key: cord-0793695-kywve3i8
authors: Ong, William Lay Keat; Lechmiannandan, Sivaneswaran; Loeb, Stacy; Teoh, Jeremy Yuen-Chun
title: Urological Services in Public Hospitals Suffered a Greater Detriment than Private Hospitals During the Battle of COVID-19
date: 2020-07-18
journal: Urology
DOI: 10.1016/j.urology.2020.07.010
sha: e56c1e52c3d5f0b568aea3498ccaff25e39d6591
doc_id: 793695
cord_uid: kywve3i8

nan

Dear editor,

The Coronavirus disease-19 (COVID-19) has been regarded as the most challenging global health crisis since its declaration as pandemic on 11 th March 2020 by the World Health Organization (WHO) 1 . As COVID-19 swept through continents, health care services across all specialties, including urology were disrupted 2 .

Recently, a global survey on the impact of COVID-19 on urological services was conducted, with a total of 1004 responses from urology health care professionals (HCPs) reviewed 3 . Results showed that COVID-19 had a profound negative impact on the delivery of urological care globally. The level of setbacks corresponded to the degree of COVID-19 outbreak. The severity of this impact, however, may not be representative of the various urological establishments. We thus performed a post-hoc analysis to compare the severity of COVID-19 effects on urology services between the public and private institutions.

After excluding participants who had mixed public and private practices, 891 participants remained for the analysis. 71.8% were from public hospitals and 16.9% were from private hospitals. Majority of respondents were 30 to 49 years old and were predominantly consultant urologists. 57.4% of them have been in practice up to 10 years. The demographic characteristics of survey respondents are shown in Supplementary Table 1. There were more public than private hospital-based respondents working in COVID-19 centres (85.8% versus 50.8%, p<0.001). 45.9% from public and 25.4% from private hospitals reported staffs diagnosed with COVID-19 infection (p<0.001). 30.2% from public and 9% from private hospitals were deployed to manage COVID-19 patients (p<0.001), with manpower shortage posing more concerns in the public hospitals (45.9% versus 25.4%, p<0.001). Although most hospitals were equipped with personal protective equipment (PPE) (surgical mask, N95, bodysuits, splash guard or face shield, goggles and others), only 33.1% of public and 36.9% of private respondents confirmed the sufficiency of PPE in their centres (p=0.025). 36.5% of public and 20.5% of private respondents were adequately trained to use PPE. Concerningly, more public than private (24.5% versus 7.4%, p<0.001) administrative authorities prohibited health care workers from sharing their experience on conventional and social media (Table 1) .

Finally, 52.5% from public and 39.8% from private believed that postponement of clinical services would affect their patients' treatment and survival outcomes (p=0.025). Only 42.6% from the public hospitals (versus 61.9% from the private hospitals, p=0.001) had the confidence to deal with accumulated workload in a timely manner after the pandemic. In terms of income, however, private urology professionals (88.5%) suffered significant salary cutbacks compared to their colleagues in public (49.7%) (p<0.001). Urological patients screened negative for COVID-19 could be referred to non-COVID-19 private hospitals to avoid delay in intervention. Private institutions may also cope better to deal with the backlog once COVID-19 has settled. It may help alleviate the potential financial problems that private practice providers may be facing, given the significant salary reduction during this critical period. Implementation of public-private partnership strategies in tackling this matter appears imperative 4 .

In summary, public hospitals suffered greater losses of manpower, inadequacy of PPE and restriction of media contact while HCPs in the private hospitals suffered greater loss financially. Profound repercussions are to be anticipated and necessitates reallocation of resources by financing bodies to halt the foreseen exhaustion. 

WHO Timeline -COVID-19

COVID-19 and urology: a comprehensive review of the literature

A Global Survey on the Impact of COVID-19 on Urological Services

Enabling the private health sector in the national response to covid-19: six current policy challenges

Jeremy Yuen-Chun Teoh has received honorarium from Olympus and Boston Scientific, travel grants from Olympus and Boston Scientific, and research grants from Olympus and Storz. Stacy Loeb reports reimbursed travel from Sanofi and equity in Gilead.