From the COVID-19 frontline
28 May 2020
May 2020 was to be month when Rio de Janeiro welcomed the international spine community to the Global Spine Congress. It was to be the busiest week of the year for the organizers, several years' work coming together. It turned out to be a very different story indeed for healthcare workers around the world instead.
As for so many AO Spine surgeons, also Asdrubal Falavigna's calendar started filling up with projects seeking to reduce the impact of the COVID-19 disease. Falavigna, who is starting his chairperson-elect term this summer, shares his experiences of projects related to COVID-19 diagnosis, telemedicine, and provision of supplies and resources in the Caxias do Sul region in southern Brazil.
How do you perceive the initial response to the COVID-19 emergency?
We could never have foreseen such significant changes in our lives as those with COVID-19. Suddenly we are locked in our homes without any social or physical contact, working from home, attending to patients via telemedicine, and performing only emergency surgeries. Elective surgeries have been canceled or postponed.
We follow the physician’s oath and treat also patients who may be contagious and whose disease may threaten us. The best policy to protect us, is to treat these patients because if they are safe, we will be safe. Working in this scenario made me think about why I became a doctor, and I wanted to help more people through innovation and multidisciplinary teamwork.
I started wearing different hats to fight COVID-19’s consequences. We needed to get involved in administrative and health-care decisions to act fast in areas such as provision of supplies, diagnosis, support to patients, and implementing telemedicine solutions. I have learned that multidisciplinary teams have different ways of thinking and working, which requires strategic planning. In times of disasters, one command brings speed and increases efficacy.
How did you go about tackling the challenges?
In a couple of weeks, ideas started leading to results. Like in most countries, also here companies were quickly restructuring operations to respond to the urgency. A laboratory was making alcohol-based disinfecting gel; a fashion design course was engaged to make face masks. The next problem was the lack of ventilators for treating the high number of patients expected. Volunteer university engineers created a respiratory ventilator prototype that is now in the last phase of approval.
Diagnosis of COVID-19 was critical for both doctors and the population. We had no laboratory in the region to test for the disease; patients and health workers had to wait seven days to receive test results. But we had a new lab at the Center for Infectious Diseases, which was equipped and could engage professionals from various labs. They started running up to 200 tests daily and we had results within 48 hours. We also purchased real-time antigen/antibody tests to detect previous contact with COVID-19 in health care professionals.
Knowing whether a person is COVID-19 positive or negative or whether they already have immunity was important in strategic planning for the uptake of economic recovery, social impact, isolation-related psychological issues, and expending equipment for protection. For surgical patients and for surgeons, COVID-19 diagnosis is linked to deciding who can be operated on, prevention of complications, patient protection, and the safety of surgical staff.
You mentioned telemedicine; how are you making use of it?
We had started to build a "digital health center" already some time ago, and it was ready to be used. The center provides a virtual office for health professionals to consultant with and monitor their patients. On this platform, the infectious disease specialist provides orientation for general physicians about COVID-19 patients.
In mid-March, we started a community-based program of teleconsultation to help people with clinical symptoms of COVID-19. We provide guidance on isolation, regarding anxiety or depression, and methods for COVID-19 prevention. The program is open access, free of charge, and takes place in four virtual rooms with trained students and teachers from university medical courses. A multidisciplinary group was created in parallel, to prepare a strategic plan for improvements for the local economy, how to prevent COVID-19 transmission, and the safe resumption of university activities.
What comes next?
I foresee many changes in the way that humans will interact, a new adjustment of the mindset, change of habits and attitudes, the culture, the widespread use of telemedicine, and more gratitude, empathy, and love of life.