Abstract
OBJECTIVES:Strategic planning for coronavirus disease (COVID-19) care has dominated the agenda of medical services, which have been further restricted by the need for minimizing viral transmission. Risk is particularly relevant in relation to endoscopy procedures. This study aimed to describe a contingency plan for a tertiary academic cancer center, define a strategy to prioritize and postpone examinations, and evaluate the infection rate among healthcare workers (HCWs) in the endoscopy unit of the Cancer Institute of the State of São Paulo (ICESP).METHODS:We created a strategy to balance the risk of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to mitigate the effects of postponing endoscopic procedures in oncological patients. A retrospective analysis of prospectively collected data on all endoscopies between March and June 2020 compared with those during the same period in 2019 was carried out. All HCWs were interviewed to obtain clinical data and SARS-CoV-2 test results.RESULTS:During the COVID-19 outbreak, there was a reduction of 55% in endoscopy cases in total. Colonoscopy was the most affected modality. The total infection rate among all HCWs was 38%. None of the senior digestive endoscopists had COVID-19. However, all bronchoscopists had been infected. One of three fellows had a serological diagnosis of COVID-19. Two-thirds of all nurses were infected, whereas half of all technicians were infected.CONCLUSIONS:In this pandemic scenario, all endoscopy services must prioritize the procedures that will be performed. It was possible to maintain some endoscopic procedures, including those meant to provide nutritional access, tissue diagnosis, and endoscopic resection. Personal protective equipment (PPE) seems effective in preventing transmission of COVID-19 from patients to digestive endoscopists. These measures can be useful in planning, even for pandemics in the future.
Highlights
At our tertiary cancer center, it was possible to expand the variety of endoscopic procedures performed during the pandemic to include those for nutritional access, diagnosis of malignant neoplasia, and resection of malignant neoplasia, as all preventive measures to control infection spread had been taken
protective equipment (PPE) seems effective in preventing the transmission of COVID-19 from patients to digestive endoscopists
Special attention must be paid to avoid transmission in other sectors and transmission between healthcare workers (HCWs). These measures can be useful in planning for pandemics in the future as well as for a possible second wave of COVID-19
Summary
In mid-December 2019, a cluster of pneumonia cases associated with coronavirus disease (COVID-19) emerged in Wuhan, China, and rapidly spread to other areas globally [1]. The World Health Organization declared that the pneumonia outbreak caused by the novel coronavirus was a public health emergency of international concern (pandemic) [2]. In Brazil, the first case of COVID-19 was confirmed by the Health Authorities on February 26, 2020, in São Paulo city [3]. On March 19, 2020, the Medical Council of São Paulo State (CREMESP) recommended that surgeries, examinations, and elective consultations be postponed to prioritize care for patients diagnosed as having COVID-19 and, to safeguard limited resources such as Personal protective equipment (PPE) for care of suspected and confirmed cases of COVID-19. It was recommended that surgery, radiotherapy, chemotherapy, and other strategies for the treatment of cancer patients be continued [4]
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