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World J Gastrointest Surg. Jun 27, 2020; 12(6): 259-268
Published online Jun 27, 2020. doi: 10.4240/wjgs.v12.i6.259
COVID-19 outbreak and surgical practice: The rationale for suspending non-urgent surgeries and role of testing modalities
Andrew D Grubic, Shahin Ayazi, Javad Zebarjadi, Hamed Tahmasbi, Khosro Ayazi, Blair A Jobe
Andrew D Grubic, Shahin Ayazi, Blair A Jobe, Esophageal and Lung Institute, Department of Surgery, Allegheny Health Network, Pittsburgh, PA 15224, United States
Javad Zebarjadi, Hamed Tahmasbi, Khosro Ayazi, Department of Surgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1617763141, Iran
Author contributions: All author contributed to this work; Grubic AD, Ayazi S, Zebarjadi J, Tahmasbi H, Ayazi K, and Jobe B had concept of the study and designed it; Grubic AD, Ayazi S, Zebarjadi J, and Tahmasbi H reviewed the literature; Grubic A, Ayazi S, Zebarjadi J, Tahmasbi H, Ayazi K, and Jobe BA drafted the manuscript; Ayazi S, Ayazi K, and Jobe BA provided critical revision.
Conflict-of-interest statement: There is no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shahin Ayazi, MD, Foregut Surgeon, Esophageal and Lung Institute, Department of Surgery, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA 15224, United States. shahin.ayazi@ahn.org
Received: April 23, 2020
Peer-review started: April 23, 2020
First decision: April 29, 2020
Revised: May 1, 2020
Accepted: May 19, 2020
Article in press: May 19, 2020
Published online: June 27, 2020
Abstract

One-hundred years after the 1918-19 H1N1 flu pandemic and 10 years after the 2009 H1N1 flu pandemic, another respiratory virus has now inserted itself into the human population. Severe acute respiratory syndrome coronavirus has become a critical challenge to global health with immense economic and social disruption. In this article we review salient aspects of the coronavirus disease 2019 (COVID-19) outbreak that are relevant to surgical practice. The emphasis is on considerations during the pre-operative and post-operative periods as well as the utility and limitations of COVID-19 testing. The focus of the media during this pandemic is centered on predictive epidemiologic curves and models. While epidemiologists and infectious disease physicians are at the forefront in the fight against COVID-19, this pandemic is also a “stress test” to evaluate the capacity and resilience of our surgical community in dealing with the challenges imposed to our health system and society. As recently pointed out by Dr. Anthony Fauci, the virus decides the timelines in the models. However, the models can also change based on our decisions and behavior. It is our role as surgeons, to make every effort to bend the curves against the virus’ will.

Keywords: COVID-19, SARS-CoV-2, Surgery, Pandemic, Predictive model, Diagnosis

Core tip: Severe acute respiratory syndrome coronavirus has become a critical challenge to global health with immense economic and social disruption. Coronavirus disease 2019 (COVID-19) pandemic has become a “stress test” to evaluate the capacity and resilience of our surgical community in dealing with the challenges imposed to our health system and society. Some aspects of the COVID-19 outbreak are relevant to surgical practice and modifying practice can reduce risk to patients and staff alike. We discuss considerations during the pre-operative and post-operative periods as well as the utility and limitations of COVID-19 testing. Computed tomography scan is currently the most sensitive modality for COVID-19, and while reverse transcription polymerase chain reaction is highly specific, sensitivity is considerably viable based on multiple factors.