COVID-19 and urology in Australia and New Zealand: uncertain times.

Abstract

Much has changed as the world adapts to coronavirus disease 2019 (COVID-19) and the scope and practice of medicine and urology has likely changed forever. Australia and New Zealand have largely avoided the catastrophic impact of the pandemic but as we speak, Melbourne, a city of 5 million people, is again in lockdown with a second wave of cases in the community. We hope we do not mimic other regions where the coronavirus has wreaked havoc and destruction in so many ways. The government and authorities have largely been praised for management in our region, which includes the strategies (made for small and large islands) of (i) ‘eradication’, which has been the disciplined plan in New Zealand but even this remains just on the edge whilst (ii) ‘suppression’ in Australia has proven largely successful but challenging – particularly where cracks and ‘blind spots’ with containment have occurred. It is a ‘fluid environment’ for ‘unprecedented times’. We are all eagerly awaiting some sort of return to ‘normality’, but this would seem not less than a year away. Prioritisation of surgical cases has been the main issue in our region with urgent cases largely uninterrupted, but much debate over which oncological and other cases could safely be deferred. Indeed, what was considered ‘urgent surgery’ had the government and specialty societies scrambling for definitions. Was the operation urgent or the condition necessitating it? Classifications had been based using both systems. Realising that rudimentary documents and insufficient planning for such a unique situation meant new policies had to be created. USANZ was able to act swiftly and provide guidance. Understandably, elective surgery had to be wound back to allow for capacity within the health systems – emergency medicine resources, intensive care beds, protection of staff with patient safety paramount. Concerns about personal protective equipment (PPE) linger and modes of spread – relevant to anaesthesia and staff exposure not just in the operating theatre. ‘Donning’ and ‘doffing’ became buzz words (originally contractions of ‘do on’ for don and ‘do off’ for doff) of course related to PPE. As time went on thankfully resources were not stretched and time to ‘catch up’ was provided – we hope it remains that way. Debate about virus spread and surgery were largely based on assumption rather than fact - laparoscopic surgery being an excellent example [1]. In the end, everyone agreed getting patients who actually needed surgery in and out of hospital safely was the best advice. The next challenge is COVID-19 testing of every elective patient in Melbourne – logistics will be strained. The downturn in cancer diagnoses, such as prostate cancer, is only beginning to be realised and it will be the subject of much study as to how patterns have changed compared to recent times [2, 3]. How other conditions have played out such as BPH will also be of interest [4]. In Australia, as restrictions were lifted then consideration as what procedures should return first were announced – the subject of a commentary in this supplement [5]. The points raised are fair and worth challenge and debate. Men with various cancers affecting sexual health and cosmesis (e.g. prostate/urothelial/penile) have a finished voice. When COVID-19 has moved to the back seat certainly measured debate must start on providing equity of resources (medicine/psychological support/prostheses) for what is a genuine survivorship issue with many men and some women (e.g. urothelial cancer). Finally, can any good come from the pandemic for urology? Well, perhaps better adoption of Telehealth including telephone clinics – we hope governments fund these consultations for all including general practice and specialists as they are valid, productive and resource thin urology nurses have also shown themselves to be even more adaptable and take on greater roles and this should be recognised. The ability to attend meetings you may otherwise have apologised for us also helpful (if not sometimes overwhelming), but a urological voice on committees may grow louder. Perhaps a general sense of shared concern and asking your workplace colleagues, friends and family about their wellbeing will hopefully continue. We hope the supplement provides stimulus away from the omnipotent and ever-present coronavirus. Of course, we would like to reach out and thank the contribution of health, emergency service and other workers and our colleagues who have put themselves at risk and allowed society to function in these difficult times. None declared.