EHS-COVID (367) Impact of COVID-19 on elective (non-urgent) surgery (6) WHO guidance

1 June, 2021

Thanks to J Gnanaraj for sharing his direct experience as a rural surgeon in India.

I have just consulted the WHO guidance on Maintaining essential health services during COVID-19 and it says remarkably little about how to maintain essential surgical services. While other areas of health have dedicated sections, surgery is only mentioned in passing. Here are all the instances I could find, followed by a comment from me.

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The suspension of surgical services, for example, is likely to create substantial backlog in most systems, with some procedures that were initially deemed elective becoming progressively more urgent

Anticipate and plan for surge capacity to manage the backlog of nonurgent health services that were suspended (e.g. cataract surgery).

Tailor and modify to individual circumstances and service context: treatment sequence (such as the use of chemotherapy or radiotherapy before surgery)

Delay elective surgery for epilepsy and delay any psychometric assessments

Suspend non-urgent surgical interventions and rehabilitation [for Buruli ulcer] when there is minimal risk of deformity if treatment is delayed.

Where availability of surgical services is limited, hydrocele surgeries may be postponed. Surgical camps should be postponed.

Where surgical services are limited, prioritize surgical correction of trichiasis cases in whom greater numbers of eyelashes touch the cornea or where trichiasis affects the only eye with good vision. For other patients, consider instructing a family member to undertake careful epilation with high-quality forceps.

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Comment (NPW): Would it be helpful for surgeons and hospital managers to have more comprehensive guidance on how to maintain essential surgery services, which might complement the current general guidance? Is anyone aware of such guidance?

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org