Where do Urologists Stand in the Era of Novel Coronavirus-2019 Disease

Thomas Hughes; Hui Ching Ho; Shahrokh F. Shariat; Bhaskar Kumar Somani

Disclosures

Curr Opin Urol. 2020;30(4):610-616. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: The novel coronavirus-2019 disease (COVID-19) pandemic has had devastating consequences on healthcare systems globally. The effect this has on urologists and the patients they care for is not fully understood and presents the challenge of prioritizing the most urgent cases. We aim to review the impact on urology services and evaluate strategies to minimize disruption.

Recent findings: Various healthcare systems have been forced to postpone treatment for many urological conditions as resources are dedicated to the treatment of COVID-19. Training has been postponed as staff are reallocated to areas of need. Face-to-face contact is largely minimized and innovative, virtual communication methods are used in the outpatient setting and multidisciplinary team meetings. Surgical practice is changing because of the risks posed by COVID-19 and procedures can be prioritized in a nonurgent, low priority, high priority or emergency category.

Summary: Although the COVID-19 pandemic will inevitably affect urological services, steps can be taken to mitigate the impact and prioritize the patients most in need of urgent care. Similarly, in future; simulation, e-learning and webinars will allow interaction to share, discuss and debate focused training and education.

Introduction

Since the first cases were identified in Hubei Province, China, in December 2019, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has relentlessly spread around the world affecting all inhabited continents.[1] As of the 7th April 2020, more than 1.2 million people have been infected with approximately 67 000 deaths globally. The WHO declared novel coronavirus-2019 disease (COVID-19), caused by SARS-CoV-2, to be a public health emergency and a pandemic on 11th March 2020.[2]

SARS-CoV-2 causes a wide range of clinical manifestations from asymptomatic infection to death.[3] The majority of patients develop a mild upper respiratory tract infection with fever that does not require hospitalization in most cases. However, a significant proportion of patients develop severe viral-pneumonia, which can result in respiratory failure requiring mechanical ventilation. Overall, the fatality rate due to COVID-19 is currently estimated to be between 1 and 5%.[4] However, this is higher in older patients and those with comorbidities including hypertension, diabetes, cancer and coronary heart disease.[3]

The key initial management for all suspected cases is infection control and prevention by isolation into a separate area and adequate protective personal equipment (PPE).[5] Diagnosis will require laboratory confirmation. Nasopharyngeal swabs and sputum are widely tested using the real-time transcription polymerase chain reaction. Radiological imaging of the chest including x-ray and computed tomography can be used to aid diagnosis. Currently, serology testing is under development aiming to identify antibodies to SARS-CoV-2.[6]

The rapid, overwhelming surge of COVID-19 cases has resulted in unprecedented numbers of critically unwell patients requiring ICU treatment, straining health systems globally. As ICU and hospitals are overwhelmed by the impact of COVID-19, the progressive cancellation of elective services is widely enacted.

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