Urgent Covid-19 Update from the OAS President
March 14, 2020
Dear OAS members:
It is my great honor to serve you again as your president, I really appreciate your support for the board of directors and me. Thank you.
Our country is facing a great challenge because of the national Covid-19 epidemic alongside the global epidemic. The United States President just announced a national emergency. Compared to other countries, our country is not quite as ready as they were to fight this deadly disease. There are several guidelines published by the CDC, ASA Patient Safety Foundation, and local public health agencies, which are very useful and updated, however, they are significantly lacking instructional guidance to the medical professionals. On Monday, the third ophthalmologist died from the coronavirus in China, adding the numbers of doctors and nurses who died from the disease to close to hundreds, including a vice president of the hospital, a chair of the gastroenterology department, a chair of the pulmonary department, etc. The conclusion from the Chinese experience is that the Covid-19 is very contagious! In our country, the reality is that we do not know how many patients or Covid-19 carriers among us because of the lack of capacity of testing. My question is how can we protect ourselves and minimize the possible risk of exposure under current circumstances?
I believe most of you and I are working in the surgical centers for ambulatory ophthalmic surgery, but I am not sure how many of your surgical centers have a preoperative screening service, which I believe can play a very important role for the prevention of infection. In my place, we have a "Preoperative Evaluation Service" (PES) to screen most of the patients undergoing elective eye surgery. We demand that all patients should have history and a physical exam completed and post in the electronic medical record system 5 days before the surgery date. Two full-time nurses and a nurse practitioner will review their medical problems and call every patient, and complete the pre-op evaluation process. If a patient needs more information or further workup, they will work with the surgeon's clerk and follow until it is done. Therefore, almost every patient shows up in the morning of surgery in my facility, she or he already be evaluated and optimized. With this setting, my hospital just send out an email to adding more questions in the pre-op screening trying to further identify those patients with symptoms and prevent them to the hospital and infect other patients. Last week, we prevented at least two patients with symptoms (but no test for Covid-19) after traveling to China and Taiwan to come to our OR.
As I am finishing this email, many hospitals in the nation have postponed all elective surgery, but my hospital is not. If your surgical centers still doing "business as usual" and continue elective surgery, I strongly recommend you to sit down with the leadership of your surgical centers, to make sure you have a pre-op screening for all patients (if you do not have one, it is time to set up one), reschedule surgery for any patients with symptoms, or travel history to the infected countries and symptomatic, make sure your surgical centers have adequate protective equipment to protect you and your staffs, and consider to create traffic paths to separate staffs and patients, etc.
Thank you for your attention, take care and keep safe and healthy!
Zhuang T. Fang, M.D., MSPH, FASA
David Geffen School of Medicine at UCLA
Department of Anesthesiology and Perioperative Medicine
Associate Medical Director, Wasserman Stein Operating Rooms