American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

The novel coronavirus (COVID-19) has spread to almost every country, infecting at least 446,000 people. That’s the number of people worldwide who have tested positive for the virus. Many more have not yet been tested, so it is difficult to determine just how many people have this virus. COVID-19 often is fatal. As of yesterday morning, the U.S. death toll was at 1,050 after eclipsing 600 just two days earlier. Globally, the virus has killed more than 21,200 people, according to the Johns Hopkins University data dashboard.

Surgeons and other health care professionals generally make decisions based on the best available evidence. Unfortunately, reliable evidence about COVID-19 has yet to emerge, which makes it difficult to determine best practices in providing care. An opinion piece in STAT describes the possible repercussions of inadequate testing and evidence to predict possible mortality rates.

As seven leaders of academic medical centers in the U.S. noted in the March 24 issue of The New York Times, the statistical modeling of the viral spread actually is highly predictable, locally and globally. Each of these health care leaders has run best- and worst-case scenarios based upon the number of infected patients they have, the doubling time of viral spread, and the predicted number of patients who will be admitted to hospitals and require intensive care and a ventilator. For example, if today an institution has 25 COVID-19 patients in the hospital, with two in intensive care and one on a ventilator, the model predicts that with a three-day doubling rate, there will be a surge of  approximately 800 intensive care unit patients in 30 days.

Responding to this surge in COVID-19 patients would more than tax our nation’s health care system and economy. It may very well send both into a tailspin, but as an article in the March 26 Atlantic notes most economists cannot predict the economic toll at this time because it’s nearly impossible to estimate how many people will go into bankruptcy and find themselves out of work for a long stretch of time.

The American College of Surgeons (ACS), the American Medical Association, The Joint Commission, and other concerned stakeholder organizations issued a public statement outlining our concerns about the existing shortages of masks, face shields, other personal protective equipment (PPE), ventilators, swab kits, and testing capacity that frontline caregivers and patients critically need. The statement calls for federal, state, and local policymakers to immediately remove any impediments in the supply chain.

Congress passed and President Trump signed into law The Coronavirus Aid, Relief and Economic Security (CARES) Act. We have included a summary of some of the provisions of the legislation that may be most applicable to surgeons and their practice in this edition.

Guixi Zhang, MBBS, MHSM, MTS, FACS, has provided an excellent overview of the COVID-19 situation as it developed, mushroomed, and became contained in China, which has excellent charts and timelines. You can view that presentation here. We have much to learn from the experience of our colleagues in China. The First Affiliated Hospital, Zhejiang University School of Medicine, has developed a wonderful handbook outlining their efforts to provide optimal care to COVID-19 patients, which be accessed here.

As surgeons we are trained to put our patients first, and part of fulfilling that ethos is ensuring that we remain protected from contaminants in the operating room and that our patients have access to the resources they need to begin early and effective care. This issue of Bulletin: ACS COVID-19 Updates includes a range of articles that describe efforts the ACS, health care facilities, and other stakeholders are carrying out to preserve the integrity of our health care system in this time of crisis.

The American College of Surgeons is committed to providing the surgical community with information that can guide quality care during the COVID-19 global health pandemic. College leadership and others review information before it is released. However, given the nature of the situation and how quickly the science is evolving, what is presently thought to be accurate may change. Information will be updated whenever possible.