How Anaesthesiology Helped to Fight the First Wave of the COVID-19 Pandemic in Portugal
Keywords:Anesthesiology, COVID-19, Critical Care, Health Personnel, Health Planning
Introduction: The dissemination of the COVID-19 pandemic in Europe, namely in Portugal, demanded an organizational and clinical reaction from the Portuguese National Health Service. With the unpredictable impact of COVID-19 infected patients redefining hospital logistics, reducing non-priority elective care and extending the hospital capacity for critical care patients made mobilizing a significant part of human resources a priority. We conducted a national survey to monitor the contribution and the role of anaesthesiologists belonging to the 53 Portuguese National Health Service hospitals in the first wave fight against the pandemic.
Material and Methods: This prospective cross-sectional observational study used a weekly survey sent to the Directors of the Anaesthesiology Departments of all Portuguese National Health Service hospitals, between the period of 13th April and 21st June 2020. Directors were asked about human resources, hospital logistics, anaesthetic activity and residency programs in their departments as well as contingency plans facing the impact of the pandemic growth in the PNHS.
Results: Contingency strategy for all Portuguese National Health Service hospitals planned for a total of 1524 level III critical care beds during the initial phases of the pandemic, an increase of 151% from the existing 607 level III critical care beds in Portugal in January 2020. This re-configuration effort of the Portuguese National Health Service was only possible due to the partial or total suspension of non-urgent elective activity that reached over 90% of these institutions in the first pandemic months (March and April) and the deployment of anaesthesiologists from their normal activities to the treatment of critical care patients. During the peak of the first pandemic wave, 209 anaesthesiology specialists and 170 trainees (22.9% of the total anaesthesiologist’s staff in the Portuguese National Health Service) were deployed in critical care. There was an almost complete interruption of the residency program rotation in 70.4% of hospitals with anaesthesiology residents, between March and April 2020.
Conclusion: During the first pandemic wave there was an effective and fast reorganisation of the Portuguese National Health Service in order to increase level III critical care beds, which might have contributed to the low mortality rates in Portugal. We believe that this could have also been a result of the contribution given by all public anaesthesiology departments.
Cheng ZJ, Shan J. 2019 Novel coronavirus: where we are and what we know. Infection. 2020;48:155-63. DOI: https://doi.org/10.1007/s15010-020-01401-y
Sun P, Lu X, Xu C, Sun W, Pan B. Understanding of COVID-19 based on current evidence. J Med Virol. 2020;92:548-51. DOI: https://doi.org/10.1002/jmv.25722
Portugal. Decree-Law nr. 14-A/2020. Official Gazette, I Series, nr. 55 (2020/03/18).
Direcção-Geral da Saúde. Norma n.º 005/2020, de 26 de Março. COVID-19: Fase de mitigação. Resposta em Medicina Intensiva. 2020. [cited 2022 Jun 01]. Available from: https://www.dgs.pt/directrizes-dadgs/normas-e-circulares-normativas/norma-n-0052020-de-26032020-pdf.aspx.
Governo da República Portuguesa. Comunicado do Conselho de Ministros de 2020/04/30. 2020. [cited 2022 Jun 01] Available from: https://www.portugal.gov.pt/pt/gc22/governo/comunicado-de-conselhode-ministros?i=344.
Buonanno G, Morawska L, Stabile L. Quantitative assessment of the risk of airborne transmission of SARS-CoV-2 infection: prospective and retrospective applications. Environ Int. 2020;145:106112. DOI: https://doi.org/10.1016/j.envint.2020.106112
Gabinete da Ministra da Saúde. Despacho do Gabinete da Ministra da Saúde, de 2020/03/16. 2020. [cited 2022 Jun 01] Available from: https://app.parlamento.pt/webutils/docs/doc.pdf?path=6148523063446f764c324679626d56304c334e706447567a4c31684a566b786c5a793944543030764f554e544c305276593356745a57353062334e4259335270646d6c6b5957526c5132397461584e7a595738764e5759335a4451795a5755744d5751324e4330304d474e694c574a6c4e544d744e6d55774e6a49774e57526a4f5459324c6e426b5a673d3d&fich=5f7d42ee-1d64-40cbbe53-6e06205dc966.pdf&Inline=true.
Díaz Ramírez M, Veneri P, Lembcke AC. Where did it hit harder? Understanding the geography of excess mortality during the COVID-19 pandemic. J Reg Sci. 2022 (In Press). doi: 10.1111/jors.12595. DOI: https://doi.org/10.1111/jors.12595
Sorbello M, El-Boghdadly K, Di Giacinto I, Cataldo R, Esposito C, Falcetta S, et al. Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) Airway Research Group, and The European Airway Management Society. The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia. 2020;75:724-32. DOI: https://doi.org/10.1111/anae.15049
Direcção-Geral da Saúde. Ponto da situação actual em Portugal. [cited 2020 Dec 08]. Available from: https://covid19.min-saude.pt/ponto-desituacao-atual-em-portugal/.
Worldometers. COVID-19 coronavirus pandemic. [cited 2022 Jun 01]. Available from: https://www.worldometers.info/coronavirus/.
Bauer J, Bruggmann D, Klingelhofer D, Maier W, Schwettmann L, Weiss DJ, et al. Access to intensive care in 14 European countries: a spatial analysis of intensive care and capacity in the light of COVID-19. Intensive Care Med. 2020;46:2026-34. DOI: https://doi.org/10.1007/s00134-020-06229-6
Kursumovic E, Cook TM, Vindrola-Padros C, Kane AD, Armstrong RA, Waite O, et al. The impact of COVID-19 on anaesthesia and critical care services in UK: a serial service evaluation. Anaesthesia. 2021;76:1167-75. DOI: https://doi.org/10.1111/anae.15512
Sorbello M, Morello G, Pintaudi S, Cataldo R. COVID-19: intubation kit, intubation team, or intubation spots? Anesth Analg. 2020;131:e128-30. DOI: https://doi.org/10.1213/ANE.0000000000004970
Diaz A, Sarac BA, Schoenbrunner AR, Janis J, Pawlik TM. Elective surgery in the time of COVID-19. Am J Surg. 2020;219:900-2. DOI: https://doi.org/10.1016/j.amjsurg.2020.04.014
Gharibo C, Sharma A, Soin A, Shah S, Diwan S, Buenventura R, et al. Triaging interventional pain procedures during COVID-19 or related
elective surgery restrictions: evidence-informed guidance from the American Society of Interventional Pain Physicians (ASIPP). Pain Physician. 2020;23:S183-204. DOI: https://doi.org/10.36076/ppj.2020/23/S183
Prasad NK, Englum BR, Turner DJ, Lake R, Siddiqui T, Mayorga-Carlin M, et al. A nation-wide review of elective surgery and COVID-surge capacity. J Surg Res. 2021;267:211-6. DOI: https://doi.org/10.1016/j.jss.2021.05.028
COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with peri-operative SARS-CoV-2 infection: an international cohort study. Lancet. 2020;396:27-38. DOI: https://doi.org/10.1016/S0140-6736(20)31182-X
COVIDSurg Collaborative. Elective surgery cancellations due to COVID-19 pandemic: global predictive modeling to inform surgery recovery plans. Br J Surg. 2020;147:1440-9.
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