Interview by Miguel Cunha.

Julio Mayol is Professor of Surgery and Chief Medical and Innovation Officer at Hospital Clinico San Carlos, Universidad Complutense de Madrid. He is Vice-President and trustee of Hospital Clinico San Carlos Biomedical Research Foundation, Chief Networking Officer at Royal Academy of Medicine of Spain and Secretary of the BJS Society.

Miguel Cunha: Professor Julio, thank you for agreeing to speak with us regarding the current COVID-19 crisis, around the surgical recovery from the pandemic in Spain.

Julio Mayol: Thank you very much for inviting me to share some ideas and reflections with you.

MC: To start, it is well-known that COVID-19 has had a devastating impact among the Spanish population. We would like to ask you what was the major impact for Spanish surgical patients?

JM: Although surgical patients who needed urgent interventions and those with conditions that could put their lives potentially at risk if delayed for more than two months (surgical oncology, cardiovascular surgery, etc) received appropriate treatment, thousands of procedures have been postponed and we are working hard to ramp up our surgical capacity.

MC: We’ve read with great interest your recent article in BJS about this subject. You referred to three main topics regarding the rescheduling of postponed elective surgical procedures during the pandemic: the local epidemiological context, the COVID-19 patient condition and the health status of the surgical team. Further ahead, the pandemic seems to be getting milder, but we still need to bare in mind the "wave beyond the horizon". What are the main concerns at this moment and how can we optimise our future response?

JM: In addition to the pandemic, patients and families may be facing a very severe economic crisis. We should work shoulder to shoulder with primary care physicians to prioritise patients based not only on the severity of their conditions but also on their social context. And let's not forget that many of them, particularly the elderly, refuse to come to the hospital because they are scared. That fear of getting infected is something our institution is trying to fight.

MC: Did the government in your country, or any healthcare organisation, propose special approaches to help deal with this "retake activity vs. stand by" issue?

JM: The regional government has given each hospital in Madrid (there are 34 public hospitals) some autonomy to deal with this important problem. However, we will need additional resources and the economy is not doing very well. Over the next three months we have planned to carry out around 1,500 extra procedures to compensate and decrease the number of patients in the waiting lists, specifically for orthopedics, general surgery, urology and ophthalmology.

MC: Are you already seeing any effects of the delayed surgeries?

JM: Some patients showed up in the Emergency Room with complications not previously seen because they avoided seeing their GP or contacting the Emergency Service out of fear. Anyway, I think it is too early to see a meaningful impact in outcomes because of a three-month delay in surgical treatment of benign conditions.

MC: What about the long-term effects of the pandemic? In your opinion, what will be the main issues regarding the recovery of the surgical health care, and what are our weapons to deal with them?

My main concern is the "economic toxicity" of this pandemic. The change in behavior and culture will depend on whether there is a second viral wave or not. If there is a second viral wave, our system will be better prepared for it. Unfortunately, I do not think healthcare professionals would come out of it with enough strength to battle the non-COVID-19 consequences. Therefore, in my opinion applying strict preventive measures is the best option.

MC: Can you give us a personal example of how the pandemic affected your life?

JM: Between March 1st and May 29th, I went to the hospital every single day, while participating in two or three programs per week on national or international media (Sky News, BBC, ITV and so on). Being a physician and a manager, so much exposure may have adverse effects in the future.

MC: Spanish doctors, in line with your paper, referred to the value of social media as a tool that ensured global connections during the pandemic. Also, social media allowed for research sharing, and to optimise medical resources and circuits. What do you think was the main role of social media during the pandemic?

JM: It kept us connected and informed, counteracting the sense of isolation that strict confinement could have brought. Besides, surgical research has benefited immensely, as the @CovidSurg collaboration has clearly shown. I must commend the efforts by the BJS editorial team to rapidly publish high quality papers that are useful to the surgical community at a global scale and to disseminate them via Twitter.

MC: In terms of technology, what will the future bring to help health systems recover from this pandemic? Comparatively, do you think we will be able to optimise responses for future pandemics?

JM: I propose the following:

  1. Automatisation of diagnostic processes and low complexity care
  2. Robotisation of low value activities
  3. Mobile technology for pandemic control
  4. Simulation, virtual and augmented reality for training (severely affected by the pandemic)
  5. CRISPR platforms

For sure, healthcare systems will be better prepared for respiratory virus pandemics, but I am not so sure about other types of virus.

MC: What new emerging technologies have impressed you the most?

JM: Biotechnology, and CRISPR platforms in particular, is very promising. Mobile technology has worked tremendously well in some Asian countries. However, there are many issues with privacy and the use of personal information for purposes beyond public health.

MC: I would like to thank you for providing us with the Spanish view regarding surgical recovery from the pandemic, and I would like to ask you one final question: what is the most important lesson we can take from this pandemic so far?

JM: I would say that when one faces complexity and uncertainty, trust well-trained healthcare professionals. They will show you what to do and how to do it in the most caring and compassionate way.


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