key: cord-0957819-my7ew203 authors: Sarkar, S. title: Letter to the Editor: Neurosurgical Planning in Patients’ Management During the COVID-19 Pandemic—Our Early Experience in Bangladesh date: 2020-06-25 journal: World Neurosurg DOI: 10.1016/j.wneu.2020.06.152 sha: d07a3120b4b26e28ba82d7e0ff3dcc7d3ff618e7 doc_id: 957819 cord_uid: my7ew203 nan The novel coronavirus was first reported in Wuhan, China, in December 2019. The World Health Organization (WHO) formally declared COVID-19 a pandemic on March 11, 2020. Bangladesh's first confirmed COVID-19 case was reported on March 8, 2020, and from June 3 rd through 17 th , Bangladesh experienced the highest number of cases. Currently, on June 17 th , 98,489 COVID-19 cases have been confirmed in Bangladesh. The number of deaths has risen to 1,305 with a case fatality rate (CFR) of 1.36%. These data show that Bangladesh has exceeded China in the number of cases, and is the 18th most affected nation in the world [1]. COVID-19's large impact on patients, caregivers, doctors, nurses, and hospitals means that this disease also impacts neurosurgeons and their patients. A major consequence of the rapid spread of the virus is that hospitals run out of resources to treat patients. The goal is to decrease the number of surgeries to preserve resources (doctors, operating rooms, ICU beds, etc.) for the treatment of COVID-19 patients [2] . Here we summarize our experience in managing neurosurgical patients during the COVID-19 pandemic at the Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh. Patients are either admitted directly (direct admission), or referred from other departments (indirect admission). Prior to admission, patients undergo medical history checking and fever testing. In our setup, we believe that systematic pulmonary computed tomography (CT) scan helps initially in assessing a patient's COVID-19 status, so we obtain a pulmonary CT before admission [3] . COVID-19 polymerase chain reaction (PCR) testing further reinforced the algorithms set up by the local committee and accelerated the diagnosis of suspected cases. Admitted patients belonged to 2 groups: those requiring an immediate surgical procedure (group I) and those requiring urgent but still scheduled surgery (group II). Emergency neurosurgical cases include traumatic cranial and spinal emergencies, intracerebral cerebral hemorrhages, acute hydrocephalus, tumors at risk of intracranial hypertension, cauda equina syndrome, spinal cord compression with neurological deficit, etc. Admission is limited to a maximum of one patient per room, and in the general neurosurgical ward a minimum of 6 feet physical distance between beds is maintained. Group I patients are operated in the emergency operating room/casualty OR; group II patients are operated in the main operating theatre, directly connected to the intensive care unit (ICU). Discharge is made early, and patients are followed up by teleconference. The patient's bed and room are then thoroughly sterilized and kept free of patients for at least 24 h. During hospitalization, only 1 visitor per day/patient is allowed (wearing protective masks). Each staff member is fitted with N95 masks and eye shields. All healthcare workers report their temperatures twice daily and declare any sickness through a desktop or mobile-based staff health surveillance system. Temperature recording compliance is monitored and reminders issued to noncompliant staff [4] . For triage of the non-emergent surgical procedures, we follow the Elective Surgery Acuity Scale (ESAS) recommendations adopted by the American College of Surgeons (ACS) [5] . This system has three tiers of surgical acuity depending on the overall health of the patient: I think COVID-19 added a new dimension -an ongoing third World War. Unlike the first and second World Wars, this time the enemies are invisible, and they can strike from anywhere at any time. The race against COVID-19 will be prolonged; resilience and teamwork are imperative in the coming days. Although the sustainability of this system may be questionable for the long term, it has proven to be efficient in preserving the resources of the hospital so far. Effects of the COVID-19 outbreak in Northern Italy: perspectives from the Bergamo Neurosurgery Department Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases Editorial. COVID-19 and its impact on neurosurgery: our early experience in Singapore American College of Surgeons (2020) COVID-19: guidance for triage of non-emergent surgical procedures The author has no conflict of interest in relation to this article.