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      COVID-19: Pandemic surgery guidance

      brief-report
      1 , 2 , 3 , * , , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 3 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 18 , 22 , 23 , 14 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 1 , 2 , 31 , 32 , 1 , 2 , 33 , 34
      4open
      EDP Sciences
      Anesthesia, Cancer, Cardiothoracic surgery, China, Coronavirus, COVID-19, Dermatology, Elective surgery, Emergency, Endocrine surgery, Endoscopy, ENT, Epidemic, Epidemiology, Europe, Face masks, General surgery, Germany, Guidance, Gynecology, Inflammation, Italy, Laparoscopy, Laparotomy, Morbidity, Mortality, N95 masks, Neurosurgery, Orthopedics, Pandemic, Patient safety, Pediatric surgery, Pneumonia, Protection, Reconstructive and plastic surgery, Surgical critical care, Respiratory masks, SARS-CoV-2, Sepsis, Surgery, Thoracoscopy, Transplantation surgery, Trauma surgery, Urology, Virus

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          Abstract

          Based on high quality surgery and scientific data, scientists and surgeons are committed to protecting patients as well as healthcare staff and hereby provide this Guidance to address the special issues circumstances related to the exponential spread of the Coronavirus disease 2019 (COVID-19) during this pandemic. As a basis, the authors used the British Intercollegiate General Surgery Guidance as well as recommendations from the USA, Asia, and Italy. The aim is to take responsibility and to provide guidance for surgery during the COVID-19 crisis in a simplified way addressing the practice of surgery, healthcare staff and patient safety and care. It is the responsibility of scientists and the surgical team to specify what is needed for the protection of patients and the affiliated healthcare team. During crises, such as the COVID-19 pandemic, the responsibility and duty to provide the necessary resources such as filters, Personal Protective Equipment (PPE) consisting of gloves, fluid resistant (Type IIR) surgical face masks (FRSM), filtering face pieces, class 3 (FFP3 masks), face shields and gowns (plastic ponchos), is typically left up to the hospital administration and government. Various scientists and clinicians from disparate specialties provided a Pandemic Surgery Guidance for surgical procedures by distinct surgical disciplines such as numerous cancer surgery disciplines, cardiothoracic surgery, ENT, eye, dermatology, emergency, endocrine surgery, general surgery, gynecology, neurosurgery, orthopedics, pediatric surgery, reconstructive and plastic surgery, surgical critical care, transplantation surgery, trauma surgery and urology, performing different surgeries, as well as laparoscopy, thoracoscopy and endoscopy. Any suggestions and corrections from colleagues will be very welcome as we are all involved and locked in a rapidly evolving process on increasing COVID-19 knowledge.

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          Most cited references57

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            A Novel Coronavirus from Patients with Pneumonia in China, 2019

            Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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              Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

              Abstract Background The initial cases of novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. Methods We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. Results Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). Conclusions On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.)
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                Author and article information

                Journal
                fopen
                https://www.4open-sciences.org
                4open
                4open
                EDP Sciences
                2557-0250
                13 April 2020
                2020
                10 April 2020
                10 April 2020
                : 3
                : ( publisher-idID: fopen/2020/01 )
                : 1
                Affiliations
                [1 ] Theodor-Billroth-Akademie® , , Germany, USA,
                [2 ] INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Academy® , , Germany, USA,
                [3 ] Department of Surgery, Carl-Thiem-Klinikum, , Cottbus, Germany,
                [4 ] Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, St. Andrea University Hospital, , Rome, Italy,
                [5 ] Department of Obstetrics and Gynecology, Veris delli Ponti Hospital, , Scorrano, Lecce, Italy,
                [6 ] Department of Otorhinolaryngology, College of Medicine-Philippine General Hospital, University of the Philippines Manila, , Manila, Philippines,
                [7 ] Department of Surgery, Vall d’Hebron, Universitat Autonoma de Barcelona, , Barcelona, Spain,
                [8 ] Department of Thoracic Surgery, Istituto Clinico Humanitas CCO, , Catania, Italy,
                [9 ] Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, , Munich, Germany,
                [10 ] Department of Surgery, Hospital General San Juan de Dios, Universidad de San Carlos de Guatemala, , Calle, Guatemala,
                [11 ] New Liberty Proteomics Corporation, , New Liberty, KY, USA,
                [12 ] Department of Surgery, Sana Klinikum Hameln-Pyrmont, , Hameln, Germany,
                [13 ] Centro de Imunologia e Biologia Parasitária, Scientific Director of Center for Study in Animal Science, ICETA, University of Porto, , Porto, Portugal,
                [14 ] Department of General Surgery and Shock Trauma Unit, Hadassah-Hebrew University Medical Center, , Ein Kerem, Jerusalem, Israel,
                [15 ] Department of Surgery, Ankara Numune Hospital, , Ankara, Turkey,
                [16 ] Department of Plastic, Aesthetic and Hand Surgery, Sana Klinikum Hameln-Pyrmont, , Hameln, Germany,
                [17 ] Colorectal and Pelvic Surgery, Dokuz Eylül University Hospital, , Izmir, Turkey,
                [18 ] Gastrointestinal Surgical Oncology Department, Greater Poland Cancer Centre, , Poznan, Poland,
                [19 ] Cancer Institute, Hospital das Clínicas, School of Medicine, University of São Paulo, , São Paulo, Brazil,
                [20 ] Department of Surgery, Ernst von Bergmann Hospital, , Potsdam, Germany,
                [21 ] Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, , Tehran, Iran,
                [22 ] Department of Surgery, Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, , Bethesda, MD, USA,
                [23 ] Department for Orthopedics and Trauma Surgery, Helios Amper Hospital Dachau, , Dachau, Germany,
                [24 ] Orthopedic Department, Vila Velha Hospital, , Vila Velha, Espirito Santo, Brazil,
                [25 ] Department of Surgery, Medical University of Lublin, , Lublin, Poland,
                [26 ] Surgical Oncology, University of Siena, , Siena, Italy,
                [27 ] Surgical Oncology Department – Portuguese Institute of Oncology, , Porto, Portugal,
                [28 ] Department of Surgery, Federal University of Piauí, , Teresina, Piauí, Brazil,
                [29 ] Assia Medical Group, Assuta Medical Center, Tel Aviv, , Israel,
                [30 ] Surgical Oncology, HPB and Liver Transplantation, Ecuadorian Cancer Institute, , Quito, Ecuador,
                [31 ] Center for Physiology and Pharmacology, Medical University of Vienna, , Vienna, Austria,
                [32 ] Department of Surgery, UK Knappschaftskrankenhaus, Ruhr University, , Bochum, Germany,
                [33 ] Risk-Based Decisions Inc., , Sacramento, CA, USA,
                [34 ] Department of Colorectal Surgery, Royal North Shore Hospital, University of Sydney, , Australia,
                Author notes
                [* ]Corresponding author: b-bruecher@ 123456gmx.de
                Author information
                https://orcid.org/0000-0002-3930-6416
                https://orcid.org/0000-0002-7656-7789
                https://orcid.org/0000-0001-8426-8490
                https://orcid.org/0000-0002-5794-1878
                https://orcid.org/0000-0002-6410-8980
                https://orcid.org/0000-0002-5137-2889
                https://orcid.org/0000-0002-5101-7449
                https://orcid.org/0000-0001-8235-7246
                https://orcid.org/0000-0001-8978-9359
                https://orcid.org/0000-0002-3744-4882
                https://orcid.org/0000-0001-9738-2305
                Article
                fopen200002s
                10.1051/fopen/2020002
                bb941edc-3362-460e-94c6-ba24bb454d4f
                © B.L.M.D. Brücher et al., Published by EDP Sciences, 2020

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 April 2020
                Page count
                Figures: 4, Tables: 0, Equations: 0, References: 122, Pages: 19
                Categories
                Brief Report
                Custom metadata
                4open 2020, 3, 1
                2020
                2020
                2020

                Medicine,Chemistry,Physics,Mathematics,Materials science,Life sciences
                Laparoscopy,Elective surgery,Dermatology,COVID-19,Urology,Trauma surgery,Respiratory masks,Inflammation,Pneumonia,Guidance,Surgical critical care,Morbidity,Gynecology,Surgery,Reconstructive and plastic surgery,Cancer,SARS-CoV-2,Virus,Europe,Endocrine surgery,Pediatric surgery,Patient safety,Pandemic,Protection,Epidemic,Orthopedics,Germany,Cardiothoracic surgery,Coronavirus,Endoscopy,Epidemiology,Sepsis,Face masks,ENT,China,Neurosurgery,Transplantation surgery,N95 masks,Thoracoscopy,General surgery,Laparotomy,Mortality,Emergency,Anesthesia,Italy

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