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COVID-19 and Surgical Preparedness
considerable caution is advised.” However, the level of risk is showed that 217 (68.2%) were aware of the correct sequence of
unknown. Thirty-six (58%) of the respondents in the private sector donning and doffing the PPE. One-hundred and sixty-three (75.1%)
and 26 (42%) in the public sector implied that they would prefer of private hospital respondents and 54 (24.8%) of the public hospital
open surgery to laparoscopic surgery. Surgical practitioners in respondents were following the correct procedure and sequence
private sector were less likely to prefer open surgery to laparoscopic for donning and doffing the PPE. The difference was found to be
surgeries OR = 0.37 (0.20–0.66), and the difference was found to be statistically nonsignificant (p = 0.43). In a questionnaire-based
highly statistically significant (p <0.001). survey among the medical students and healthcare professionals
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Fifteen (63.5%) participants from private sector have deferred in Urban Mumbai, Modi et al. found adequate awareness in
surgery compared to nine (37.5%) from public sector due to COVID- 71.2% of the individuals. We recommend the help of various online
19 scare (p >0.05). resources available for adequate guidance. 25,26 Occupational health
As stated, early initial response was to halt elective procedure and safety are of paramount importance to minimize the risk of
in the interest to preserve resources and aid in preventing further transmission to surgical professionals and to provide optimum
spread of disease. In our study, 62.5% of private practitioner care to patients.
compared to 37.5% of public sector surgeons deferred elective One of the limitations of this study was that the nonresponse rate
surgery with the statistical significant difference between two could not be calculated. However, since our survey is anonymous,
groups (p = 0.08). we believe that the participants were truly honest in responding.
In vitro studies have shown chloroquine to be effective
against severe acute respiratory syndrome-associated coronavirus
15
(SARS-COV). Chloroquine was suggested as drug for treating conclusIon
16
SARS during epidemic. However, due to lack of double-blind The COVID-19 pandemic has profoundly impacted the surgeons’
randomized control study, the true efficacy of chloroquine in daily practice. Surgical services vary widely depending upon local
treating coronavirus was never established. Chloroquine and its and regional variation and health system configuration. There is a
related drugs were tentatively included among drugs for use in need to implement periodic educational interventions and training
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containing the burden of COVID-19. Hydroxychloroquine 400 mg programs on surgical practice in reference to COVID-19 pandemic.
twice a day on day 1and then 400 mg once a week thereafter
have been recommended for asymptomatic healthcare workers
taking care of suspected or confirmed COVID-19 patients as references
18
per the guidelines of ICMR. In our study, 170 respondents had 1. Nagarajan R. 6 states have more doctors than WHO’s 1:1000 guideline.
consumed hydrochloroquine as recommended by ICMR—114 (67%) The Times of India. 2018. Available from: https://timesofindia.
were private practitioners and 56 (32.9%) were public healthcare indiatimes.com/india/6-states-have-more-doctors-than-whos-
sector professionals. The odds of the health providers in public 11000-guideline/articleshow/65640694.cms.
sector consuming hydrochloroquine were 0.39 times lesser than 2. Kapur A, Chowdhury A. National Rural Health Mission. GOI Budget
Briefs 2011–2012. 2011.
those in private sector, and the difference in consumption of 3. Availability of doctors per capita in India. Answer to Q no 236, Rajya
hydrochloroquine was highly significant among the two groups Sabha, MOHFW, GOI Sep 15, 2020. Available from: medical dialogues.
(p <0.001). However, no statistically significant differences were in/pdf134559
found in the two groups as far as consumption of immunity boosters 4. WHO. Coronavirus disease 2019 (Covid-19). 2020. Available
was concerned (p = 0.06). from: https://www.who.int/docs/default-source/coronaviruse/
Various guidelines have recommended to get reverse s i t u a t io n - r ep o r t s / 2 0 2 0 0 0 415 -s i t r ep - 8 6 - c o v id -19.
transcription–polymerase chain reaction (RT-PCR) for COVID-19 pdf?sfvrsn=c616ea20_6.
done before elective surgery. However, it may not be feasible in 5. Spinelli A, Pellino G. Covid-19 pandemic: perspectives on an unfolding
crisis. BJS 2020;107(7):785–787. DOI: 10.1002/bjs.11627. Available from:
every situation due to the lack of enough resources for testing. As http://bjssjournals.onlinelibrary.wiley.com/doiabs/a0.1002/bjs.11627.
found in our survey, only 67.2% got it tested before surgery. Our 6. Pulla P. Covid-19: India imposes lockdown for 21 days and cases rise.
study has shown that more private sector surgeons got it tested— BMJ 2020;368:m1251. DOI: 10.1136/bmj.m1251.
192 (89.7%) compared to public sector surgeons—22 (10.2%). The 7. Nepogodiev D. Global guidance for surgical care during the COVID-19
difference was statistically significant (p = 0.00). pandemic. Br J Surg 2020;107(9):1097–1103. DOI: 10.1002/bjs.11646.
Surgeons who remain in close contact with patients’ body fluids 8. Royal College of Surgeons of Edinburgh. Intercollegiate general
while performing surgical procedures are therefore at increased surgery guidance on COVID-19 update. 2020. Available from:
risk of exposure and contracting COVID -19 infection. 19,20 The PPE is https://www.rcsed.ac.uk/news-public-affairs/news/2020/march/
intercollegiate-general-surgery-guidance-on-covid-19-updatae
required with proper donning and doffing for adequate protection. [Accessed April 6, 2020]
Adequate use of PPE depends not only upon the availability but 9. Mowbray N, Ansell J, Warren N, et al. Is surgical smoke harmful to
also on comfort and training. 21,22 The use of PPE during surgery theater staff? A systematic review. Surg Endosc 2013;27(9):3100–3107.
raised concerns about its impact on surgery performance, overall DOI: 10.1007/s00464-013-2940-5.
comfort, and surgeon fatigue. In our study, 62.2% of surgeons 10. Mowbray NG, Ansell J, Horwood J, et al. Safe management of surgical
reported impaired vision and difficulty in performing surgery. smoke in the age of COVID-19. Br J Surg 2020;107(11):1406–1413.
Carlos et al. in their study reported that 54% of the surgeons felt DOI:10.1002/bjs.11679.
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hampering of surgery performance with PPE. Proper technique 11. Francis N, Dort J, Cho E, et al. SAGES and EAES recommendations for
and sequencing should be adhered while donning and doffing minimally invasive surgery during COVID-19 pandemic. Surg Endosc
2020;34(6):2327–2331. DOI: 10.1007/s00464-020-07565-w.
PPE to prevent getting infected with COVID-19. Two-hundred and 12. Coccolini F, Perrone G, Chiarugi M, et al. Surgery in COVID-19 patients:
seventeen (68.2%) of the respondents reported checking out the operational directives. World J Emer Surg 2020;15(1):25. DOI: 10.1186/
correct sequence of donning and doffing the PPE. Our survey has s13017-020-00307-2.

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