How to modify medical “business as usual” for #covid. Should we stop elective surgery or non urgent GP work?

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In reply to Shaun O’Brien & Paul Langton “Given the ASA (the National representative body of Anaesthesia in Australia) has called for postponement of all ELECTIVE surgery, could you please inform us what is the AMA (WA)’s stance is on this matter ??
Surely, in an attempt to adhere to ‘Social Distancing’, anaesthetists, like myself, will find it near impossible whilst giving an anaesthetic for a procedure that can safely be postponed to a later date, to perform our normal duties. Allowing ELECTIVE surgery to continue puts our HCWs at an unnecessary level of potential exposure to COVID-19 whilst we are currently unsure of the ‘true’ community load of this virus. Your thoughts and action would be greatly appreciated!”

OK there are a number of issues with elective surgery which also apply to pretty much all medical “business as usual” – different in public than private. We should always listen to the front line – if you don’t work there, you don’t understand it.

1. PPE supply – if no PPE then we cant do many procedures, though masks are not required for eg gastroenterology scope lists (more PPE in a few weeks now so we are trying to delay the virus until it gets here).

2. In public, we need to clear as many high category cases as we can, or they suffer, while also allowing time for training of staff in COVID management and processes. So low category cases and non essential outpatients should stop, which is the focus of the ASA advocacy.

3. In private, the hospitals need to keep running to maintain a staff pool, avoid redundancies, keep facilities commissioned and make plans to deal with public overflow or substitution. Many high category cases can and are done in private but we need weeks to work out the handover process and have that operational (pun intended). This is second order for public planners so more time is essential, as is involvement of those on ground.

4. Once URTIs from other viruses start to rise in next few weeks ALL the hospitals will see natural attrition of elective surgery as the threshold for admission will exclude anyone with common cold, parainfluenza etc. Workforce will also drop, and testing may be unavailable to HCW for a while as we sort reagent & swab supply.

5. Although we don’t know the community load, because we are not testing for it, we know that we are not seeing the severe cases yet (which take a week or 2 to develop) so we know the risk of picking it up from an asymptomatic elective case is very low atm.

6. When the numbers of community cases start to surge, if we have operational systems in private we are in a better place to provide support for both COVID and non COVID work, or even to systematically rotate staff from private to public to provide pool cover for colleagues .If it all goes pear shaped we may all need to sit by a ventilator adjusting noradrenaline infusions for a while, or even just take care of trauma and other stuff while the long term public teams have a rest.

7. We will keep talking about this every few days as we see whether the early attempts to flatten the curve are starting to bite. If they do, then we can continue with important elective cases, allowing time for everyone in public and private to skill up.

So there are some aspects we can control, and some that will be thrust upon us anyway, which will combine to see elective slow down. People on the front line should have a strong say in what happens cos no-one at the top ever understands the real world consequences of something as simple as “cancel all elective surgery, everywhere”.

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