key: cord-257995-kgmsecg3 authors: Vilallonga, Ramon; Blanco-Colino, Ruth; Armengol Carrasco, Manel title: Reply To The Article “Bariatric Surgical Practice During the Initial Phase of COVID-19 Outbreak.” by Aminian, A., Kermansaravi, M., Azizi, S. et al. Published in Obesity Surgery date: 2020-05-13 journal: Obes Surg DOI: 10.1007/s11695-020-04678-y sha: doc_id: 257995 cord_uid: kgmsecg3 nan viral hosting and propagation [4] . Moreover, there are several factors in which obesity can play a role in poor outcomes from COVID-19 infection. Some have proposed that obese patients can present a metabolic dysfunction due to a proinflammatory state and also that adipose tissue can serve as a reservoir for some human viruses [5] . Clinical diagnosis of COVID-19 is heterogeneous among the 4 cases presented. Criteria for performing a chest CT or RT-PCR are not clearly stated. Case 4 misses RT-PCR, while chest CT has not been done for case 2. This is a limitation for this early case series that will need to be explored in future perioperative protocols globally [6] . Also, it will be important to take into consideration that some inflammatory parameters such as CRP, white blood cell count, and liver function alterations, as well as pulmonary pneumonia or thromboembolism and collapsed lung, can also be seen in patients presenting with bariatric surgery complications. Therefore, it is important to do a complete differential diagnosis in those patients failing after gastric bypass or sleeve gastrectomy and to include COVID-19 as one more possibility. The patients included received different treatments that have already been described for COVID-19 pneumonia management, including hydroxychloroquine, antiretroviral (lopinavir and ritonavir), tocilizumab, and hemoperfusion. As there is many controversy and variability in pneumonia management across the globe [7] , details on the dose and duration of the treatments should have been included to better use these interesting data in the future. Finally, short case series can help to have a picture of early experiences in bariatric surgery patients. In the meantime, we need to prepare for when normal activity return to surgical centers. Some recommendations would be needed to be considered with regards to bariatric surgery [8, 9] . However, it will be key further evidence coming from larger cohort multicentric studies once the elective procedures are rescheduled after COVID-19 pandemic. Bariatric surgical practice during the initial phase of COVID-19 outbreak World Health Organisation(2020) WHO Director-General's opening remarks at the media briefing on COVID-19 -11 Estimation of coronavirus disease 2019 (COVID-19) Burden and potential for international dissemination of infection from Iran COVID-19 outbreak and surgical practice COVID-19 and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. What is the evidence? Risk of COVID-19 for patients with obesity Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases Perioperative management of patients infected with the novel coronavirus: recommendation from the joint task force of the Chinese society of anesthesiology and the Chinese association of anesthesiologists Recommendations for metabolic and bariatric surgery during the COVID-19 pandemic from IFSO Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Acknowledgments We thank Aminian A et al. for reporting their experience in bariatric cases during COVID-19 outbreak [1] . We would like to highlight a few points and reservations.