A novel and contagious primary atypical (viral) pneumonia outbreak started in Wuhan-China in December 2019 [1]. The rapid increment of cases in Wuhan over a short period of time indicated the severity of this contagious novel virus. Rapid and effective contact tracing can reduce the initial number of cases, which would make the outbreak easier to control overall [2].
The Hashemite Kingdom of Jordan, which is located in the Middle East, with around 10 million population, was leading the challenge against COVID-19 efficiently with cooperation of the authority, military and people during the lockdown. Early strict measures applied professionally helped to control the spread of this pandemic. Jordan's first case was reported on March 2, 2020. The total number of COVID-19 confirmed cases in Jordan till the 4th of May 2020 was 465, with 9 deaths, and 370 recovered patients from the disease [3].
On March 15, 2020, the Jordanian government progressively started to lockdown the country, they suspended study in schools and universities, stopped praying in mosques and churches, closed its borders, and suspended all incoming and outgoing flights, while all the arrivals from Queen Alia Airport during that period were placed in quarantine for 14 days[4].
King Abdullah University Hospital (KAUH) was the official authorized centre to deal with COVID-19 pandemic in the North of Jordan. As a tertiary hospital, several protocols have been assigned to the whole staff including the physicians from all departments, nurses and maids to accommodate the pandemic. In addition, several separated units including 2 floors, 1 ICU and 2 operation rooms have been prepared for COVID-19 patients. The total number of confirmed COVID-19 patients until 4th May 2020 in north Jordan was 110 patients out of 8000 suspected cases who underwent COVID-19 test.
At the Neurosurgery Department in KAUH with a staff containing six specialists and eleven residents we have applied strict precautions in dealing with the current situation. All outpatients’ clinics visits have been suspended. In addition, all elective surgeries had postponed till the end of lockdown then a reschedule for the elective surgeries will be done depending on government statement. Moreover, the admitted patients in that duration had been discharged home as soon as their clinical status improved with ability to visit the ER regarding any complaint or finding. Furthermore, we have maintained the lower capabilities with the minimal staff count to receive the emergency cases by the on-call team.
Our Neurosurgery intensive care unit changed to be the COVID-19 intensive care unit, our residents have been assigned to be a stand-by team to COVID-19 response in a case of dramatic increase in COVID-19 patients and one resident from our department joined COVID-19 screening teams for the suspected cases for 14 days then he underwent quarantine for another 14 days at home.
All the protective measures have been taken including full separation of patients from the COVID-19 floors, minimizing staff contact with patients and decreasing the total hospitalization period.
During COVID-19 pandemic the emergency cases in neurosurgery have been accepted, a minimal count of residents recruited including: two residents per one-shift with two on-call specialists, instead of three to four residents per one-shift and one specialist on-call as each shift is a 24 h.
Emergency cases must call the paramedic emergency services of the civil defense in order to reach our center by dialing 911, this is the only way to access our hospital during the lockdown, because the civil defense-paramedic team is the main responsible team for the ambulance in our country, an estimation for the patient situation is done by civil defense paramedics during ambulation then a reevaluation is done in ER by our on-call team.
The following situations have been considered as neurological emergencies: Traumatic brain injury (moderate to severe traumatic brain injuries, traumatic brain injury associated with other injuries, extreme age groups), Spine trauma (unstable fractures, neurological or sphincter deficits) Intracranial bleedings (any type of bleeding was admitted), Congenital anomalies(newborns with congenital myelomeningocele), Hydrocephalus(shunt malfunction), and Infections (brain abscess, spondylodiscitis, shunt infection and post operation wound infection) while traumatic brain injury such as concussion, admission depending on many factors like age and other associated injuries, also superficial post operation wound infection was treated with oral antibiotics with regular follow up in the Emergency department.
Fifty-five patients were admitted to our neurosurgery department through the ER as well as we were consulted on forty-six patients which referred from other medical specialties like oncology, internal medicine, neurology and pediatrics, in total fifty-two patients out of ninety-nine patients underwent neurosurgical operations during the period from March 15th, 2020 till May 4th, 2020, as Table 1 demonstrates.
Table 1.
Number of Neurosurgical operations and type of operation.
| Type of surgery | Number of patients |
|---|---|
| Evacuation of Epidural Hematoma | 1 |
| CSF Shunting (All Procedures) | 18 |
| Decompressive Craniectomy (All Indications) | 5 |
| Repair of neural tube defects | 4 |
| Spine Surgeries (All Types) | 8 |
| Cranioplasty | 4 |
| Wound Infection and Debridement | 2 |
| Evacuation of Subdural Hematoma | 5 |
| Brain Tumor | 3 |
| Spinal Cord Tumor | 1 |
| Brain Abscess | 1 |
| Total number of patients | 52 |
three of our patients have underwent COVID-19 screening tests after suspicion of increased fever more than 37.7° with negative full septic workup, however they tested negative. our hospital criteria for screening is any person had a contact with a COVID-19 patient or with a person who came from other country after lockdown or fever more than 37.7° or cough.
The Neurosurgery department at King Abdullah University Hospital committed to maintain our patient’s health and safety during the COVID-19 pandemic.
We hope that COVID-19 outbreak will stop soon in our country Jordan and the whole world, in order to reach our patients again. We would like to thank our colleagues from the infection control unit for their major efforts in fighting COVID-19.
Conflict of interest
No conflict of interest to declare.
Funding
No funding received.
CRediT authorship contribution statement
Mohammed M. Al Barbarawi: Writing - review & editing, Supervision, Project administration. Omar F. Jbarah: Data curation, Writing - original draft, Conceptualization. Amer A. Alomari: Resources, Writing - review & editing.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.inat.2020.100793.
Appendix A. Supplementary data
The following are the Supplementary data to this article:
References
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