Commentary: Preparation for pandemics prevents pandemonium

Recent pandemics.

Central Message.

Uncertainty in emergency and the quickly evolving healthcare crisis can lead to chaos. Preparation strategies for the Coronavirus Disease 2019 pandemic provide purpose and direction for optimal outcomes.

See Article page 937.

Healthcare crises are rare and far between. Not since the Spanish flu of 1918 has there been a pandemic as severe and worldwide as the Coronavirus Disease 2019. However, in 1918 the luxury of ventilators and intensive care unit was not accessible. Therefore, without a vaccine to protect against the infection or antibiotics to treat secondary infection, nonpharmaceutical interventions were implemented. The lessons of 1918 remind that isolation, quarantine, and good hygiene are paramount to minimize the spread of infectious organisms.¹ A century later, the world adjusts to another viral pandemic wreaking havoc on the universal healthcare system.

To accommodate the rapid influx of patients in distress, hospitals have had to incorporate massive adjustments, including redeployment of essential personnel, revision of department roles, and allocation of limited lifesaving resources. The impact on adult cardiac surgical practice and cardiovascular disease, and the prioritization of common cardiac surgical procedures are thoroughly reviewed in this article.

The effort placed forth by George and colleagues² in compiling this detailed and thorough composition regarding their preparation and execution of the Coronavirus Disease 2019 crisis resource allocation is commendable. The coordinated effort with leadership portrays how necessary it is to have system-wide agreement and planning across all levels of the institution. Their resource allocation reminds us of The New England Journal of Medicine recommendations for scarce resources, which was recently published.³ The subjects addressed are relatable to anyone in the surgical practices. The visual representation in Figure 1 depicts nicely the risk stratification in all 3 phases of pandemic levels.

Figure 1.

Recent pandemics. HIV, Human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; COVID 19, Coronavirus Disease 2019.

As surgeons, our focused interest is 2-fold: operative intervention and application of our skills to areas of need. George and colleagues² address their response to the reduction in operative volume and the adaptive transition into critical care management and procedures while still maintaining a core for emergency surgical activity.

Challenges and logistic solutions to address the implementation of massive redeployment, reorganization of team allocation, and overall complete restructuring of operating room and intensive care unit management are important to follow for future pandemics. George and colleagues² have started the conversation that should continue. How do we, as cardiothoracic surgeons, continue to provide care for the cardiovascular diseases that continue during a pandemic while balancing the needs of a new patient population? Discussions on this magnitude can and should continue well after the crisis abates to allow our specialty to continue to grow and evolve without depriving patients of necessary cardiovascular and thoracic care.