Some Thoughts on the Impact of COVID-19 on Plastic Surgery.

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Dear Editor

The outbreak of coronavirus disease (COVID-19) in December 2019 changed the way human society operates [1]. As plastic surgeons, we are worried about the future of plastic surgery in the context of the COVID-19 epidemic. We read the published study by Kaye and Paprottka entitled Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management [2],carefully. Due to our in-depth study of COVID-19 in the early stages of the epidemic [3-5], we strongly agree with the following points mentioned in the article.

In the near future, several pandemics of COVID-19 are inevitable around the world [6]. We believe that the end result of COVID-19 will be a decline in virulence, a decline in mortality among patients infected with COVID-19, and COVID-19 will coexist with humans, just as the influenza virus does [7]. After several outbreaks of COVID-19, some humans will produce antibodies to the COVID-19.

At present, the conclusions of studies that COVID-19 increases mortality in surgical patients are not fully applicable to plastic surgery because plastic surgery is mostly less traumatic surgery for patients and the group of patients receiving plastic surgery is younger, with less suffering from chronic diseases such as diabetes and hypertension. Therefore, we believe that plastic surgery with a short duration and less physical trauma can be performed in the context of the COVID-19 epidemic.

With regard to the perioperative standard use of antibiotics mentioned by the authors in the article, we believe that prophylactic use of antibiotics can be avoided in plastic surgery without obvious infection lesions if the operation time is less than 3 h. Plastic surgery with a clean incision within 3 h has a low chance of bacterial infection, and there is no evidence that prophylactic use of antibiotics can help prevent infection with COVID-19.

It is essential that every patient is treated as a COVID-19-infected patient. In the process of receiving patients, plastic surgery, communication with patients and adequate protection can avoid the infection of COVID-19 to the maximum extent. Every patient who comes to plastic surgery should be screened for COVID-19 and should be highly alert to asymptomatic infection with COVID-19.

Although there are many points that we agree with in the author’s article, there are also many points that make us confused.

The authors mentioned vitamin C, vitamin D, zinc, curcumin and other drugs in the article. They believe that these drugs can enhance the body’s resistance to prevent or treat the COVID-19. We question the author on this point of view. COVID-19 infects humans by binding to ACE2 receptors, and the main cause of severe illness and even death in humans is the factor storm caused by the COVID-19 infection in humans [8]. We don’t think the more resistant the body is, the more resistant it is to avoid infection with COVID-19. There is also no clear evidence that these drugs can effectively reduce the infection of the COVID-19 and improve the survival rate of patients infected with the COVID-19.

In this paper, the author describes the operation of the anesthesiologist to prevent COVID-19 infection during anesthesia, but does not describe in detail how plastic surgeons prevent COVID-19 infection during surgery. We believe that it is necessary for plastic surgeons to wear surgical masks and eye masks during the operation. Non-facial surgery can also place a plastic closure mask on a patient’s face to prevent respiratory droplet and aerosol transmission of COVID-19. Blood spatter should also be avoided during surgery.

Vaccinating every plastic surgeon may be a reliable way to prevent COVID-19 infection. But the COVID-19 mutates quickly [9], and some COVID-19 patients who have been cured become infected again [10]. Therefore, we are concerned about the method of vaccination against COVID-19 infection.

In the context of the COVID-19 virus epidemic, how to carry out aesthetic plastic surgery safely and efficiently and how to ensure the safety of patients and medical personnel, these are the great challenges that each of our plastic surgeons are facing now. We believe that with the deepening of the understanding of the new coronary pneumonia virus, we will be able to find an effective way to prevent and treat the COVID-19.