Table 1.

General recommendations for surgical services

All elective surgeries should be postponed until further notice

It is possible that with the decrease in the number of elective surgical procedures and the need to increase Intensive Care Unit (ICU) bed capacity, surgical staff will be mobilized to provide non-surgical, COVID-19—related patient care. This shift of staff should not have a negative impact in our ability to provide timely care for trauma and emergency surgery patients

Cancer operations, patients with highly symptomatic benign disease, significant infections, and those whose delay would precipitate life-threatening outcomes or patient harm should be considered for operative intervention on a case-by-case basis by a multidisciplinary team including surgeons, anesthesiologists, and nursing leadership, depending on local availability of resources

Real-time reverse transcription polymerase chain reaction (RT-PCR) of viral nucleic acid is regarded as the reference standard in the diagnosis of SARS-CoV-2; however, delays in swab-to-result time may impact time-critical operative management of surgical conditions

The indications and principles of management for trauma and emergency general surgical operations are the same as in non-pandemic circumstances

Trauma and Emergency general surgery cases should proceed to the Operating Room in a timely manner with consideration to COVID-19 guidelines for symptomatic patients

Patients who do not have symptoms consistent with COVID-19, or have no radiologic findings, or have a negative RT-PCR test, should proceed to the OR with standard operating room precautions in place. Anesthesiologists may use N-93/FFP3 masks for intubations, if available

Patients with symptoms suggestive of COVID-19 infection who have a surgical condition requiring immediate attention and have not been tested prior to presentation to the ER, should undergo a chest X-ray and/or a chest Ultrasound and/or a Chest CT to look for bilateral interstitial pneumonitis (peripheral ground-glass consolidations) concerning for COVID-19 infection (Figs. 1, 2) [7–10]