key: cord-337605-s07aorzi authors: Leow, Lowell; Ng, Calvin S H; Mithiran, Harish title: Surgery beyond COVID‐19 date: 2020-08-04 journal: ANZ J Surg DOI: 10.1111/ans.16245 sha: doc_id: 337605 cord_uid: s07aorzi nan TEXT COVID-19 has changed the world as we know it and the practice of medicine forever. Past pandemics may have primed us but COVID-19 unfolded on a scale not seen in modern history with many likening it to the 1918 Spanish Flu. Fortunately, medicine has progressed since then, and the response to COVID-19 in countries like Australia, New Zealand, Singapore, Hong Kong and Taiwan has been robust. The aggressive stance adopted by Australia and New Zealand in travel bans, social distancing and active quarantine and surveillance has flattened the curve, curtailed the spread and prevented overwhelming of healthcare systems by COVID-19 patients. This has helped keep the case-fatality rate to near 1% 1 . Despite healthcare systems coming under siege from the surge, inspirational stories surface each day on how healthcare workers support each other and continue to deliver excellent care. As surgeons, we pride ourselves in our kinaesthetic ability and physical stamina in service of our patients. However, this crisis has forced many of us to adapt to new roles and redefine our practices 2, 3 . Proud custodians of tradition have been compelled to adopt new technology and function within the confines of lockdowns and social distancing. With the advent of a vaccine or herd immunity, we will eventually overcome this pandemic but the landscape of surgery will be transformed. How do we navigate what is to come? As countries learn to live with COVID-19, with a flattened curve and limited outbreaks that can be controlled by quarantine and case contacting, coming out of a lockdown presents equal challenge to entering one. Across the world, countries lifting restrictions are being hit by a second wave of infections and have reinstated lockdowns 4 . To reduce this impact, countries such as Australia and Singapore have adopted three phase plans to guide the re-opening 5, 6 . As the final line of defence, healthcare institutions are expected to unwind restrictions within the workplace slower compared to the rest of society. This means many of our services will continue to function in a pandemic mode until the crisis within our countries are truly over. Mass testing of healthcare workers may expedite this reversal process and mitigate the risk of workplace transmission 7 . Ramping back up of services will be required despite personnel still recovering from the exhaustion of such a prolonged heightened Accepted Article posture. Having prioritized surgeries and displaced most benign and non-emergent cases, surgeons will be faced with a backlog of anxious patients 2 . We need to anticipate this by reprioritizing surgeries and progressively performing more elective cases where resources allow 8 . In this globalized age, spread between countries as borders reopen may cause the pandemic to be further protracted. We This episode reminds us that behind the scalpel, we need to continually update our knowledge and maintain relevance as clinicians first. Medicine has always been slow to adapt, perhaps due to the nature of our training to be only convinced by hard evidence before adopting an idea. Surgery, where the outcomes of our patients are directly and immediately apparent from our actions, carries even higher thresholds. This pandemic has forced us to catch up with the rest of the world in the adoption of technology in our daily practice. Online platforms such as Zoom have radically changed the way we practice multidisciplinary boards, hold department meetings and conduct teaching sessions 2, 9, 10 . We believe this transition will eventually be permanent. Even if physical meetings resume, there will have to be provisions made for participants to join via these platforms 9 . This is especially beneficial for surgeons as we often shuttle between these meetings and the operating theatre. Such accessibility exists though, as a double-edged sword. "Zoom fatigue", a lower threshold for excessive meetings, potential security breaches and an invasion of home privacy may create more problems 11 . We need to remain cognisant of these pitfalls and utilize technology responsibly and rationally. Teleconsultation has also seen a resurgence in this pandemic. We feel this event will serve as an impetus for healthcare systems to develop information Accepted Article This article is protected by copyright. All rights reserved. technology infrastructure and expand on existing programmes that bring healthcare more conveniently to patients. Newer technology conceptualized only for the distant future, such as remote robotic surgery, hybrid "one stop" theatres or bespoke 3D printed PPE may get a much-needed kick-off in the name of infection control. Training programmes will need to embrace virtual reality and simulation training as norm 9, 10 . However, technology cannot fully replace the physical aspect of medicine and surgery. Patients still require the "human touch" and we must continue to respect and uphold this therapeutic privilege that they entrust us with. Beyond the scope of our own institutions, conferences will also benefit from this transition. We are seeing record number of attendees on streamed webinars hosting international panellists despite ongoing travel restrictions. The resources and logistics associated with organizing a conference has been greatly reduced both for participants and faculty 9 . It is likely that future conferences will have to incorporate live stream access and remote participation. Clinical immersion programmes also now come at a fraction of the cost for the visiting surgeons 9 . Technology as a tool should be used to encourage international collaboration and the exchange of ideas and information within our surgical fraternity. Compared to 1918, we as a community have collectively responded better to COVID-19. An explosion of ideas, research and clinical practices have surfaced and been exchanged rapidly via webinars and international conferences. Whilst we remain vigilant against the propagation of misleading information, we have witnessed the sharing of ideas between national health ministries, hospitals down to medical professionals in combating this disease 12 . Such efforts should persist beyond this pandemic to resolve universal problems like wound care and cancer therapy. Against the ever-evolving diseases in modern medicine, we can achieve so much more as a united global front. At the essence of it, this pandemic has reminded us that wherever we may be, we are unified by a common desire to do good for our patients. This article is protected by copyright. All rights reserved. https://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-statementon-restoration-of-elective-surgery This article is protected by copyright. All rights reserved. How New Zealand and Australia are tackling COVID-19. World Economic Forum Lessons already learnt from the Covid-19 pandemic Covid-19 outbreak in Northern Italy: viewpoint of the Milan Area Surgical Community Risk of new lockdowns rises with fear of second COVID-19 Ending circuit breaker: phased approach to resuming activities safely Special Feature Australian Government Department of Health. 3-step framework for a COVIDSafe Australia The Past, Present, and Future of Orthopaedic Education: Lessons Learned from the COVID-19 Pandemic Here's Why You're Feeling Zoom Fatigue. Forbes A midpoint perspective on the COVID-19 pandemic Accepted Article This article is protected by copyright. All rights reserved.