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

Clinical Issues and Guidance

Updated ACS Guidelines for Urological Cancer Patients

The American College of Surgeons has developed updated guidelines for the triage and management of patients with urological cancer—testicular, kidney, urothelial, bladder, and upper tract cancers—during the COVID-19 pandemic. This document provides surgical decision-making support by highlighting potential risks and benefits of treating urological cancer patients at this time and outlines general diagnostic workup and staging evaluation management recommendations. Last week, the ACS Guidelines for Triage and Management of Elective Cancer Surgery Cases During the Acute and Recovery Phases of Coronavirus Disease 2019 (COVID-19) Pandemic were updated to include additional information related to the care of prostate cancer patients.

Guidance for Return to Practice for Otolaryngology–Head and Neck Surgery

The American Academy of Otolaryngology−Head and Neck Surgery, in collaboration with the otolaryngology specialty societies, developed recommendations for a safe return to practice, presented in two parts. These will be “living documents” that will be updated on a regular basis as new information becomes available.

Ophthalmic Organizations Offer Checklist for Reopening Surgical Services

The American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and the Outpatient Ophthalmic Surgery Society have developed a checklist for reopening ophthalmic surgical services.

The checklist, issued May 6, details how to approach and manage some of the key decisions in reopening more normal practice in the COVID-19 era and was developed in collaboration with the Ambulatory Surgery Center Association.

COVID-19 Continues to Affect Small Physician Practices

An article published this week in the New York Times points to the financial challenges that small physician practices across the U.S. continue to face in the COVID-19 era and to the broader impact of this crisis on the nation’s economic downturn.

As patients postpone medical appointments, elective operations, and diagnostic screenings, health spending dropped an annualized rate of 18 percent in the first three months of the year, according to recent federal data.

Congress has provided tens of billions of dollars to the hospitals reporting large losses and passed legislation to send even more, but has been less responsive to small physician practices, particularly in medicine’s least profitable fields like primary care and pediatrics. Furthermore, none of the money that lawmakers have allocated has been specifically targeted to physicians. As reported previously, funds have been set aside for small businesses, including many physicians’ practices, and the U.S. Department of Health and Human Services has taken some steps to help small practices, including advancing Medicare payments and reimbursing physicians for telehealth services.

Latest Updates from Department of Health and Human Services

The U.S. Department of Health and Human Services (HHS) has taken further action this week on COVID-19-related issues.

Policy to expand testing capacity: The Food and Drug Administration (FDA) released an updated policy for COVID-19 tests with guidance for clinical laboratories, commercial manufacturers, and agency staff.

Expanding access to convalescent plasma: The Biomedical Advanced Research and Development Authority (BARDA) has entered into a collaboration with Mayo Clinic to support an expanded access program to provide access to convalescent plasma for patients hospitalized with COVID-19.

Reporting cases of COVID-19: The Centers for Disease Control and Prevention (CDC) updated its information for health departments on reporting cases of COVID-19.

First authorized serology test: The FDA authorized the first serology, or antibody, test where the results of a new independent validation effort by the U.S. government provided the scientific evidence used to support the authorization.

CDC grows the viral culture: The CDC has supported global efforts to study and learn about SARS-CoV-2 in the laboratory by growing the virus in cell culture and ensuring its wide availability. Researchers in the scientific and medical community may use the virus obtained from this work in their studies.

Optimizing the supply of personal protective equipment (PPE): The CDC updated its web page on strategies to optimize the supply of PPE.

Information on collection of postmortem specimens: The CDC updated its guidance on collection and submission of postmortem specimens from deceased persons with known or suspected COVID-19.

CDC Reports on Number of COVID-19 Cases and Deaths in U.S.

According to the National Center for Immunization and Respiratory Diseases (NCIRD), as of May 6, more than 1.19 million confirmed or probable cases of COVID-19 have been identified in the U.S. Global confirmed cases of COVID-19 totaled more than 3.5 million as of May 5. In addition, the Centers for Disease Control and Prevention (CDC) has reported that 70,652 people in the U.S. have died of COVID-19 to date.

Promising Therapeutics

COVID-19 and Herd Immunity

An article in Cell discusses how the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease, COVID-19, has demonstrated the devastating impact of a novel, infectious pathogen on a susceptible population.

Hydroxychloroquine Fails to Improve Outcomes in a Large New York City Study

The New England Journal of Medicine published a large observational study (1,376 patients) treated in New York, NY, for COVID 19 between March 7 to April 8, with follow up through April 25. This nonrandomized but well-controlled study examined the outcomes of patients treated with hydroxychloroquine (59 percent) versus patients who did not receive hydroxychloroquine (HCQ) and observed no difference in death or intubation in the two groups when illness severity was adjusted. For this study use of hydroxychloroquine was decided upon by individual attending physician judgment, and some patients treated with hydroxychloroquine also received azithromycin. A small number of patients received remdesivir in a randomized controlled trial and another small number received sarilumab.

This study does not recommend the use of HCQ outside of a randomized clinical trial.

Former CDC Chief Testifies on Preventing COVID-19 and Prevention of Future Epidemics

Thomas R. Frieden, MD, former Director, Centers for Disease Control and Prevention (CDC), and now President and Chief Executive Officer, Resolve to Save Lives, testified this week before the U.S. House of Representatives Labor, Health and Human Services, and Education Appropriations Subcommittee. Dr. Frieden’s testimony provided a perspective on where the nation is and what needs to be done to protect Americans from COVID-19 and future pandemics. He proposed a new approach to bring stability and security to our efforts to keep the U.S. safer from epidemics, underscoring that the war against COVID-19 will be long and difficult, and, until we have a vaccine, we must have a comprehensive strategy and use data to drive our policies and programs in order to save lives and restore the economy. Read his testimony here.

Do Llamas Play a Role in Fighting COVID-19? New Study May Provide Immunization Insights

Coronaviruses, including COVID-19, make use of a large envelope protein called spike (S) to engage host cell receptors and catalyze membrane fusion. Because of the vital role that S proteins play, they represent a vulnerable target for the development of therapeutics. An article in Cell describes the isolation of single-domain antibodies (VHHs) from a llama immunized with prefusion-stabilized coronavirus spikes. The data provide a molecular basis for the neutralization of pathogenic beta coronaviruses using VHHs and suggest that these molecules may serve as useful therapeutics during the COVID-19 outbreak.

Interpreting COVID-19 Diagnostic Tests

Scientific knowledge of diagnostic tests for COVID-19 continues to evolve. A “Viewpoint” in the Journal of the American Medical Association describes how to interpret two types of diagnostic tests commonly in use for COVID-19 infections—reverse transcriptase-polymerase chain reaction (RT-PCR) and IgM and IgG enzyme-linked immunosorbent assay (ELISA)—and how the results may vary over time.