Miguel Cunha speaks to colorectal surgeons Dr Nicolas Avellaneda and Dr Mariano Vaingurt in Buenos Aires about how they are coping with and looking to recover from the COVID-19 pandemic. #SouthAmericaWeek

Mariano Vaingurt is a colorectal surgeon and emergency surgeon at the Hospital Dr Teodoro Alvarez and Nueva Proctologia, Buenos Aires. Nicolas Avellaneda is a colorectal surgeon at the Nueva Proctologia and Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Buenos Aires.

Miguel Cunha: Dr Nicolas and Dr Mariano, thank you for agreeing to speak with us on the current COVID-19 crisis, concerning the Argentina reality. From a Portuguese interviewer who proudly speaks Spanish: muchas gracias por la disponibilidad, es un placer para nosotros contar con su colaboración!

To start, the pandemic’s devastating impact worldwide is well-known. We would like to ask you what was the major impact for the Argentinian surgical patients?

Miguel Cunha, Mariano Vaingurt and Nicolas Avellaneda

MV/NA: First of all, thank you Miguel for inviting us to share our experience. In Argentina we basically have two kinds of healthcare system, one is public (free and accessible for any patient of any country) and the other one is private and depends on the private medical insurance and HMOs.

Most COVID-19 patients are located in Buenos Aires where the public healthcare system is typically overcrowded so this situation makes it worse. Even though lockdown started on March 20th, we are expecting to reach the apex of cases in a few weeks (which correlates directly with more aggressive testing and easing of quarantine). Consequently, and as has happened in many other countries, all surgical procedures that are elective, not urgent or not absolutely necessary (e.g. oncological patients) have been postponed.

MC: In what way do you think the situation in Argentina differs from the other South American countries?

MV/NA: We think that the situation is very different between countries in South America. In Argentina, the number of cases has been increasing in the last two weeks, but not dramatically as shown in neighboring countries. Brazil, Peru, Mexico and Chile have shown a faster escalation of the curve. There are also countries like Ecuador which has suffered major impact with high mortality rates due to lack of time for preparation. However, in Buenos Aires we are expecting a significant increase in the number of COVID positive cases in the weeks ahead.

MC: Concerning surgery postponement in general, was this also an initial approach in Argentina? Are you already seeing any consequences from these delayed surgeries? What are your main concerns at this moment, and in the longer term?

MV/NA: The policy at the beginning of lockdown for both public and private hospitals was to postpone all procedures that were not considered absolutely necessary to save beds for potential COVID-19 patients.

Because of economic issues, private hospitals have had autonomy to decide which surgical procedures can be done since mid-April so we have different situations. Anyway, it was instilled in patients that they shouldn’t go to hospitals unless strictly necessary.

It is too early to see major consequences but we have started to see that many urgent surgeries have been needed for patients who have delayed their consultations too much. Some hospitals have already published their results, which reflects this (e.g. more incidences of complicated appendicitis). In the long term, we believe that when we resume surgical activities there is going to be an overload of patients on waiting list. Some countries are already developing strategies to cope with this and we think that it’s a good idea to learn from them.

MC: Do you feel your government or healthcare system is aware of surgical postponement consequences? Are these entities in your country advocating any solutions for these issues?

MV/NA: We do not think that any official (working for government, public or private system) is thinking about what will happen when this pandemic is finally over - mostly because all resources are allocated to control patients and social security and also because all the predictions made by experts were incorrect (the curve keeps being pushed away, we started thinking it was going to be reached in April, and recent data now shows July as a goal). The major impact on the economy and our healthcare system when this is over remains uncertain.

MC: Were your residents or any of you senior surgeons redeployed to other services during the pandemic? How do you think we may continue to provide surgical education during the upcoming months?

MV/NA: Even though some senior surgeons or surgical residents have been moved to triage units, they do not manage hospitalised COVID-19 patients, but the worst is yet to come so this might happen over the next few weeks.

Regarding surgical education, we think that this crisis has encouraged some interesting resources on teaching, using platforms to give virtual classes and multidisciplinary meetings, and also giving time for residents to develop investigation skills (which is difficult during regular times for lack of free time). Anyway, this issue is very challenging for surgeons in the setting of COVID-19.

MC: How has the current situation affected your own practice? Were the surgical wards and the operating rooms rearranged in some way? Are you taking any precautions in your social life?

MV/NA: As lockdown is still mandatory, social life is definitely banned in Buenos Aires. Most hospitals have rearranged their wards, operating rooms and hospitalisation beds to give major priority to COVID-19 patients.

PPE level 3 is mandatory. Cleaning time between surgeries takes quite a bit longer and patients are not allowed to be accompanied by more than one person during a hospital stay and they have to wear a mask.

In some private hospitals, COVID-19 PCR and thorax CT is an option 48 hours before surgery as screening.

MC: That brings us to the end of the interview! I would like to thank you for giving us the local insight on the COVID 19 pandemic in Argentina, and I would like to ask you a final question - what are the main lessons we can take from this pandemic so far?

MV/NA: That is a very good question Miguel. We think that, at least in Argentina and mostly Latin America, we have a fragile healthcare system that is overloaded with patients and has to be rearranged. Moreover, we have healthcare providers who do their best on their daily activities, they are overworked, poorly recognised and underpaid. This might need fixing as well.

On the other hand, the use of virtual resources for teaching and meeting has provided us with a very helpful tool for lectures, classes and MDT meetings, webinars. Sharing knowledge has become easier and these tools are here to stay.

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