key: cord-300855-vba552kh
authors: Dungar, Keval Dhanji; Sooriah, Kirstin Louise
title: The lessons to learn with regards to hospital admissions during the COVID-19 pandemic, a Commentary on “acute care surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study”
date: 2020-10-08
journal: Int J Surg
DOI: 10.1016/j.ijsu.2020.10.001
sha: 
doc_id: 300855
cord_uid: vba552kh

nan

Acute Surgery Elective Surgery Acute Cholecystitis Cancer Hospital Admissions Dear Editor,

We read with great interest the study by Cano-Valderrama et al [1] which compared the number of acute care surgery procedures during the COVID-19 pandemic with a control period. It reported a significant reduction in acute care surgeries during the pandemic.

Furthermore, it highlighted an increased period of time between symptom onset and presentation to the emergency department. One of the driving factors of this delay in presentation could be due to fears of contracting COVID-19. Many patients believe hospitals to be a key source of infection and perhaps decide that their health complaint is not severe enough to warrant the risk of becoming ill with COVID-19 [2] . We consider in this letter how a delay in presentation may affect patients in the future and how it could be avoided.

Undoubtedly, a delayed presentation leads to increased morbidity and mortality. Delayed presentations during the COVID-19 pandemic have contributed to death in major conditions such as diabetic ketoacidosis, sepsis and appendicitis in children [3] . Furthermore, patients with cancer have also presented later during the pandemic, which has contributed to a more aggressive disease burden that is increasingly difficult to manage. It is estimated that there will be a significant increase in avoidable cancer deaths, in part due to a delay in presentation. [4] . symptoms require attendance to the emergency department [2] . This could help to avoid unnecessary delays in presentation.

In summary, the risk of a second wave of COVID-19 presents a very unpredictable future for hospital admissions as a whole. As the public becomes more accustomed to life during a pandemic, they may access healthcare sooner in an emergency due to a better understanding of how to reduce transmission. However, if the fear of being infected with SARS-CoV-2 remains at the current level, delay in presentation of medical and surgical emergencies will continue during the second peak of the pandemic. Therefore, a key lesson to be learnt in the event of a second wave, is to reduce patient fear. This can be done by increasing testing capacity, creating COVID-19 free zones where possible, and enforcing public health campaigns confirming that health services are open for all emergencies and that patient safety is an utmost priority.

Acute Care Surgery during the COVID-19 pandemic in Spain: Changes in volume, causes and complications. A multicentre retrospective cohort study

Where Are All The Patients? Addressing Covid-19 Fear To Encourage Sick Patients To Seek Emergency Care. NEJM Catalyst -Innovations in Care Delivery

Delayed access to care and late presentations in children during the COVID-19 pandemic: a snapshot J o u r n a l P r e -p r o o f survey of 4075 paediatricians in the UK and Ireland

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study

Research At University College Hospital Shows Safe Cancer Surgery Is Possible During The COVID-19 Pandemic

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