Management and outcomes of a vascular surgery department with sudden medical staff outbreak of COVID-19.

The rapidly spreading COVID-19 pandemic, first identified in China in December 2019, caused an outbreak in the medical staff of our Department of Angiology and Vascular Surgery. The first positive case of COVID-19 (the head of the department) was diagnosed on March 13, when the country counted just 112 cases. High-risk contacts had to go through quarantine, with five more colleagues testing positive in the subsequent week. In the blink of an eye, the department suffered a 55% reduction of medical staff (62.5% specialist reduction).

Besides the contingency measures already implemented, such as suspension of all ambulatory activity and a reduction of ≈73% in operating room time, a tailored contingency plan was mandatory to rationalize the scarce medical resources of our department—a pioneer attitude that was in general accordance with the posteriorly issued recommendations.

Six weeks have passed, and thankfully, all of our infected colleagues had a good recovery; only one needed intensive care support but has already been discharged. During this 6-week period, there were three infected patients, without medical staff cross-infection. Even with this huge human resource constraint, the department fulfilled all planned activities.

Retrospectively reviewing our databases and comparing this 6-week period with the prior 6 weeks, we could verify that the ward occupancy rate decreased from 101.41% to 64.61%, while outpatient clinic visits decreased 87.7% (≈83.7% appointments performed in this pandemic era were via telemedicine). Furthermore, there was a huge surgical impact with ≈87% decrease, with a higher reduction in elective surgery being registered, as expected (≈90%). However, even urgent interventions had a significant reduction, ≈57%, raising concern as to whether fear of COVID-19 infection was preventing patients from coming to the emergency department.

With a successful flattening of the curve and 23,392 confirmed cases in Portugal (880 deaths and 1277 recovered cases to this date), a “new normal” is being redefined. Nonetheless, with a “second coming” of COVID-19 and an expected wave of vascular patients resulting from prolonged waiting times with a possibly deteriorated clinical status, vascular practice will have to evolve pliably and efficiently.