Background to COVID-19 and effects on services for Cardiac
Surgery in UK
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) first
emerged in the city of Wuhan, China, in December 2019 and it has since
spread rapidly across the globe, causing a disease named as COVID-19 in
February 2020 and with the World Health Organisation (WHO) declaring a
pandemic in March 2020 (1). As of 20th of August 2020,
there are more than 22.2 million confirmed cases of COVID-19 and over
795,000 deaths reported globally (Figure 1) with the United Kingdom (UK)
being 12th among countries in term of confirmed cases
(more than 326,000) and 5th in COVID-19 related deaths
(more than 41,000, Figure 2), (2).
Public Health England (PHE) published the very first report on COVID-19
on 22nd January 2020. Just one day later, the
Emergency Department at Royal London Hospital swabbed its first
potential COVID-19 patient (3). The declaration of this disease as a
pandemic put health care systems in the UK on alert and the government
introduced national lockdown on 23rd of March 2020 in
an attempt to contain the disease and minimize the transmission risk to
others. A campaign was launched under the slogan of “Stay home, Protect
the NHS (National Health Service) and Save lives”. Although a critical
step to combat this highly contagious disease, it created a significant
burden on an otherwise a freely accessibly health care system, the NHS.
The NHS had to undergo a significant transformation diverting resources
to frontline health care services including ambulance services,
emergency departments and allocation of intensive care beds in
preparation for the potential influx of COVID-19 patients and the
requirement for ventilatory support (Figure 3). De novo facilities, the
Nightingale Hospitals, were created throughout the nation to increase
capacity; private hospital capacity was purchased, industries were
tasked with producing ventilators and academia with producing treatments
and vaccines. Effectively, all elective care was stopped with services
only maintained for emergencies.
Amongst the many specialities affected by the NHS service
reconfiguration was cardiac surgery, given its ownership of a large
resource of ventilated beds normally required in elective practice.
Attempts were made in a number of regions to create centralized cardiac
surgical services to continue provision of care to this high-risk cohort
and avoid secondary deaths due to untreated cardiovascular diseases (4).
The Royal College of Surgeons (RCS), Society of Cardiothoracic Surgery
in UK and Ireland (SCTS) and the NHS issued guidelines and regular
updates on the practice of cardiac surgery during this pandemic,
introducing protocols and pathways to minimize the risk of COVID-19 to
patients and staff without affecting the quality of service and care to
those needing cardiac surgery (5-11).
The network of centres that perform cardiac surgery in England generally
responded to the crisis according to government guidance by reducing or,
more frequently, halting elective operating, but with a degree of
independence. The exact timeline during which each centre wound down
elective and urgent services varied according to local circumstances and
pressures. The processes by which each centre managed patient pathways
were dependent on local arrangements. In addition, England, Wales,
Scotland and Northern Ireland, each with its own devolved government,
responded differently. This paper focusses on the experience of
Liverpool Heart and Chest Hospital with changes to service provision for
cardiac surgery, focussing on aorto-vascular patients.