Commentary: When a cardiac surgeon takes care of patients with Coronavirus Disease 2019: It’s gonna be ok!

It's gonna be ok.

Central Message.

The strict observance of protective measures and the interruption of elective surgical procedures enhance the security and safety of patients and health care personnel.

See Letter page e39.

Pandemic, lockdown, stay home. Words that nobody would have ever wanted to hear. An invisible enemy, widespread everywhere, that causes fear, agony, and deaths. It has been recorded that more than 1.5 million people have been affected by Coronavirus Disease 2019 (COVID-19) and 85,000 have died.¹ Unfortunately, data will surge. After China, Italy was struck first, requiring a reorganization of the health system. In Lombardy (the most hit Italian region), hospitals saturated their bed availability, overwhelmed with patients with COVID-19. Intensive care units crashed, requiring the transfer of patients to other hospitals outside of the region or in some cases outside of the country. Since the beginning of March, all elective procedures stopped, guaranteeing only urgent or emergency operations. The regional health system identified 4 hub centers of 20 cardiothoracic departments in Lombardy, serving more than 10 million people. Despite a large amount of patients, few patients have undergone operations per week, pointing out that people fear COVID-19 rather than a heart attack or dissection.

My lifestyle has changed and my job has changed since I started taking care of patients with COVID-19. Nevertheless, a cardiothoracic hub center allowed my team to take care of 1 urgent case from our waiting list. Per policy, the following protection procedures were established:

• 1.Self-isolation for at least 14 days (incubation period) whenever possible.
• 2.Nasal swab screening for COVID-19 done the same day of admission in hospital, keeping the patient isolated as with COVID-19 infection.
• 3.All medical and nurse staff must wear personal protective equipment until a swab test shows negative results.
• 4.All surgical staff has an FFP3 mask plus a surgical mask during operations to avoid contamination from patient to surgeon and vice versa.
• 5.Intensive care, high dependency unit, and ward COVID-19 free.

Despite these measures, there is still a percentage of COVID-19 infection. Data from other hospitals show there are still some patients infected who may not receive this strict surveillance. The risk of not following the policy of personal protective equipment by health personnel, asymptomatic patient visitors, and false-negative and precocious swab tests may cause COVID-19 spread in hospitals.

To reduce the risk of severe acute respiratory syndrome coronavirus 2 nosocomial transmission, Mayeur and colleagues² propose suspending all preoperative nasal swab screening for Staphylococcus aureus. ² Patients undergoing cardiac surgery who have S aureus also have a greater risk of surgical site infection, and their identification is mandatory for good outcome.³ I agree with the authors that all patients should be considered positive for S aureus. However, in this world crisis, the focus is COVID-19 infection. All patients with cardiac disease should be considered positive for COVID-19, and elective cardiac surgery has to be stopped. The risk of dying of pneumonia is too high for low-risk surgery. It seems that the average person infected with coronavirus contaminates 2 to 3 people. In light of my considerations, only emergency and urgent operations should be performed. The strict observance of protective measures and the interruption of elective surgical procedure will enhance the security and safety of patients and health care personnel. While the infection advances in other countries, the social distancing has brought its first positive effects in Italy. In the meantime, we learned the importance of a hug with friends and family, solidarity, and time. We will win this war and see the rainbow. It's gonna be ok!