key: cord-0841042-rxt75zex authors: Ma, Xiya; Vervoort, Dominique; Reddy, Ché L.; Park, Kee B.; Makasa, Emmanuel title: Emergency and essential surgical healthcare services during COVID-19 in low- and middle-income countries: A Perspective date: 2020-05-16 journal: Int J Surg DOI: 10.1016/j.ijsu.2020.05.037 sha: 89b89ead0f4e9be2e36bdad74634b9e28f7ba3d9 doc_id: 841042 cord_uid: rxt75zex The COVID-19 pandemic resulted in significant changes in health care systems worldwide, with low- and middle-income countries (LMIC) sustaining important repercussions. Specifically, alongside cancellation and postponements of non-essential surgical services, emergency and essential surgical care delivery may become affected due to the shift of human and material resources towards fighting the pandemic. For surgeries that do get carried through, new difficulties arise in protecting surgical personnel from contracting SARS-CoV-2. This scarcity in LMIC surgical ecosystems may result in higher morbidity and mortality, in addition to the COVID-19 toll. This paper aims to explore the potential consequences of COVID-19 on the emergency and essential surgical care in LMICs, to offer recommendations to mitigate damages and to reflect on preparedness for future crises. Reducing the devastating consequences of the COVID-19 pandemic on LMIC emergency and essential surgical services can be achieved through empowering communities with accurate information and knowledge on prevention, optimizing surgical material resources, providing quality training of health care personnel to treat SARS-CoV-2, and ensuring adequate personal protection equipment for workers on the frontline. While LMIC health systems are under larger strain, the experience from previous outbreaks may aid in order to innovate and adapt to the current pandemic. Protecting LMIC surgical ecosystems will be a pivotal process in ensuring that previous health system strengthening efforts are preserved, comprehensive care for populations worldwide are ensured, and to allow for future developments beyond the pandemic. In a matter of weeks, the COVID-19 crisis led to the cancelation and indefinite 23 postponements of countless surgical clinics and elective surgeries in favor of redirecting 24 resources towards the pandemic preparedness and response. As the pandemic paralyzes some 25 of the world's most robust health systems, how will surgical ecosystems in LMICs cope with 26 the crisis, in which health systems are comparatively weaker? as canceling all non-essential surgical elective procedures and outpatient clinics, urgent and 48 emergent surgical diseases will continue to occur and contribute to avoidable morbidity and 49 mortality. Though the need for trauma care for road traffic incidents may have declined due 50 to COVID19 response measures of quarantine and self-isolate, emergency and essential 51 surgical healthcare will remain a significant need due to other indications. 5 These include Eventually, the pandemic will come to an end. However, emergency and essential 225 surgical care will continue to be needed, both throughout the pandemic and beyond. Protecting our surgical healthcare workers is critical to ensure optimal care delivery for World Health Assembly Resolution WHA68.15: 237 "Strengthening Emergency and Essential Surgical Care and Anesthesia as a 238 Component of Universal Health Coverage"-Addressing the Public Health Gaps 239 Arising from Lack of Safe, Affordable and Accessible Surgical and Global Surgery 2030: Evidence and 242 solutions for achieving health, welfare, and economic development Global access to surgical care: A modelling 245 study Global burden of surgical disease: an 247 estimation from the provider perspective How coronavirus is affecting trauma systems in Italy. Trauma System News The global met 253 need for emergency obstetric care: A systematic review Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 Virus Knocks Thousands of Health Workers Out of Action in The New York Times Italian doctors call for protecting healthcare 263 workers and boosting community surveillance during covid-19 outbreak Protecting health-care workers 266 from subclinical coronavirus infection Number of Boston-Area Hospital Workers With Coronavirus 269 Swells Past 150 Healthcare Workers Who Died From Coronavirus COVID-19 Dashboard by the Center for Systems Science 274 and Engineering Achieving affordable critical care in low-278 income and middle-income countries The 281 variability of critical care bed numbers in Europe Cuomo Says New York Needs As Many As 37,000 ICU Beds It Has Only 3,000. Forbes Critical care capacity during the COVID-19 pandemic: Global 288 availability of intensive care beds. J Crit Care. 2020. clock (and at cost) in coronavirus fight The Italian coronavirus disease 2019 300 outbreak: recommendations from clinical practice A cluster randomised trial of cloth masks 303 compared with medical masks in healthcare workers Part of the Cure or Spreader of Disease? Is Africa prepared for tackling the COVID-19 CoV-2) epidemic. Lessons from past outbreaks, ongoing pan-African public 309 health efforts, and implications for the future Community Participation in Health Systems 312 Research: A Systematic Review Assessing the State of Research Interventions Involved and the Features of Engagement with Communities COVID-19) epidemics, the newest and biggest global health threats: what lessons 319 have we learned? New Technology, and Proactive Testing Researchers Devise New Breakthrough To Protect Healthcare Workers 324 From Coronavirus. Forbes Surgical Task-Sharing to Non-specialist Physicians in Low-Resource Settings Globally: A Systematic Review of the Literature Modi Orders 3-Week Total Lockdown for All 1.3 Billion 331 Unique Identifying number or registration ID: 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Author contribution Please specify the contribution of each author to the paper, e.g. study design, data collections Conceptualization, Writing, Reviewing and Editing Dominique Vervoort: Conceptualization, Writing, Reviewing and Editing Che L. Reddy: Writing, Reviewing and Editing Park: Writing, Reviewing and Editing, Supervision Emmanuel Makasa: Writing, Reviewing and Editing The following additional information is required for submission. Please note that failure to respond to these questions/statements will mean your submission will be returned. If you have nothing to declare in any of these categories, then this should be stated. 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