PMC:7543325 / 16719-22392 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7543325","sourcedb":"PMC","sourceid":"7543325","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7543325","text":"DISCUSSION\nOn 30 January 2020, the World Health Organization declared the Chinese outbreak of COVID-19 to be a Public Health Emergency of International Concern [15, 16]. In early February 2020, the World Health Organization based the diagnostic criteria for COVID-19 on compatible clinical features (fever and lower respiratory tract infection) associated with epidemiological risk (history of travel to Hubei province, China or close contact with confirmed COVID-19 patients within days of symptom onset) [15]. These were the criteria that we used in our hospital during February and mid-March to screen for the disease.\nIn Spain, at the writing of this article, there are a total of 205 905 cases confirmed by SARS-CoV-2 PCR, of which 58 819 are located in the Madrid region [17]. The 12 de Octubre University Hospital is a tertiary care hospital with more than 1300 hospital beds, of which more than 1000 were reserved for patients with COVID-19 during the worst moments of the pandemic. Clinical practice has been altered and that of the thoracic surgery department has not been an exception.\nThe institutional resources were altered: 3 thoracic surgeons were assigned to the hospital's COVID-19 units or to Madrid’s Ifema field hospital. As specialists in pulmonary disease, we also contributed to reduce the workload in the intensive care units [18] by treating pulmonary diseases likely to require our intervention (e.g. pneumothorax, pneumomediastinum and surgical tracheostomies [19]).\nDespite the preventive measures approved by our hospital, 4 doctors out of 11 (36%) from our department, 3 medical residents and 1 attending physician have been diagnosed with COVID-19. One required hospital admission but all evolved favourably.\nDue to the increased risk of surgical complications [20, 21] in those patients with asymptomatic COVID-19, we established a protocol in the thoracic surgery department designed to detect these patients prior to undergoing surgical procedures.\nOur protocol includes the use of chest CT. As recently reported [13, 14], chest CT demonstrates typical radiographic features in almost all patients with COVID-19, including ground-glass opacities, multifocal patchy consolidation and/or interstitial changes with a peripheral distribution.\nIn our experience, none of the chest CTs performed as part of the screening protocol for COVID-19 prior to surgery identified initial signs of infection with SARS-CoV-2. This finding correlates well with the PCR tests performed, all of which had negative results.\nHowever, at the beginning of the pandemic in our hospital, we detected in several follow-up chest CTs of oncological patients who were asymptomatic the typical radiographic features of coronavirus disease. For this reason and due to the lack of sensitivity of PCR tests and chest radiographs in identifying the initial signs of COVID-19, we decided to apply all the resources available in our hospital to screening for the disease. We also suggest that, in further and more favourable phases of the pandemic, CT screening could be omitted.\nOf the 34 patients who were operated on, 2 developed COVID-19. Of these, 1 died and the other patient is still hospitalized. The operation performed on the first patient, a 79-year-old man with multiple comorbidities who had a history of a contralateral lobectomy, was a wedge segmentectomy. The other operation was a thoracotomy for damage control following thoracic trauma. It is interesting to note that both patients were operated on, on 16 and 15 March, respectively. These dates coincide with the dates of the peak incidence of COVID-19 in our region and with the declaration of the state of emergency and confinement in Spain: 14 March 2020 [22].\nThe coronavirus disease pandemic has impacted all areas of daily life, including medical care. The treatment of patients with lung cancer during this crisis is challenging [23, 24]. On the one hand, patients have a risk of death from cancer, which is increased if radical surgery is delayed. On the other hand, the risk of death or of serious complications from coronavirus disease and the higher lethality of the infection in immunocompromised patients have to be weighed in relation to the former. The Royal College of Surgeons of England [25] noted that patients with cancers with a high risk of progression without treatment should be operated on as resources, such as the capacity of intensive care units, permit. In some cases [10], neoadjuvant therapy may be used as a means of delaying surgery, although the risk of exposure to COVID-19 during clinic visits for chemotherapy or radiotherapy is still high.\nThe spread of SARS-CoV-2 has already taken on pandemic proportions, affecting over 100 countries in a matter of weeks [26]. As of April 2020, we are almost at the 4-month mark of COVID-19.\nRegarding the future [27], the Spanish College of Surgeons [28] has defined 5 scenarios of the pandemic, based on the percentage of patients with COVID-19 in the hospital in relation to capacity. When the percentage becomes \u003c5%, surgical activity could return to normal.\nWith this article, our goal was to offer our experience as thoracic surgeons in the epicentre of the COVID-19 pandemic in our country. We highlight that once we added preoperative asymptomatic patients to those checked with the screening protocol for COVID-19 to the preventive measures practiced in our hospital, none of our patients presented with SARS-CoV-2 infection.\n\nLimitations\nThis study has several limitations: the small sample size, the retrospective nature of the study and the limited diagnostic testing available during the early period of the 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