand for their own perspectives.

Here are their thoughts for your reading pleasure.

Please feel free to insert your comments under the blog and share on social media.

Yours in friendship,
Prokar Dasgupta
Editor in Chief, BJUI

 

In China, after a 3-month period of lockdown, the whole country is looking forward to run back to the normal life.  The central government of China asked the local authorities lead the economic and daily life come out of lockdown gradually. Although the atmosphere of pandemic in China has become less tense, we are still paying fully attention on the prevention and detection of COVID-19. Below are the brief measures used in our hospital after the complete lockdown. It is important to note that the rules and guidelines varied from place to place, and adjusted according to the up-to-date situation.

  • On-site registration service in out-patient clinic is still prohibited. Outpatient clinic accepts online appointment only.
  • A temporary shelter clinic was built in February in my hospital. We are now still using the temporary shelter clinic to distinguish the suspicious infectors with other patients.
  • The flow of visitors in hospital is still under control. All the entrances are still monitoring people’s temperature and travelling history.
  • In the temporary shelter clinic, urologists have to wear examination gloves, surgical masks, and disposable hat and shoe cover in a single room for face to face consultation.
  • Negative complete blood count, chest CT, and oropharyngeal swab DNA tests are compulsory before inward admission for both patients and their accompanied relatives.

With the strict application of the protective measures, no in-ward patient or staff member had been infected by COVID-19 in my hospital. Although these measures add up a lot of works for my colleagues, I believe it is worthy as the threat of COVID-19 still exist.

Guohua Zeng, Di Gu and Wei Zhu
First Affiliated Hospital of Guangzhou Medical University, China

Coming out of lockdown safely – A view from Germany

How our lives have changed. Over two months ago we published a popular blog on the effect of COVID-19 on our surgical practice (https://www.bjuinternational.com/bjui-blog/covid-19-and-urology/). In many ways it informed us as to what to do during challenging times to keep our patients safe.

As we gradually take careful steps out of lockdown, our minds are focused on the most important of all words – SAFETY. 

While every nation will have differences and nuances, the principles of learning from each other, remain the same as they did when lockdowns started.

I am not surprised by new and ever changing information about the disease almost every day and see international collaboration as a powerful and positive tool in this situation.

With this in mind I requested our friends from Italy, China, Germany and New Zealand for their own perspectives.

Here are their thoughts for your reading pleasure.

Please feel free to insert your comments under the blog and share on social media.

Yours in friendship,
Prokar Dasgupta
Editor in Chief, BJUI

After having been hit by the pandemic just shortly after Italy, Germany experienced some early waves of COVID19  especially after some carnival festivities had spread the disease in some areas. The German government decided quite early to implement a strategy to deal with the outbreak. Initially the Ministry of health gave the restriction order to potspone evey plannable / elective surgery and hospital treatment, to „flatten the curve“  and thus avoid situations like in Italy, Spain or in the USA,  so that the Healthcare system would always allow for those in need to get an unflattered access to ventilation. This order had an immediate effect on urology practice throughout Germany. Some areas in Germany struggled with severe numbers of  COVID19, others were barely affected by the pandemic.

In our department, besides the usual hygiene measures like distancing, triage of patients by questionnaire and sending staff into „home office“ (the German term for working from home),  we immediately cancelled all benign cases, as well as low risk Prostate Cancer or small kidney cancer cases. Moreover, we additionally postponed those patients who would clinically fit into a higher risk category for suffering from a severe COVID19 course if they had acquired it, i.e patients with diabetes, severe COPD, older patients etc. also, initially surgeries with a higher likelihood for the necessity of postoperative ICU surveillance and treatment were postponed if possible.

After these initial tremendous cuts in caseload and patient numbers had more or less emptied the Intensive care units as well as hospital beds throughout Germany, it slowly became clearer that the quite solid Health System offered a lot more hospital beds as well as ICU / ventilation options, and that the general hygiene measures had apparently lead to a less intense outbreak in most parts of the country, some states and counties allowed to stepwise get back to a (reduced) normality – always under the caveat that epidemiological numbers stay low.

The German Government acted with a strong scientific support by one the world’s most respected coronavirus virologists, Prof Drosten of Charité Hospital Berlin, together with a team of the German Disease Control Institution („Robert Koch Institut“), and worked closely together with the state governors of the 16 German states, to share a common bundle of measures (still with nuances from state to state). Mass testing was made available quite early (yet, usually restricted to those with symptoms or contact persons). Currently, of 174,824, nationwide confirmed cases  7,917 people have died, making the death rate hit 4.5%.

Since a couple of days, we experience a stepwise way out of the lockdown in everyday life, with every state setting up slightly different measures; still, physical distancing and face masks are mandatory and shape the picture of everyday life. Since last week, restaurants and bars  are opening up again, and even the German Premier league went back to playing (with extremely strict measures like regular testing for every team member, as well as quarantine, but without any fans at the stadiums). Of note, regular testing for hospital staff is not required throughout Germany…

The way we work in our department has changed dramatically since the beginning of the pandemic. Our staff gatherings are restricted to only a few people, everybody wears masks, and is trying to keep their distance as much as possible, staff members who have office jobs like secretaries work from home. Urologic Surgery has resumed and is now performed back to almost normal case numbers; robotic cases have resumed to 100%, now performing 10 RARPs per day again. The waiting lists are long enough to cope with the otherwise probably reduced demand (due to a lack of biopsies, or outpatient urology consults resulting in referrals). There are still no visitors allowed, our hospital still has a separated entrance gateway for an initial triage, we send patients home sooner than we used to (for various reasons, patients usually stayed as inpatient for a week after surgery).

A recent survey of the German Working Group on Laparoscopic and Robotic Surgery of the German Society of Urology, amongst the busiest minimally invasive departments in Germany, reflected the situation of a quite colourful picture of minimally invasive Urology during the pandemic; it ranged from departments that are still barely functionally operating to hospitals with little or no restrictions in numbers. In some departments, parts of the wards were closed, and urologists were taking care of COVID 19 wards instead. The huge variety of responses reflects the differences in epidemiological impact in the 16 states of Germany – resulting in different restriction order patterns by the governments and county authorities. The results of our survey are currently put together and are soon to be published.

Dr. Christian Wagner , FEBU
Head of Robotic Urology, St. Antonius Hospital Gronau , Germany

 

Coming out of lockdown safely – A view from New Zealand

How our lives have changed. Over two months ago we published a popular blog on the effect of COVID-19 on our surgical practice (https://www.bjuinternational.com/bjui-blog/covid-19-and-urology/). In many ways it informed us as to what to do during challenging times to keep our patients safe.

As we gradually take careful steps out of lockdown, our minds are focused on the most important of all words – SAFETY. 

While every nation will have differences and nuances, the principles of learning from each other, remain the same as they did when lockdowns started.

I am not surprised by new and ever changing information about the disease almost every day and see international collaboration as a powerful and positive tool in this situation.

With this in mind I requested our friends from Italy, China, Germany and New Zealand for their own perspectives.

Here are their thoughts for your reading pleasure.

Please feel free to insert your comments under the blog and share on social media.

Yours in friendship,
Prokar Dasgupta
Editor in Chief, BJUI

It is hard to believe that 9 weeks ago as USANZ President the ASM was cancelled, due to the impending wave that was the Covid-19 global pandemic. Health and safety, reputation and finances were considered, in that order. USANZ 2020 ASM was the first major medical conference cancelled – others followed lockstep. There was no blueprint for this global black-swan event!

On our return to New Zealand an island country of 5 million, where 60% of health care is delivered via the public health “free for all” system, the remainder in the private sector. Our visionary Prime Minister, Jacinda Ardern initiated a “go-hard go-early” level 4 lockdown with only essential services open – elimination was the goal.

We were all un-prepared, and it lasted 5 weeks. A surgical pause in both health sectors allowed planning, preparation and training in PPE for the disease surge that did not arrive. We zoomed in our pyjamas and made sure we were free for the 1pm daily national television briefings featuring Jacinda Ardern and Ashley Bloomfield, DG of health, who has achieved cult status, and now features on a range of t-shirts. Cell phone tracking data indicated over 90% reduction in movement. Our “team of 5 million” has been a large part of the evolving success story. Elimination was possible, is possible and was confirmed! During this time manual contact tracing was expanded, testing snowballed, and Covid cases fell to zero.

During level 4 we undertook only non-deferrable surgical cases, with case definitions agreed by all specialties. We lost only 10% of our theatre volumes. OPD were completed by phone or video, and only patients that needed a procedure were seen face to face. Medically we have had no actual Covid cases in the surgical service, a handful of Covid patients in ICUs nationally. The majority of deaths did not reach ICU due to their age and co-morbidity.

We have now welcomed stepdown, level 2 with open arms, although concerned about a second wave of cases, however our unquestionable advantage of living in this unique country – our island fortress with a salt-water moat – sees us optimistic. We’re adjusting to sign in manually to all retail premises in light of no electronic tracing App and 80% of our businesses are open with the exception of bars, gatherings are restricted, and our hard borders remain.

Currently we enter the hospital via a staff entrance, with hand sanitiser but no masks. Patients are allowed 1 visitor only and have to sign in, use hand sanitiser and have restricted duration of visit. Normal surgical volumes have now resumed with no restrictions on the type of cases allowed.

We are advised to stay home if we have any respiratory symptoms, get a swab and cancel activity – no more kiwi grit or soldiering on! Patients are screened 7 days pre op by a phone call, delayed if international travel or a Covid contact within 14 days. A swab is only recommended if the patient is symptomatic, and if negative surgery can be completed. Patients are cancelled on the day of admission if they are unwell. Cancellations are now acceptable. A 20% operating theatre throughput reduction has been observed. We feel lucky, for now. From a USANZ perspective we are looking into innovative virtual meeting formats along with cancelling or postponing all face to face meetings.

Our international borders remain hard with a 14-day voluntary lockdown for all incoming. This will be in place until a successful vaccine is available. We accept international isolation will be in place for a while and hope to enjoy this pause, while implementing any useful learned strategies. We are proud of our inspirational leader, intelligent government and unprecedented international success – at least up until now. We wait, watch, listen and hold our breath… remember we are all in this together!

Stephen Mark, USANZ President

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