Summary by Professor Peter Christensen and Dr Miguel Cunha.

As ESCP is becoming a global network, worldwide views and perspectives are considered very important for us, not only to know what is happening in each continent, but also to share experiences and knowledge. We aim for teamwork to be a foundation for our daily practice as medical doctors in general, and colorectal surgeons in particular.

During last week, we've had very real and valuable reports from four experienced colorectal surgeons from different South America countries on the COVID-19 pandemic's surgical impact.

The first reports concern two different countries perspectives, the Brazilian one by Professor Guilherme São Julião, and the Argentinian one by Dr Nicolas Avellaneda and Dr Mariano Vaingurt. From these interesting points of view we can definitely highlight three main messages:

  1. Argentina and Brazil weren’t affected equally in terms of the beginning nor the dissemination broad of SARS-CoV-2, but are both facing the pandemic consequences. While oncological surgeries and chemo/radiotherapy treatments are getting the most attention for their undeniable importance, and are being dealt and solved by medical doctors, the benign diseases and procedures are being postponed, and there is no bigger plan ahead to solve this problem.
  2. Concerning diagnostic tools, such as endoscopy and imaging, two main problems were reported: the population is avoiding health facilities, mostly because they are afraid of getting infected; secondly, a lot of these procedures and techniques were canceled or postponed because of the pandemic restrictions. Both countries highlight that, in the next few months, one of the major consequences is going to be the diagnosis of malign diseases in a more advanced stage, which may seriously compromise patients’ prognosis.
  3. Both interviewees were asked about government and health organisation measures and plans concerning the recovery from this pandemic. There seems to be an almost absolute agreement on this, the pandemic wave hasn’t yet reached its peak in South America, and these issues do not seem to be a priority at the moment. According to Dr Mariano from Argentina, right now "all resources are allocated to control patients and social security". Similarly, Professor Guilherme from Brazil highlights that he does "not think political authorities are aware of the consequences of surgical postponement".

In the final interview with Dr Cristián Gallardo, we've aimed to gather a global South American perspective on the pandemic. He shared some worrisome data with us:

"This week South America has surpassed both the United States and Europe in the daily number of COVID-19 infections… becoming the world's newest epicentre of the global pandemic".

From his impressive insight on the matter, the pandemic's progression in developing countries has highlighted:

"the problematic existing political trends in the region. Crowded people at home and unstable jobs make it hard for people to distance… and underfunded, overstretch health systems potentially exacerbate the crisis".

Regarding the effects in coloproctology patients, Dr Cristián agrees with Professor Guilherme's and Dr Mariano's views when he says

"One important consequence of the pandemic is the postponement of a large number of endoscopies particularly colonoscopies" and he adds that "this will produce a delay in the diagnosis of new cancers and because of that, probably, a worse prognosis of those newly-diagnosed cases".

As we believe that we also learn a lot in the difficult moments, we've asked all of our interviewees what was the main lesson learned from this pandemic by now. We underline these ideas:

  1. Dr Mariano and Dr Nicolas believes that Argentina "has a fragile healthcare system that is overloaded with patients and has to be rearranged..". Also,"the use of virtual resources has provided a very helpful tool for lectures, classes and MDT meetings, webinars. Sharing knowledge has become easier and these tools are here to stay."
  2. Professor Guilherme from Brazil highlighted that "COVID-19 will not disappear… in 2-3 months… Until an effective vaccine is discovered, all measures to avoid dissemination of the virus will continue."
  3. Dr Cristián referred that the pandemic gave us several lessons, namely "the ability to adapt and react to unexpected situations", and that "research is essential and must be considered a priority within government policies". Finally, he believes "the use of new platforms to communicate information will be essential in the future".

By the end, of this week we are enriched by this South American perspective. We really feel that we've promoted a worldwide network between the coloproctology surgeons in different continents. Until now, one of the main lessons learned with these expert surgeons is that "teamwork, research, new technology and communicating channels are the main foundations of this new normal".

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