The New Normal and Summary
Without doubt, the COVID-19 pandemic has caused significant disruption to services globally. One of the most affected sectors was healthcare provision, which required extensive support from governments and volunteers in order for it to provide safe care. Globally there has been service reconfiguration, with some units shutting down some of their services to cope with COVID-19 patient influx while others diverted their activity into a more centralized, regional hub to be able to deliver emergency, specialist services. NHS England has been in the frontline combating COVID-19 and cardiothoracic surgical services have been modified to reflect this. In England, the only regions with a clear cardiothoracic surgical pathway for the COVID-19 pandemic were London through PLEC and the North West of England.
Following service modifications, there remain thousands of patients affected by cancellation of their operation, clinic assessment or follow-up. The outcomes of this cohort is unknown; it will be of great interest to understand how these patients, and their quality of life, have been affected.
There is uncertainty about when a full cardiothoracic service will re-run and whether preoperative testing for COVID-19 will be a permanent requirement; data are emerging on daily base and to-date there are more than 47,000 entries in PubMed.gov related to COVID-19, increasing on daily base. Will the present state of affairs be the new norm for cardiac surgeons for the foreseeable future? How will the NHS provide its services in the future? Time and further research will address these questions.
ConclusionsThe COVID-19 pandemic has had significant impact on our nation causing death, disability, and resulting in incalculable effects on families, social structures through long-lasting consequences for our economy. Through changes in social behaviour, building of our bed base and changes in NHS structures and priorities, the country stopped the pandemic overwhelming our critical care capacity. There was, however, a significant impact on NHS health care provision including cardiac surgery. The burden of cardiovascular disease on morbidity and mortality as a consequence of these arrangements remain unknown at present. Our patient survey showed that patients are more worried about risks to their health from underlying aortic pathology than contracting COVID-19 in hospital and its associated perioperative risks. Cardiac surgeons have learnt an enormous amount on how to manage the service in the context of a national pandemic. Hopefully, this manuscript will offer some insight on how we managed the challenge.AcknowledgementsWe would like to acknowledge that many of the systems and processes described for LHCH are the result of input from multiple disciplines and individuals across different specialities including the management team. We are thankful to the team at Department of Anaesthesia and intensive care at LHCH for their efforts and inputs into the design of theatre protocols and COVID-19 Care Pathways at our hospital. We would also like to acknowledge that many of the pathways are edited versions from documents that are freely available and accessible on SCTS and RCS websites including PLECS, and are modified for local use. We are grateful to Professor Aung Oo at St. Bartholomew’s Hospital, Barts Heart Centre, London, United Kingdom for sharing the early experience of COVID-19 in London and their development of Care Pathways. We would like to thank the patients of Aortic Dissection Awareness in contributing to the patient survey.Human Studies: No ethical approval required for this study as no patient identifiable information in included.References:
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Appendices:These are local amendments to freely accessible documents published on the SCTS website (https://scts.org/covid-19/)
  1. North-West Urgent Cardiothoracic Service
  2. LHCH Patient Pathway
  3. LHCH Operative standard operating policy
Figure Legends:Figure 1. World Health Organization statistics of COVID-19 globally.Source www.WHO.int (accessed 22nd August 2020)Figure 2. United Kingdom COVID-19 status of confirmed cases and deaths.Source www.gov.uk (accessed 22nd August 2020)Figure 3. Status of patient admission to hospital and requirement of mechanical ventilation in COVID-19 patients in the United Kingdom.Source www.gov.uk (accessed 22nd August 2020)Figure 4. Average weekly Cardiac surgery activities at Liverpool Heart and Chest Hospital