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COVID-19 Discussion
By Alison Shamwana | Started 30th Apr 2020
INTRODUCTION BY MARTIN SMITH, IHPBA PRESIDENT
Follow this link to read the introduction by our President, Professor Martin Smith.
Note of Gratitude, Dr Jagannath
Hope all well…
Stay well…
I've received so many messages from the IHPBA family across the world enquiring about my wellbeing and of my family.
I am deeply touched by this concern and warmth from my extended family.
I am glad to share that ‘We are all well … today’ ! In the current times we start with the greeting – ‘Hope you are well’
In 2020 the experts debated as to how as to ‘why India had lower mortality from Covid. In 2021 the same experts are debating ‘why mortality is high in India’. It is a paradox which is difficult to understand.
Perhaps the lower impact initially led to complacency in both the people and the government. The infrastructure and the supplies were not ramped up sufficiently.
The second wave is actually a ‘Tsunami’ which hit with limited notice and with great force. City after city, state after state are reeling under the impact.
We are fortunate that we have been vaccinated as a priority and also have been taking precautions. We were just starting our elective work as many of the cancer patients were waiting patiently for their surgeries. Just as we thought that normalcy is returning and we are out of the tunnel, that we've been hit badly.
The international community has been generous in sending the supplies but real shortage is a healthcare infrastructure not just physical infrastructure but the manpower. Above all ‘vaccine’ shortage in a country which produces vaccines for the world!
Media always sensationalises. It’s not as horrific as they project. We don’t see ambulances screaming , but hospitals are full and ICU beds are in short supply.
All my resident staff and from other all other departments are all on Covid duties. They have not gone home for now more than 12 months. Not met their families as they fear that they may take the virus home. In fact whenever I go to the hospital and return, I feel apprehensive that the new variant may be carried in spite of vaccination.
I am grateful that those who are known in the HPB community are safe so far.
Many intensivists, chest physicians , nurses and staff have contracted Covid. Some of them have gone through ICUs. Most of them have recovered, but yes there were some tragedies in the second wave.
We will continue to work, to provide care as much as we can within the constraints of the resources. We have an efficient teleconsult platform which is working well. HPB surgical care has been decentralised has many surgeons trained across the country are performing complex procedures in semiurban settings. Necessity is the mother of invention.
With all good wishes ‘This too shall pass’ .
Wishing you, your families, residents, colleagues, staff and friends -safety and good health
Stay well my friends, you are very precious for the society
Dr Jagannath
COVID-19 Video Diaries
Doctor P. Jagannath: Close call followed by a long week...
Follow this link to read Dr Jagannath’s account of his close brush with COVID during the first wave in India.
Michelle L de Oliveira - President of the UEMS HPB Board of Examination:
Follow this link to read an explanation by Michelle L de Oliveria, President of the UEMS HPB Board of Examination) on the impact of the COVID-19 crisis on the late 2020 examinations, the wider impacts to the HPB surgical education system, and how the HPB syllabus may need to change in response.
Orlando Torres: Being an HPB surgeon during the COVID-19 era.
Follow this link to read Dr Orlando Torres’ account of how COVID-19 impacted not only his professional, but also personal life.
AHBPA Webinar on COVID-19
Follow this link to view the AHPBA Webinar on COVID-19 and HPB Surgery. This is a very useful discussion, but please note that it took place on 17 April 2020 so data provided in the webinar and the Q&A should be viewed in light of a rapidly changing landscape.
Impact of the coronavirus pandemic on the role of HPB surgeons in Tongji Hospital, Wuhan, China
This report [link] by Lin Chen, Zhi-yong Huang and Xiao-ping Chen describes how HPB surgeons in the Tongji Hospital of Wuhan, at the epicentre of the coronavirus outbreak in China, were called upon to assist in the fight against coronavirus, and the strategies adopted to successfully deliver HPB service to the most severely affected COVID-19 patients and others during the last four months.
Fabio Ausania: Being an HBP Surgeon during COVID19 times
Follow this link to read a report by Fabio Ausania, Hospital Clínic de Barcelona, on the impact COVID-19 has had in Catalonia.
Delivery of HPB surgery during the COVID-19 pandemic: an European-African HPB Association Survey
Watch this presentation by Anita Balakrishnan of the results of the above survey to which many of you will have contributed:
A paper is also being published in HPB, you can view the full text here
Please use the discussion board below if you have any questions for the authors on the survey or results.
GROUND RULES
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Jagannath Palepu 5th May 2020
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Tihomir Georgiev Hristov 6th May 2020
(2)
Dear colleagues,
My name is Tihomir Georgiev, an HPB surgeon from Spain.
As the pandemic progresses, I am more and more concerned about those patients that have recently passed a COVID-19 pneumonia with some residual chest X-ray changes, that already have at least one negative PCR test and, being asymptomatic for more than 2-3 weeks, are to undergo an elective HPB surgery.
The available protocols do not consider the possibility the patient continues being infective even after negative PCR test and, at least in my institution, the current protocol do not recommend any additional protective measures when operating on such patients.
Would you be so kind to share your personal experience and opinion on whether you would use PPE during a complex liver resection in such patient or you could consider the patient definitely non infective (being asymptomatic and SARSCOV2 PCR negative).
Thank you
Debanshu Bhaduri 7th May 2020
(1)
Dear Tihomir
My name is Debanshu Bhaduri, and I am a surgical oncologist from Maharashtra, India, the state hit hardest by COVID 19 in this country. I can share my department's policy with you and I hope it is of some use.
We have not shut oncology services even a single day at our institute even though India has, and is witnessing the most stringent lockdown in the history of the planet (so I am informed). As a charitable institute with moderate funding, PPE acquisition is a perpetual conundrum. Since the outbreak, major surgical procedure numbers have abated just a bit because of the logistics involved in reaching the hospital (for patients and their care givers). However, as testing and 'window period' period dilemmas continue, and with several of our staff struck with the virus, we treat each and every patient undergoing surgery or in house as positive for COVID 19 regardless of test conclusions. Accordingly, protective measures are taken for all patients undergoing surgery.
I am happy to inform you that thus far my team and I are virus free and the policy seems to be working. We have also been lucky enough to have performed major HPB surgery on just one patient who had a prior history of COVID 19. There was no flare up of symptoms during the perioperative period.
In our non HPB patients, we have not yet encountered a single COVID positive patient (all patients are tested prior to admission), but we continue to follow a policy of "a high degree of suspicion" universally.
Prashant Bhangui 11th May 2020
(1)
Dear Prof Orlando, yours is a heartwarming tale of how a "family" of specialists and a young doctor with a young son has demonstrated the courage to fight this deadly virus that has created havoc for us, our patients, and the whole medical and social system worldwide!! Life has ceased to be the same for more than 3 months now, but the important thing is to keep going, and stay positive!! All the best to you and your family my friend, and ...LETS KEEP THE FAITH!!!
We at Medanta, in Delhi-NCR India are continuing to operate on our HPB cancer patients with prior RT-PCR Testing (with/without preop CT Chest as indicated), and also transplanting urgent/semi urgent end stage liver disease patients, trying our best to keep our patients and ourselves safe, in these difficult times. But the logistics are overwhelming to say the least!!
Alison Shamwana 18th May 2020
(0)
The IHPBA COVID-19 REGISTRY will help members understand the consequences of COVID on HPB services worldwide.
For full background & to REGISTER YOUR CENTRE / get a password: https://medscinet.com/Covidihpba/
Real-time results: https://
https://www.medscinet.com/Covidihpba/about.aspx?lang=1
Contributors may access a more detailed dashboard.
Prasad Wagle 6th Jun 2020
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Prasad Wagle 6th Jun 2020
(0)
Let me begin by giving my best wishes to my good friend Dr Orlando Torres & his family for having recovered well from COVID .
As you would be aware India & in particular Mumbai are in the throes of COVID currently, probably peaking as i write this.
India currently is trying to wriggle out of the lockdown enforced on March 22. Not only has the economy been brought to its knees but even routine surgical services have been hampered greatly as the focus currently like elsewhere is on the Pandemic.
I would like to confess & not sheepishly that HPB work has plummeted since the enforced lockdown. The reasons as i see it are primarily due to patient reluctance to come to a COVID facility & secondary from the Surgeons viewpoint point of not burdening the already crunched resources. Working long hours in a claustrophobic PPE would be a distant third, though i am certain things will be better over time.
I would also like to draw attention to the COVID registry. I have registered for the same though i would like to mention as a rule we are not operating COVID positive HBP related work & perhaps rightly so as recent studies have indeed shown higher perioperative morbidity & mortality.
Let me end this piece wishing all my HPB colleagues a safe 2020 & looking forward meeting my friends in Melbourne early next year.
Åsmund Avdem Fretland 7th Jun 2020
(0)
Dear colleagues,
In Oslo, Norway we are now running HPB surgery almost as normal. We are also getting patients in who has had COVID19 and who recovered well. I guess many of you have operated patients like that now. Any good advice for us? Did anyone encounter unexpected complications?
Best regards,
Åsmund
Alison Shamwana 24th Jun 2020
(0)
NEW CONTENT ADDED
A presentation by Anita Balakrishnan explains the results of the E-AHPBA survey on delivery of HPB surgery during the COVID-19 pandemic to which many members contributed.
There is also a link to the full-text manuscript detailing the findings of the survey which will be published in HPB journal.
Alison Shamwana 7th Jul 2020
(1)
NEW CONTENT ADDED
Read Dr P Jagannath's vivid and powerful account of his recent brush with COVID-19, and what he describes as "the longest week of my life".
Alison Shamwana 10th Jul 2020
(1)
In "What next after the Close Call?", Dr Jagannath's personal and inspiring follow up to his article on the COVID-19 outbreak in his hospital clearly illustrates how much front line medical staff are prepared to give in providing care to those struck down by this virus.