Lessons Already Learnt From the Coronavirus Disease 2019 Pandemic.

To the Editor:

The first patient with coronavirus disease 2019 (COVID-19) in Spain was registered on January 31, 2020. Since then, the escalating growth of the disease has affected more than 150,000 patients, has caused over 15,000 deaths, and a similar number of health professionals have been infected. As of April 10, 2020, Spain has the highest number of patients in Europe and the third highest number of deaths in the world.

The thoracic surgery service of our 400-bed hospital serves a population of 1.2 million, and performs about 120 lung resections for lung cancer and over 90 surgical explorations of the mediastinum per year. In early March, the commission in charge of the hospital organization during the pandemic restricted the outpatient clinic to the day hospital for oncohematologic treatments, and also restricted surgical activities to priority oncologic operations. However, with the exponential increase of patients with COVID-19, the outpatient clinics and the postsurgical recovery rooms have had to be transformed into hospital wards and intensive care units, respectively, and the respirators in the operating rooms have had to be used for patients with COVID-19. The result is that no surgical procedure, except for emergency cases, can be performed, and no new patients can be accommodated in the outpatient clinics.

Our hospital is like a casualty hospital; all wards are filled with patients with COVID-19. Nearly 300 health professionals have been infected, and more are in quarantine for having been in close contact with infected patients or colleagues. Those who can still work are devoted exclusively to patients with COVID-19. Some patients have been externalized in a nearby hotel because there was no room in the hospital. Pulmonologists, thoracic surgeons, and oncologists, who usually meet in tumor boards, are now working as part of improvised medical teams attending infected patients. There is only one thoracic surgeon who controls the chest tubes and performs tracheostomies. Tumor boards are now conducted virtually if there is a need to discuss some patients. The numbers in surgical waiting lists and of patients waiting to be diagnosed are increasing. The consequences of delays are difficult to quantify, but most likely will jeopardize the fate of many patients. The workload, once we can resume normal activities, will be enormous.

The COVID-19 pandemic may not be the only disease that we will have to face in our professional lives. Should there be another one, all measures should be taken to keep a section of the hospital clean so that the regular activities can continue for as long as possible. Sooner or later, patients will have to be transferred to makeshift hospitals. If this were done in the early phase of the disease, normal activities could be continued for much longer and priority patients with cancer would be one of those to benefit from timely treatment. The early testing of health personnel and patients, coupled with the use of adequate protective gear, would prevent the dissemination of disease in the hospital, which has been catastrophic in our case. These measures would reduce the number of infections among the health care personnel, would maintain cleanliness in areas of the hospital, and would increase the capacity to continue the regular activities involving patients without COVID-19.