Rebuilding Global Plastic Surgery Services and Safeguarding Workforce Density after COVID-19.

Abstract

A recent report has found that approximately 150,000 health care workers have been infected with the SARS-CoV-2 virus, resulting in more than 1400 deaths.1 Of the 32 reported deaths of doctors in the United Kingdom due to coronavirus disease of 2019 (COVID-19), one was a plastic surgeon.2 Although the loss of any colleague is tragic, this pandemic will have an unprecedented and disproportional effect on low-income and middle-income countries and our collective global surgery aspirations. Recently, an extensive scoping review of health care workers’ COVID-19–related infections and deaths worldwide was published.1 Interestingly, the majority of documented health care worker deaths were seen in specialties not routinely associated with exposure to oronasal secretions, thereby highlighting the risk to all surgeons, including our plastic surgery community.1 While in the United Kingdom there are approximately 900 plastic surgeons, with over one surgeon per 100,000 people, the majority of countries worldwide are not as well equipped. For example, in Malawi, there are only three qualified plastic surgeons, representing 0.01 surgeons per 100,000 people.3 These figures are consistent across the multitude of low- and middle-income countries. The implications, therefore, of COVID-19 on the plastic surgery workforce in such countries are striking, with one death in Malawi representing a loss of 33 percent of the qualified plastic surgeons. The Lancet Commission on Global Surgery revealed the importance of an adequate surgical, obstetric, and anesthesia workforce density, due to a clear positive association between surgical, obstetric, and anesthesia workforce density and reduced morbidity and mortality rates and increased life expectancy.4The Lancet commission’s target of at least 20 surgical workers per 100,000 aimed to provide equality in health system staffing and patient outcomes.4 However, as many of our plastic surgery colleagues around the world (and particularly in low- and middle-income countries) are working exclusively as COVID-19 doctors, plastic surgery units are being converted to COVID units (e.g., the biggest plastic surgery specialist hospital in the world, with 500 beds and based in Dhaka, Bangladesh, is currently used solely for COVID-19), and personal protective equipment remains sparse and supply chains broken, we must act swiftly and in unison to safeguard global plastic surgery.5 The current global consequences of COVID-19 and restrictions in travel have strained traditional means of workforce training and attempts to improve surgical, obstetric, and anesthesia workforce density. However, biopsychosocial, economic, and ethical arguments should continue to compel us to overcome these challenges. Moving forward, we must focus on promoting safe working practices and preventative measures (such as advocating for safe and resilient personal protective equipment supply chains) and supporting our plastic surgery colleagues in low- and middle-income countries. Plastic surgery training in low- and middle-income countries must continue, and may require further development of our virtual teaching, e-learning, webinar, and simulation resources. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.