COVID-19 Preparedness Within the Surgical, Obstetric, and Anesthetic Ecosystem in Sub-Saharan Africa
Identifieur interne : 000415 ( Pmc/Corpus ); précédent : 000414; suivant : 000416COVID-19 Preparedness Within the Surgical, Obstetric, and Anesthetic Ecosystem in Sub-Saharan Africa
Auteurs : Adesoji O. Ademuyiwa ; Abebe Bekele ; Atakltie Baraki Berhea ; Eric Borgstein ; Nina Capo-Chichi ; Miliard Derbew ; Faye M. Evans ; Mekdes Daba Feyssa ; Moses Galukande ; Atul A. Gawande ; Serigne Magueye Gueye ; Ewen Harrison ; Pankaj Jani ; Neema Kaseje ; Louis Litswa ; Tihitena Negussie Mammo ; Jannicke Mellin-Olsen ; Godfrey Muguti ; Mary T. Nabukenya ; Eugene Ngoga ; Faustin Ntirenganya ; Stephen Rulisa ; Nichole Starr ; Stephen Tabiri ; Mahelet Tadesse ; Isabeau Walker ; Thomas G. Weiser ; Sherry M. WrenSource :
- Annals of Surgery [ 0003-4932 ] ; 2020.
Url:
DOI: 10.1097/SLA.0000000000003964
PubMed: 32301806
PubMed Central: 7188046
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PMC:7188046Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">COVID-19 Preparedness Within the Surgical, Obstetric, and Anesthetic Ecosystem in Sub-Saharan Africa</title><author><name sortKey="Ademuyiwa, Adesoji O" sort="Ademuyiwa, Adesoji O" uniqKey="Ademuyiwa A" first="Adesoji O." last="Ademuyiwa">Adesoji O. Ademuyiwa</name><affiliation><nlm:aff id="aff1">University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">National Institute of Health Research Global Surgery Unit, Lagos Hub, Lagos, Nigeria</nlm:aff></affiliation><affiliation><nlm:aff id="aff3">Pan Africa Paediatric Surgery Association, Nigeria</nlm:aff></affiliation></author><author><name sortKey="Bekele, Abebe" sort="Bekele, Abebe" uniqKey="Bekele A" first="Abebe" last="Bekele">Abebe Bekele</name><affiliation><nlm:aff id="aff4">University of Global Health Equity, Kigali, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff5">College of Surgeons of Eastern, Central, and Southern Africa, Rwanda</nlm:aff></affiliation></author><author><name sortKey="Berhea, Atakltie Baraki" sort="Berhea, Atakltie Baraki" uniqKey="Berhea A" first="Atakltie Baraki" last="Berhea">Atakltie Baraki Berhea</name><affiliation><nlm:aff id="aff6">Addis Ababa University, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff7">Surgical Society of Ethiopia, Ethiopia</nlm:aff></affiliation></author><author><name sortKey="Borgstein, Eric" sort="Borgstein, Eric" uniqKey="Borgstein E" first="Eric" last="Borgstein">Eric Borgstein</name><affiliation><nlm:aff id="aff8">Blantyre, Malawi</nlm:aff></affiliation><affiliation><nlm:aff id="aff9">College of Surgeons of Eastern, Central, and Southern Africa</nlm:aff></affiliation></author><author><name sortKey="Capo Chichi, Nina" sort="Capo Chichi, Nina" uniqKey="Capo Chichi N" first="Nina" last="Capo-Chichi">Nina Capo-Chichi</name><affiliation><nlm:aff id="aff10">Smile Train, Francophone West Africa (Benin, Togo, Burkina Faso)</nlm:aff></affiliation><affiliation><nlm:aff id="aff11">Lifebox Foundation, Benin</nlm:aff></affiliation></author><author><name sortKey="Derbew, Miliard" sort="Derbew, Miliard" uniqKey="Derbew M" first="Miliard" last="Derbew">Miliard Derbew</name><affiliation><nlm:aff id="aff5">College of Surgeons of Eastern, Central, and Southern Africa, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff6">Addis Ababa University, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff11">Lifebox Foundation, Benin</nlm:aff></affiliation></author><author><name sortKey="Evans, Faye M" sort="Evans, Faye M" uniqKey="Evans F" first="Faye M." last="Evans">Faye M. Evans</name><affiliation><nlm:aff id="aff12">Harvard University, Cambridge, MA</nlm:aff></affiliation><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff14">Medical Advisory Board Member, Smile Train</nlm:aff></affiliation></author><author><name sortKey="Feyssa, Mekdes Daba" sort="Feyssa, Mekdes Daba" uniqKey="Feyssa M" first="Mekdes Daba" last="Feyssa">Mekdes Daba Feyssa</name><affiliation><nlm:aff id="aff15">St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff16">Ethiopian Society of Obstetricians and Gynaecologists, Ethiopia</nlm:aff></affiliation></author><author><name sortKey="Galukande, Moses" sort="Galukande, Moses" uniqKey="Galukande M" first="Moses" last="Galukande">Moses Galukande</name><affiliation><nlm:aff id="aff17">Department of Surgery, Makerere University, Uganda</nlm:aff></affiliation><affiliation><nlm:aff id="aff18">Association of Surgeons of Uganda, Uganda</nlm:aff></affiliation></author><author><name sortKey="Gawande, Atul A" sort="Gawande, Atul A" uniqKey="Gawande A" first="Atul A." last="Gawande">Atul A. Gawande</name><affiliation><nlm:aff id="aff12">Harvard University, Cambridge, MA</nlm:aff></affiliation><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff19">Ariadne Labs at Brigham Health and Harvard TH Chan School of Public Health</nlm:aff></affiliation><affiliation><nlm:aff id="aff20">Haven, UK</nlm:aff></affiliation></author><author><name sortKey="Gueye, Serigne Magueye" sort="Gueye, Serigne Magueye" uniqKey="Gueye S" first="Serigne Magueye" last="Gueye">Serigne Magueye Gueye</name><affiliation><nlm:aff id="aff21">University Cheikh Anta DIOP, Dakar, Senegal</nlm:aff></affiliation><affiliation><nlm:aff id="aff22">West African College of Surgeons, Lagos, Nigeria</nlm:aff></affiliation></author><author><name sortKey="Harrison, Ewen" sort="Harrison, Ewen" uniqKey="Harrison E" first="Ewen" last="Harrison">Ewen Harrison</name><affiliation><nlm:aff id="aff23">University of Edinburgh, Edinburgh, UK</nlm:aff></affiliation><affiliation><nlm:aff id="aff24">GlobalSurg Collaborative</nlm:aff></affiliation></author><author><name sortKey="Jani, Pankaj" sort="Jani, Pankaj" uniqKey="Jani P" first="Pankaj" last="Jani">Pankaj Jani</name><affiliation><nlm:aff id="aff5">College of Surgeons of Eastern, Central, and Southern Africa, Rwanda</nlm:aff></affiliation></author><author><name sortKey="Kaseje, Neema" sort="Kaseje, Neema" uniqKey="Kaseje N" first="Neema" last="Kaseje">Neema Kaseje</name><affiliation><nlm:aff id="aff25">World Health Organization Emergency and Essential Surgical Care Program</nlm:aff></affiliation><affiliation><nlm:aff id="aff26">Medicins Sans Frontiers, Geneva, Switzerland</nlm:aff></affiliation><affiliation><nlm:aff id="aff27">Global Initiative for Children's Surgery</nlm:aff></affiliation></author><author><name sortKey="Litswa, Louis" sort="Litswa, Louis" uniqKey="Litswa L" first="Louis" last="Litswa">Louis Litswa</name><affiliation><nlm:aff id="aff28">Gertrudes Hospital Division of Anesthesia, Kenya</nlm:aff></affiliation><affiliation><nlm:aff id="aff29">Kenya Society of Anaesthesiologists</nlm:aff></affiliation></author><author><name sortKey="Mammo, Tihitena Negussie" sort="Mammo, Tihitena Negussie" uniqKey="Mammo T" first="Tihitena Negussie" last="Mammo">Tihitena Negussie Mammo</name><affiliation><nlm:aff id="aff6">Addis Ababa University, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation></author><author><name sortKey="Mellin Olsen, Jannicke" sort="Mellin Olsen, Jannicke" uniqKey="Mellin Olsen J" first="Jannicke" last="Mellin-Olsen">Jannicke Mellin-Olsen</name><affiliation><nlm:aff id="aff30">World Federation of Societies of Anaesthesiologists, London, UK</nlm:aff></affiliation></author><author><name sortKey="Muguti, Godfrey" sort="Muguti, Godfrey" uniqKey="Muguti G" first="Godfrey" last="Muguti">Godfrey Muguti</name><affiliation><nlm:aff id="aff5">College of Surgeons of Eastern, Central, and Southern Africa, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff31">University of Zimbabwe, Harare, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Nabukenya, Mary T" sort="Nabukenya, Mary T" uniqKey="Nabukenya M" first="Mary T." last="Nabukenya">Mary T. Nabukenya</name><affiliation><nlm:aff id="aff32">Makerere University College of Health Sciences, Kampala, Uganda</nlm:aff></affiliation><affiliation><nlm:aff id="aff33">Education Committee, Association of Anesthesiologists of Uganda</nlm:aff></affiliation><affiliation><nlm:aff id="aff34">Lifebox Pulse Oximeter Clinical Advisory Group, Lifebox Foundation</nlm:aff></affiliation></author><author><name sortKey="Ngoga, Eugene" sort="Ngoga, Eugene" uniqKey="Ngoga E" first="Eugene" last="Ngoga">Eugene Ngoga</name><affiliation><nlm:aff id="aff35">Department of Obstetrics and Gynecology, Rwanda Military Hospital (affiliated with University of Rwanda), Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff36">Rwanda Society of Obstetricians and Gynecologists</nlm:aff></affiliation><affiliation><nlm:aff id="aff37">East, Central, and Southern Africa College of Obstetrics & Gynecology</nlm:aff></affiliation></author><author><name sortKey="Ntirenganya, Faustin" sort="Ntirenganya, Faustin" uniqKey="Ntirenganya F" first="Faustin" last="Ntirenganya">Faustin Ntirenganya</name><affiliation><nlm:aff id="aff38">University of Rwanda, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff39">National Institute of Health Research Global Surgery Unit, Rwanda Hub</nlm:aff></affiliation></author><author><name sortKey="Rulisa, Stephen" sort="Rulisa, Stephen" uniqKey="Rulisa S" first="Stephen" last="Rulisa">Stephen Rulisa</name><affiliation><nlm:aff id="aff38">University of Rwanda, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff40">Finance Committee, East, Central, and Southern Africa College of Obstetrics & Gynecology</nlm:aff></affiliation></author><author><name sortKey="Starr, Nichole" sort="Starr, Nichole" uniqKey="Starr N" first="Nichole" last="Starr">Nichole Starr</name><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff41">University of California San Francisco, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Tabiri, Stephen" sort="Tabiri, Stephen" uniqKey="Tabiri S" first="Stephen" last="Tabiri">Stephen Tabiri</name><affiliation><nlm:aff id="aff42">University for Development Studies-School of Medicine and Health Sciences, Tamale, Ghana</nlm:aff></affiliation><affiliation><nlm:aff id="aff43">National Institute of Health Research Global Surgery Unit, Ghana Hub</nlm:aff></affiliation></author><author><name sortKey="Tadesse, Mahelet" sort="Tadesse, Mahelet" uniqKey="Tadesse M" first="Mahelet" last="Tadesse">Mahelet Tadesse</name><affiliation><nlm:aff id="aff6">Addis Ababa University, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff44">Ethiopian Society of Anesthesiologists</nlm:aff></affiliation></author><author><name sortKey="Walker, Isabeau" sort="Walker, Isabeau" uniqKey="Walker I" first="Isabeau" last="Walker">Isabeau Walker</name><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff45">Association of Anaesthetists of Great Britain and Ireland Foundation</nlm:aff></affiliation></author><author><name sortKey="Weiser, Thomas G" sort="Weiser, Thomas G" uniqKey="Weiser T" first="Thomas G." last="Weiser">Thomas G. Weiser</name><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff46">Stanford University, Stanford, CA.</nlm:aff></affiliation></author><author><name sortKey="Wren, Sherry M" sort="Wren, Sherry M" uniqKey="Wren S" first="Sherry M." last="Wren">Sherry M. Wren</name><affiliation><nlm:aff id="aff46">Stanford University, Stanford, CA.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32301806</idno><idno type="pmc">7188046</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188046</idno><idno type="RBID">PMC:7188046</idno><idno type="doi">10.1097/SLA.0000000000003964</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000415</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000415</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">COVID-19 Preparedness Within the Surgical, Obstetric, and Anesthetic Ecosystem in Sub-Saharan Africa</title><author><name sortKey="Ademuyiwa, Adesoji O" sort="Ademuyiwa, Adesoji O" uniqKey="Ademuyiwa A" first="Adesoji O." last="Ademuyiwa">Adesoji O. Ademuyiwa</name><affiliation><nlm:aff id="aff1">University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria</nlm:aff></affiliation><affiliation><nlm:aff id="aff2">National Institute of Health Research Global Surgery Unit, Lagos Hub, Lagos, Nigeria</nlm:aff></affiliation><affiliation><nlm:aff id="aff3">Pan Africa Paediatric Surgery Association, Nigeria</nlm:aff></affiliation></author><author><name sortKey="Bekele, Abebe" sort="Bekele, Abebe" uniqKey="Bekele A" first="Abebe" last="Bekele">Abebe Bekele</name><affiliation><nlm:aff id="aff4">University of Global Health Equity, Kigali, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff5">College of Surgeons of Eastern, Central, and Southern Africa, Rwanda</nlm:aff></affiliation></author><author><name sortKey="Berhea, Atakltie Baraki" sort="Berhea, Atakltie Baraki" uniqKey="Berhea A" first="Atakltie Baraki" last="Berhea">Atakltie Baraki Berhea</name><affiliation><nlm:aff id="aff6">Addis Ababa University, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff7">Surgical Society of Ethiopia, Ethiopia</nlm:aff></affiliation></author><author><name sortKey="Borgstein, Eric" sort="Borgstein, Eric" uniqKey="Borgstein E" first="Eric" last="Borgstein">Eric Borgstein</name><affiliation><nlm:aff id="aff8">Blantyre, Malawi</nlm:aff></affiliation><affiliation><nlm:aff id="aff9">College of Surgeons of Eastern, Central, and Southern Africa</nlm:aff></affiliation></author><author><name sortKey="Capo Chichi, Nina" sort="Capo Chichi, Nina" uniqKey="Capo Chichi N" first="Nina" last="Capo-Chichi">Nina Capo-Chichi</name><affiliation><nlm:aff id="aff10">Smile Train, Francophone West Africa (Benin, Togo, Burkina Faso)</nlm:aff></affiliation><affiliation><nlm:aff id="aff11">Lifebox Foundation, Benin</nlm:aff></affiliation></author><author><name sortKey="Derbew, Miliard" sort="Derbew, Miliard" uniqKey="Derbew M" first="Miliard" last="Derbew">Miliard Derbew</name><affiliation><nlm:aff id="aff5">College of Surgeons of Eastern, Central, and Southern Africa, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff6">Addis Ababa University, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff11">Lifebox Foundation, Benin</nlm:aff></affiliation></author><author><name sortKey="Evans, Faye M" sort="Evans, Faye M" uniqKey="Evans F" first="Faye M." last="Evans">Faye M. Evans</name><affiliation><nlm:aff id="aff12">Harvard University, Cambridge, MA</nlm:aff></affiliation><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff14">Medical Advisory Board Member, Smile Train</nlm:aff></affiliation></author><author><name sortKey="Feyssa, Mekdes Daba" sort="Feyssa, Mekdes Daba" uniqKey="Feyssa M" first="Mekdes Daba" last="Feyssa">Mekdes Daba Feyssa</name><affiliation><nlm:aff id="aff15">St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff16">Ethiopian Society of Obstetricians and Gynaecologists, Ethiopia</nlm:aff></affiliation></author><author><name sortKey="Galukande, Moses" sort="Galukande, Moses" uniqKey="Galukande M" first="Moses" last="Galukande">Moses Galukande</name><affiliation><nlm:aff id="aff17">Department of Surgery, Makerere University, Uganda</nlm:aff></affiliation><affiliation><nlm:aff id="aff18">Association of Surgeons of Uganda, Uganda</nlm:aff></affiliation></author><author><name sortKey="Gawande, Atul A" sort="Gawande, Atul A" uniqKey="Gawande A" first="Atul A." last="Gawande">Atul A. Gawande</name><affiliation><nlm:aff id="aff12">Harvard University, Cambridge, MA</nlm:aff></affiliation><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff19">Ariadne Labs at Brigham Health and Harvard TH Chan School of Public Health</nlm:aff></affiliation><affiliation><nlm:aff id="aff20">Haven, UK</nlm:aff></affiliation></author><author><name sortKey="Gueye, Serigne Magueye" sort="Gueye, Serigne Magueye" uniqKey="Gueye S" first="Serigne Magueye" last="Gueye">Serigne Magueye Gueye</name><affiliation><nlm:aff id="aff21">University Cheikh Anta DIOP, Dakar, Senegal</nlm:aff></affiliation><affiliation><nlm:aff id="aff22">West African College of Surgeons, Lagos, Nigeria</nlm:aff></affiliation></author><author><name sortKey="Harrison, Ewen" sort="Harrison, Ewen" uniqKey="Harrison E" first="Ewen" last="Harrison">Ewen Harrison</name><affiliation><nlm:aff id="aff23">University of Edinburgh, Edinburgh, UK</nlm:aff></affiliation><affiliation><nlm:aff id="aff24">GlobalSurg Collaborative</nlm:aff></affiliation></author><author><name sortKey="Jani, Pankaj" sort="Jani, Pankaj" uniqKey="Jani P" first="Pankaj" last="Jani">Pankaj Jani</name><affiliation><nlm:aff id="aff5">College of Surgeons of Eastern, Central, and Southern Africa, Rwanda</nlm:aff></affiliation></author><author><name sortKey="Kaseje, Neema" sort="Kaseje, Neema" uniqKey="Kaseje N" first="Neema" last="Kaseje">Neema Kaseje</name><affiliation><nlm:aff id="aff25">World Health Organization Emergency and Essential Surgical Care Program</nlm:aff></affiliation><affiliation><nlm:aff id="aff26">Medicins Sans Frontiers, Geneva, Switzerland</nlm:aff></affiliation><affiliation><nlm:aff id="aff27">Global Initiative for Children's Surgery</nlm:aff></affiliation></author><author><name sortKey="Litswa, Louis" sort="Litswa, Louis" uniqKey="Litswa L" first="Louis" last="Litswa">Louis Litswa</name><affiliation><nlm:aff id="aff28">Gertrudes Hospital Division of Anesthesia, Kenya</nlm:aff></affiliation><affiliation><nlm:aff id="aff29">Kenya Society of Anaesthesiologists</nlm:aff></affiliation></author><author><name sortKey="Mammo, Tihitena Negussie" sort="Mammo, Tihitena Negussie" uniqKey="Mammo T" first="Tihitena Negussie" last="Mammo">Tihitena Negussie Mammo</name><affiliation><nlm:aff id="aff6">Addis Ababa University, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation></author><author><name sortKey="Mellin Olsen, Jannicke" sort="Mellin Olsen, Jannicke" uniqKey="Mellin Olsen J" first="Jannicke" last="Mellin-Olsen">Jannicke Mellin-Olsen</name><affiliation><nlm:aff id="aff30">World Federation of Societies of Anaesthesiologists, London, UK</nlm:aff></affiliation></author><author><name sortKey="Muguti, Godfrey" sort="Muguti, Godfrey" uniqKey="Muguti G" first="Godfrey" last="Muguti">Godfrey Muguti</name><affiliation><nlm:aff id="aff5">College of Surgeons of Eastern, Central, and Southern Africa, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff31">University of Zimbabwe, Harare, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Nabukenya, Mary T" sort="Nabukenya, Mary T" uniqKey="Nabukenya M" first="Mary T." last="Nabukenya">Mary T. Nabukenya</name><affiliation><nlm:aff id="aff32">Makerere University College of Health Sciences, Kampala, Uganda</nlm:aff></affiliation><affiliation><nlm:aff id="aff33">Education Committee, Association of Anesthesiologists of Uganda</nlm:aff></affiliation><affiliation><nlm:aff id="aff34">Lifebox Pulse Oximeter Clinical Advisory Group, Lifebox Foundation</nlm:aff></affiliation></author><author><name sortKey="Ngoga, Eugene" sort="Ngoga, Eugene" uniqKey="Ngoga E" first="Eugene" last="Ngoga">Eugene Ngoga</name><affiliation><nlm:aff id="aff35">Department of Obstetrics and Gynecology, Rwanda Military Hospital (affiliated with University of Rwanda), Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff36">Rwanda Society of Obstetricians and Gynecologists</nlm:aff></affiliation><affiliation><nlm:aff id="aff37">East, Central, and Southern Africa College of Obstetrics & Gynecology</nlm:aff></affiliation></author><author><name sortKey="Ntirenganya, Faustin" sort="Ntirenganya, Faustin" uniqKey="Ntirenganya F" first="Faustin" last="Ntirenganya">Faustin Ntirenganya</name><affiliation><nlm:aff id="aff38">University of Rwanda, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff39">National Institute of Health Research Global Surgery Unit, Rwanda Hub</nlm:aff></affiliation></author><author><name sortKey="Rulisa, Stephen" sort="Rulisa, Stephen" uniqKey="Rulisa S" first="Stephen" last="Rulisa">Stephen Rulisa</name><affiliation><nlm:aff id="aff38">University of Rwanda, Rwanda</nlm:aff></affiliation><affiliation><nlm:aff id="aff40">Finance Committee, East, Central, and Southern Africa College of Obstetrics & Gynecology</nlm:aff></affiliation></author><author><name sortKey="Starr, Nichole" sort="Starr, Nichole" uniqKey="Starr N" first="Nichole" last="Starr">Nichole Starr</name><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff41">University of California San Francisco, San Francisco, CA</nlm:aff></affiliation></author><author><name sortKey="Tabiri, Stephen" sort="Tabiri, Stephen" uniqKey="Tabiri S" first="Stephen" last="Tabiri">Stephen Tabiri</name><affiliation><nlm:aff id="aff42">University for Development Studies-School of Medicine and Health Sciences, Tamale, Ghana</nlm:aff></affiliation><affiliation><nlm:aff id="aff43">National Institute of Health Research Global Surgery Unit, Ghana Hub</nlm:aff></affiliation></author><author><name sortKey="Tadesse, Mahelet" sort="Tadesse, Mahelet" uniqKey="Tadesse M" first="Mahelet" last="Tadesse">Mahelet Tadesse</name><affiliation><nlm:aff id="aff6">Addis Ababa University, Addis Ababa, Ethiopia</nlm:aff></affiliation><affiliation><nlm:aff id="aff44">Ethiopian Society of Anesthesiologists</nlm:aff></affiliation></author><author><name sortKey="Walker, Isabeau" sort="Walker, Isabeau" uniqKey="Walker I" first="Isabeau" last="Walker">Isabeau Walker</name><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff45">Association of Anaesthetists of Great Britain and Ireland Foundation</nlm:aff></affiliation></author><author><name sortKey="Weiser, Thomas G" sort="Weiser, Thomas G" uniqKey="Weiser T" first="Thomas G." last="Weiser">Thomas G. Weiser</name><affiliation><nlm:aff id="aff13">Lifebox Foundation</nlm:aff></affiliation><affiliation><nlm:aff id="aff46">Stanford University, Stanford, CA.</nlm:aff></affiliation></author><author><name sortKey="Wren, Sherry M" sort="Wren, Sherry M" uniqKey="Wren S" first="Sherry M." last="Wren">Sherry M. Wren</name><affiliation><nlm:aff id="aff46">Stanford University, Stanford, CA.</nlm:aff></affiliation></author></analytic><series><title level="j">Annals of Surgery</title><idno type="ISSN">0003-4932</idno><idno type="eISSN">1528-1140</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Brindle, M" uniqKey="Brindle M">M Brindle</name></author><author><name sortKey="Gawande, A" uniqKey="Gawande A">A Gawande</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wen, X" uniqKey="Wen X">X Wen</name></author><author><name sortKey="Li, Y" uniqKey="Li Y">Y Li</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ti, Lk" uniqKey="Ti L">LK 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Surg</journal-id><journal-id journal-id-type="iso-abbrev">Ann. Surg</journal-id><journal-id journal-id-type="publisher-id">ANSU</journal-id><journal-title-group><journal-title>Annals of Surgery</journal-title></journal-title-group><issn pub-type="ppub">0003-4932</issn><issn pub-type="epub">1528-1140</issn><publisher><publisher-name>Lippincott, Williams, and Wilkins</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32301806</article-id><article-id pub-id-type="pmc">7188046</article-id><article-id pub-id-type="publisher-id">ANNSURG-D-20-00826</article-id><article-id pub-id-type="doi">10.1097/SLA.0000000000003964</article-id><article-categories><subj-group subj-group-type="heading"><subject>Commentary (by Invitation only)</subject></subj-group></article-categories><title-group><article-title>COVID-19 Preparedness Within the Surgical, Obstetric, and Anesthetic Ecosystem in Sub-Saharan Africa</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ademuyiwa</surname><given-names>Adesoji O.</given-names></name><xref ref-type="aff" rid="aff1"><sup>∗</sup></xref><xref ref-type="aff" rid="aff2"><sup>†</sup></xref><xref ref-type="aff" rid="aff3"><sup>‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bekele</surname><given-names>Abebe</given-names></name><xref ref-type="aff" rid="aff4"><sup>§</sup></xref><xref ref-type="aff" rid="aff5"><sup>¶</sup></xref></contrib><contrib contrib-type="author"><name><surname>Berhea</surname><given-names>Atakltie Baraki</given-names></name><xref ref-type="aff" rid="aff6"><sup>||</sup></xref><xref ref-type="aff" rid="aff7"><sup>#</sup></xref></contrib><contrib contrib-type="author"><name><surname>Borgstein</surname><given-names>Eric</given-names></name><xref ref-type="aff" rid="aff8"><sup>∗∗</sup></xref><xref ref-type="aff" rid="aff9"><sup>††</sup></xref></contrib><contrib contrib-type="author"><name><surname>Capo-Chichi</surname><given-names>Nina</given-names></name><xref ref-type="aff" rid="aff10"><sup>‡‡</sup></xref><xref ref-type="aff" rid="aff11"><sup>§§</sup></xref></contrib><contrib contrib-type="author"><name><surname>Derbew</surname><given-names>Miliard</given-names></name><xref ref-type="aff" rid="aff5"><sup>¶</sup></xref><xref ref-type="aff" rid="aff6"><sup>||</sup></xref><xref ref-type="aff" rid="aff11"><sup>§§</sup></xref></contrib><contrib contrib-type="author"><name><surname>Evans</surname><given-names>Faye M.</given-names></name><xref ref-type="aff" rid="aff12"><sup>¶¶</sup></xref><xref ref-type="aff" rid="aff13"><sup>||||</sup></xref><xref ref-type="aff" rid="aff14"><sup>##</sup></xref></contrib><contrib contrib-type="author"><name><surname>Feyssa</surname><given-names>Mekdes Daba</given-names></name><xref ref-type="aff" rid="aff15"><sup>∗∗∗</sup></xref><xref ref-type="aff" rid="aff16"><sup>†††</sup></xref></contrib><contrib contrib-type="author"><name><surname>Galukande</surname><given-names>Moses</given-names></name><xref ref-type="aff" rid="aff17"><sup>‡‡‡</sup></xref><xref ref-type="aff" rid="aff18"><sup>§§§</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gawande</surname><given-names>Atul A.</given-names></name><xref ref-type="aff" rid="aff12"><sup>¶¶</sup></xref><xref ref-type="aff" rid="aff13"><sup>||||</sup></xref><xref ref-type="aff" rid="aff19"><sup>¶¶¶</sup></xref><xref ref-type="aff" rid="aff20"><sup>||||||</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gueye</surname><given-names>Serigne Magueye</given-names></name><xref ref-type="aff" rid="aff21"><sup>###</sup></xref><xref ref-type="aff" rid="aff22"><sup>∗∗∗∗</sup></xref></contrib><contrib contrib-type="author"><name><surname>Harrison</surname><given-names>Ewen</given-names></name><xref ref-type="aff" rid="aff23"><sup>††††</sup></xref><xref ref-type="aff" rid="aff24"><sup>‡‡‡‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jani</surname><given-names>Pankaj</given-names></name><xref ref-type="aff" rid="aff5"><sup>¶</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kaseje</surname><given-names>Neema</given-names></name><xref ref-type="aff" rid="aff25"><sup>§§§§</sup></xref><xref ref-type="aff" rid="aff26"><sup>¶¶¶¶</sup></xref><xref ref-type="aff" rid="aff27"><sup>||||||||</sup></xref></contrib><contrib contrib-type="author"><name><surname>Litswa</surname><given-names>Louis</given-names></name><xref ref-type="aff" rid="aff28"><sup>####</sup></xref><xref ref-type="aff" rid="aff29"><sup>∗∗∗∗∗</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mammo</surname><given-names>Tihitena Negussie</given-names></name><xref ref-type="aff" rid="aff6"><sup>||</sup></xref><xref ref-type="aff" rid="aff13"><sup>||||</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mellin-Olsen</surname><given-names>Jannicke</given-names></name><xref ref-type="aff" rid="aff30"><sup>†††††</sup></xref></contrib><contrib contrib-type="author"><name><surname>Muguti</surname><given-names>Godfrey</given-names></name><xref ref-type="aff" rid="aff5"><sup>¶</sup></xref><xref ref-type="aff" rid="aff31"><sup>‡‡‡‡‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Nabukenya</surname><given-names>Mary T.</given-names></name><xref ref-type="aff" rid="aff32"><sup>§§§§§</sup></xref><xref ref-type="aff" rid="aff33"><sup>¶¶¶¶¶</sup></xref><xref ref-type="aff" rid="aff34"><sup>||||||||||</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ngoga</surname><given-names>Eugene</given-names></name><xref ref-type="aff" rid="aff35"><sup>#####</sup></xref><xref ref-type="aff" rid="aff36"><sup>∗∗∗∗∗∗</sup></xref><xref ref-type="aff" rid="aff37"><sup>††††††</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ntirenganya</surname><given-names>Faustin</given-names></name><xref ref-type="aff" rid="aff38"><sup>‡‡‡‡‡‡</sup></xref><xref ref-type="aff" rid="aff39"><sup>§§§§§§</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rulisa</surname><given-names>Stephen</given-names></name><xref ref-type="aff" rid="aff38"><sup>‡‡‡‡‡‡</sup></xref><xref ref-type="aff" rid="aff40"><sup>¶¶¶¶¶¶</sup></xref></contrib><contrib contrib-type="author"><name><surname>Starr</surname><given-names>Nichole</given-names></name><xref ref-type="aff" rid="aff13"><sup>||||</sup></xref><xref ref-type="aff" rid="aff41"><sup>||||||||||||</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tabiri</surname><given-names>Stephen</given-names></name><xref ref-type="aff" rid="aff42"><sup>######</sup></xref><xref ref-type="aff" rid="aff43"><sup>∗∗∗∗∗∗∗</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tadesse</surname><given-names>Mahelet</given-names></name><xref ref-type="aff" rid="aff6"><sup>||</sup></xref><xref ref-type="aff" rid="aff44"><sup>†††††††</sup></xref></contrib><contrib contrib-type="author"><name><surname>Walker</surname><given-names>Isabeau</given-names></name><xref ref-type="aff" rid="aff13"><sup>||||</sup></xref><xref ref-type="aff" rid="aff45"><sup>‡‡‡‡‡‡‡</sup></xref></contrib><contrib contrib-type="author"><name><surname>Weiser</surname><given-names>Thomas G.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="aff13"><sup>||||</sup></xref><xref ref-type="aff" rid="aff46"><sup>§§§§§§§</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wren</surname><given-names>Sherry M.</given-names></name><xref ref-type="aff" rid="aff46"><sup>§§§§§§§</sup></xref></contrib></contrib-group><aff id="aff1"><label>∗</label>University of Lagos and Lagos University Teaching Hospital, Lagos, Nigeria</aff><aff id="aff2"><label>†</label>National Institute of Health Research Global Surgery Unit, Lagos Hub, Lagos, Nigeria</aff><aff id="aff3"><label>‡</label>Pan Africa Paediatric Surgery Association, Nigeria</aff><aff id="aff4"><label>§</label>University of Global Health Equity, Kigali, Rwanda</aff><aff id="aff5"><label>¶</label>College of Surgeons of Eastern, Central, and Southern Africa, Rwanda</aff><aff id="aff6"><label>||</label>Addis Ababa University, Addis Ababa, Ethiopia</aff><aff id="aff7"><label>#</label>Surgical Society of Ethiopia, Ethiopia</aff><aff id="aff8"><label>∗∗</label>Blantyre, Malawi</aff><aff id="aff9"><label>††</label>College of Surgeons of Eastern, Central, and Southern Africa</aff><aff id="aff10"><label>‡‡</label>Smile Train, Francophone West Africa (Benin, Togo, Burkina Faso)</aff><aff id="aff11"><label>§§</label>Lifebox Foundation, Benin</aff><aff id="aff12"><label>¶¶</label>Harvard University, Cambridge, MA</aff><aff id="aff13"><label>||||</label>Lifebox Foundation</aff><aff id="aff14"><label>##</label>Medical Advisory Board Member, Smile Train</aff><aff id="aff15"><label>∗∗∗</label>St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia</aff><aff id="aff16"><label>†††</label>Ethiopian Society of Obstetricians and Gynaecologists, Ethiopia</aff><aff id="aff17"><label>‡‡‡</label>Department of Surgery, Makerere University, Uganda</aff><aff id="aff18"><label>§§§</label>Association of Surgeons of Uganda, Uganda</aff><aff id="aff19"><label>¶¶¶</label>Ariadne Labs at Brigham Health and Harvard TH Chan School of Public Health</aff><aff id="aff20"><label>||||||</label>Haven, UK</aff><aff id="aff21"><label>###</label>University Cheikh Anta DIOP, Dakar, Senegal</aff><aff id="aff22"><label>∗∗∗∗</label>West African College of Surgeons, Lagos, Nigeria</aff><aff id="aff23"><label>††††</label>University of Edinburgh, Edinburgh, UK</aff><aff id="aff24"><label>‡‡‡‡</label>GlobalSurg Collaborative</aff><aff id="aff25"><label>§§§§</label>World Health Organization Emergency and Essential Surgical Care Program</aff><aff id="aff26"><label>¶¶¶¶</label>Medicins Sans Frontiers, Geneva, Switzerland</aff><aff id="aff27"><label>||||||||</label>Global Initiative for Children's Surgery</aff><aff id="aff28"><label>####</label>Gertrudes Hospital Division of Anesthesia, Kenya</aff><aff id="aff29"><label>∗∗∗∗∗</label>Kenya Society of Anaesthesiologists</aff><aff id="aff30"><label>†††††</label>World Federation of Societies of Anaesthesiologists, London, UK</aff><aff id="aff31"><label>‡‡‡‡‡</label>University of Zimbabwe, Harare, Zimbabwe</aff><aff id="aff32"><label>§§§§§</label>Makerere University College of Health Sciences, Kampala, Uganda</aff><aff id="aff33"><label>¶¶¶¶¶</label>Education Committee, Association of Anesthesiologists of Uganda</aff><aff id="aff34"><label>||||||||||</label>Lifebox Pulse Oximeter Clinical Advisory Group, Lifebox Foundation</aff><aff id="aff35"><label>#####</label>Department of Obstetrics and Gynecology, Rwanda Military Hospital (affiliated with University of Rwanda), Rwanda</aff><aff id="aff36"><label>∗∗∗∗∗∗</label>Rwanda Society of Obstetricians and Gynecologists</aff><aff id="aff37"><label>††††††</label>East, Central, and Southern Africa College of Obstetrics & Gynecology</aff><aff id="aff38"><label>‡‡‡‡‡‡</label>University of Rwanda, Rwanda</aff><aff id="aff39"><label>§§§§§§</label>National Institute of Health Research Global Surgery Unit, Rwanda Hub</aff><aff id="aff40"><label>¶¶¶¶¶¶</label>Finance Committee, East, Central, and Southern Africa College of Obstetrics & Gynecology</aff><aff id="aff41"><label>||||||||||||</label>University of California San Francisco, San Francisco, CA</aff><aff id="aff42"><label>######</label>University for Development Studies-School of Medicine and Health Sciences, Tamale, Ghana</aff><aff id="aff43"><label>∗∗∗∗∗∗∗</label>National Institute of Health Research Global Surgery Unit, Ghana Hub</aff><aff id="aff44"><label>†††††††</label>Ethiopian Society of Anesthesiologists</aff><aff id="aff45"><label>‡‡‡‡‡‡‡</label>Association of Anaesthetists of Great Britain and Ireland Foundation</aff><aff id="aff46"><label>§§§§§§§</label>Stanford University, Stanford, CA.</aff><author-notes><corresp><email>tweiser@stanford.edu</email></corresp></author-notes><pub-date pub-type="ppub"><day>13</day><month>4</month><year>2020</year></pub-date><pub-date pub-type="epub"><day>23</day><month>4</month><year>2020</year></pub-date><elocation-id>10.1097/SLA.0000000000003964</elocation-id><permissions><copyright-statement>Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.</copyright-statement><copyright-year>2020</copyright-year><license license-type="NIH OGC"><license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p></license></permissions><self-uri xlink:type="simple" xlink:href="ansu-publish-ahead-of-print-10.1097.sla.0000000000003964.pdf"></self-uri><custom-meta-group><custom-meta><meta-name>PUBSTATE</meta-name><meta-value>POST-ACCEPTANCE</meta-value></custom-meta></custom-meta-group></article-meta></front><body><p>Community transmission of COVID-19 is already being reported in Africa.<sup><xref rid="R1" ref-type="bibr">1</xref></sup> Most countries on the continent will have +10,000 confirmed cases within the month.<sup><xref rid="R2" ref-type="bibr">2</xref></sup> The population, while generally younger than in Europe and North America, has much higher rates of poverty, malnutrition, HIV, and TB, which could shift the demographics of lethality. For surgeons, obstetricians, and anesthesiologists, the major challenge will be maintaining provision of emergency and essential surgery and obstetric care while preserving precious resources, minimizing exposure of health care workers, and preventing onward transmission (Table <xref rid="T1" ref-type="table">1</xref>).<sup><xref rid="R3" ref-type="bibr">3</xref></sup> The human skill sets, resources, and supply chains supporting surgical services are also those needed for responding to the crisis.<sup><xref rid="R4" ref-type="bibr">4</xref>,<xref rid="R5" ref-type="bibr">5</xref></sup></p><table-wrap id="T1" position="float"><label>TABLE 1</label><caption><p>Recommendations for COVID-19 Preparedness Within the Surgical, Obstetric, and Anesthetic Ecosystem in Sub-Saharan Africa.</p></caption><graphic xlink:href="ansu-publish-ahead-of-print-10.1097.sla.0000000000003964-g001"></graphic></table-wrap><table-wrap id="T2" position="float"><label>TABLE 1 (Continued)</label><caption><p>Recommendations for COVID-19 Preparedness Within the Surgical, Obstetric, and Anesthetic Ecosystem in Sub-Saharan Africa.</p></caption><graphic xlink:href="ansu-publish-ahead-of-print-10.1097.sla.0000000000003964-g002"></graphic></table-wrap><sec><title>DEVELOP A CLEAR PLAN FOR PROVIDING ESSENTIAL OPERATIONS DURING THE PANDEMIC</title><p>The capacity to care for surgical and obstetric emergencies must be preserved. Many facilities have already postponed elective operations to conserve vital resources, but this approach is not as applicable as in high-income countries. Operations in the region are frequently for high-risk cancers or highly symptomatic patients, for which current guidance is not to postpone. The surgical burden is already high, and limitations on services will exacerbate waiting lists and sacrifice essential care.</p><p>Truly elective operations should, however, be postponed immediately to preserve the health and wellbeing of surgical, anesthetic, nursing, and cleaning staff. These providers will be important resources during a surge response. Many providers rely on elective and private work for their financial well-being, thus postponing elective surgery may work against their financial incentives. However, improved health worker and patient safety through reduced transmission is a compelling enough argument. To facilitate decision making and avoid conflicts, a triage algorithm needs to be established and enforced, such as that proposed by the American College of Surgeons: <ext-link ext-link-type="uri" xlink:href="https://www.facs.org/about-acs/covid-19/information-for-surgeons/triage">https://www.facs.org/about-acs/covid-19/information-for-surgeons/triage</ext-link>.</p><p>Patients should be kept geographically separate from COVID+ patients and discharged expeditiously to minimize nosocomial transmission.<sup><xref rid="R6" ref-type="bibr">6</xref>–<xref rid="R8" ref-type="bibr">8</xref></sup> If case burden is high, consider dedicating one OR to COVID+ operations only (ideally with neutral or negative pressure).<sup><xref rid="R9" ref-type="bibr">9</xref></sup> This should be emptied of all nonessential materials and equipment. No unnecessary items should be brought into the operating room, including personal items such as mobile phones and pens. Personal linens and coverings such as cloth masks and bonnets should be washed at least daily, and probably more often when treating COVID+ patients.</p></sec><sec sec-type="subjects"><title>DECREASE EXPOSURE OF HEALTH CARE STAFF AS MUCH AS PRACTICABLE AND PREVENT NOSOCOMIAL TRANSMISSION TO OTHER PATIENTS AND PERSONNEL</title><p>While few staff are adequately trained in the appropriate use and application of personal protective equipment (PPE), perioperative personnel are at an advantage given their familiarity with maintaining sterility. Staff should receive training in appropriate donning and doffing techniques through simulation and videos (without using precious resources). Clear instructional posters for PPE donning/doffing should be prominently displayed, and the use of 2 providers should be encouraged to allow 1 person to observe and coach the other through the steps of the routine: <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf">www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf</ext-link>.<sup><xref rid="R10" ref-type="bibr">10</xref>–<xref rid="R15" ref-type="bibr">15</xref></sup> Hand hygiene is critical, and 70% alcohol-based hand rub should be made widely available: <ext-link ext-link-type="uri" xlink:href="https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf">https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf</ext-link>. Symptomatic workers should not provide patient care but rather self-isolate, and testing of these workers should be prioritized.</p><p>Limiting unnecessary patient, family, and health worker movement through the hospital decreases the introduction and transmission of disease. When not essential, keep surgical and anesthetic staff out of hospital to preserve human resources. Trainees and students, in particular, should not be involved with known COVID+ cases unnecessarily. For usual care routines, including patient encounters, plain surgical masks can lower rates of health care worker infections and are recommended.<sup><xref rid="R16" ref-type="bibr">16</xref>–<xref rid="R18" ref-type="bibr">18</xref></sup> Ancillary staff such as OR cleaners, instrument reprocessing staff, and laundry personnel should take appropriate precautions and wear full PPE (goggles or face shield, surgical mask, heavy duty gloves, long sleeved gown, boots).<sup><xref rid="R5" ref-type="bibr">5</xref></sup> No special decontamination methods other than machine laundering with detergent are required for laundering linens; all surface areas should be disinfected with 0.5% chlorine or 70% alcohol solutions.</p><p>Patients with known or suspected COVID-19 should wear surgical masks when being transported through hospital spaces or in rooms without negative pressure isolation.<sup><xref rid="R19" ref-type="bibr">19</xref>–<xref rid="R21" ref-type="bibr">21</xref></sup> Intubation is an aerosolizing procedure and should be performed by the most skilled provider available wearing an N95 or KN95 mask. <italic>Only absolutely essential staff</italic> should be present during intubation, and IV rapid sequence induction without bag mask ventilation is preferred.<sup><xref rid="R22" ref-type="bibr">22</xref></sup> When appropriate and safe, consider regional anesthesia with IV sedation to reduce aerosols. Whenever practicable, decrease case duration and limit aerosol-generating maneuvers (such as the free release of pneumoperitoneum during laparoscopy). Patients should be recovered in the OR, and prior to transport an advance runner sent to clear the path. Consider using a Checklist to ensure appropriate precautions are taken for operations with suspected or known COVID-19 patients (Fig. <xref ref-type="fig" rid="F1">1</xref>).<sup><xref rid="R7" ref-type="bibr">7</xref></sup></p><fig id="F1" position="float"><label>FIGURE 1</label><caption><p>Perioperative checklist for operations on confirmed or suspected patients with COVID-19.</p></caption><graphic xlink:href="ansu-publish-ahead-of-print-10.1097.sla.0000000000003964-g003"></graphic></fig><p>Viral filters and appropriate circuit cleaning measures are essential and should be reviewed,<sup><xref rid="R6" ref-type="bibr">6</xref>,<xref rid="R23" ref-type="bibr">23</xref></sup> otherwise ventilation mechanics may disseminate aerosols throughout an intensive care unit (ICU). If single-use plastic anesthesia or surgical equipment (endotracheal tubes, ventilator circuit tubing, plastic suction tubing, electrocautery handpieces) must be reused, ensure that disinfection aiming for “high-level disinfection” or “sterility” is employed, including immersion in appropriate concentration glutaraldehyde, phenol, or hydrogen peroxide solution.<sup><xref rid="R7" ref-type="bibr">7</xref>,<xref rid="R20" ref-type="bibr">20</xref>,<xref rid="R24" ref-type="bibr">24</xref></sup></p><p>Surfaces in the OR should be thoroughly cleaned between cases, including pulse oximeter probes, thermometers, blood pressure cuffs, and other reusable materials; SARS-CoV-19 is rapidly killed with 70% alcohol solution or 0.5% chlorine solution.<sup><xref rid="R5" ref-type="bibr">5</xref>,<xref rid="R25" ref-type="bibr">25</xref></sup> Using clear plastic sheets (cleaned or changed in between patients) to cover the anesthesia machine, the monitors, and the patient's face during aerosol-producing maneuvers like intubation and extubation, could provide additional protection.</p></sec><sec><title>CONSERVE PPE AND CONSUMABLES</title><p>Manufacturers are already filling backorders from high-income countries; this will additionally stress supply chains to Africa. Familiarity with severe resource shortages may guide creative and innovative strategies to conserve and extend resources. Extended use of N95 masks (continuous wearing while seeing multiple patients) is preferred to limited reuse of N95 masks (doffing and redonning between patients).<sup><xref rid="R26" ref-type="bibr">26</xref></sup> N95 mask life may be lengthened by wearing a plastic face shield or a surgical mask over it. Use of chlorine or alcohol solution to sanitize N95 masks damages mask integrity; however heating to 70°C (160°F) in a dry oven for 30 minutes seems a promising solution to disrupt viral particles and maintain mask integrity for reuse.<sup><xref rid="R27" ref-type="bibr">27</xref>,<xref rid="R28" ref-type="bibr">28</xref></sup> Other innovative solutions are being proposed, as in this example from Boston Children's Hospital: <ext-link ext-link-type="uri" xlink:href="https://www.youtube.com/watch?v=Es_iY5WJdmI">https://www.youtube.com/watch?v=Es_iY5WJdmI</ext-link>. While N95 masks are superior to surgical masks in protecting against aerosolized viral particles, surgical masks still afford significant protection over no mask.<sup><xref rid="R29" ref-type="bibr">29</xref>–<xref rid="R31" ref-type="bibr">31</xref></sup></p><p>Cloth attire in the form of scrub hats or bonnets should be washed between each use if possible, and no less than daily. If gowns are repurposed for isolation units, they should be washed after each prolonged care routine; consider wearing rubber aprons under such gowns. The protection afforded by cloth masks is not well studied but may be significantly less than surgical masks and is not protective to the same extent as N95 respirators; it should be used as a last option only.<sup><xref rid="R5" ref-type="bibr">5</xref>,<xref rid="R29" ref-type="bibr">29</xref>,<xref rid="R32" ref-type="bibr">32</xref>–<xref rid="R36" ref-type="bibr">36</xref></sup></p></sec><sec><title>PLAN FOR STRATEGIC REPURPOSING OF ORs, RECOVERY AREAS, AND STAFF FOR MANAGING COVID-19 CASES</title><p>The commandeering of ORs for use as ICUs, which has been proposed in many high-resource settings, must be done with extreme caution. Emergency surgery capacities should not be compromised by taking up all available OR space and anesthetic machines with COVID+ patients. As the average reported time spent on mechanical ventilation has been up to 13 days,<sup><xref rid="R37" ref-type="bibr">37</xref>,<xref rid="R38" ref-type="bibr">38</xref></sup> critical resources and space will be occupied for weeks to months and will be difficult to reclaim once repurposed.</p><p>Guidance and training should be provided <italic>immediately</italic> to make best use of the technical and clinical skills of all perioperative personnel—waiting until caseloads increase will unduly delay preparations. Hospitals, professional societies, and ministries of health should provide physician and nursing staff with basic ICU and ventilator management refresher education to improve their skill sets; SAGES and the Faculty of Intensive Care Medicine have recently provided such resources: <ext-link ext-link-type="uri" xlink:href="https://www.sages.org/basics-of-mechanical-ventilation-for-non-critical-care-mds/">https://www.sages.org/basics-of-mechanical-ventilation-for-non-critical-care-mds/</ext-link> and <ext-link ext-link-type="uri" xlink:href="https://icmanaesthesiacovid-19.org/clinical-guidance">https://icmanaesthesiacovid-19.org/clinical-guidance</ext-link>.</p></sec><sec><title>MAINTAIN AND SUPPORT STAFF WELLNESS WHILE ASSISTING WITH DIFFICULT ETHICAL CONSIDERATIONS IN RESOURCE MANAGEMENT</title><p>Doctors, nurses, cleaners, and other hospital support staff have significant anxieties that must be acknowledged and managed. The fears of transmitting to family or becoming infected oneself, the increase in work hours, and the need for childcare coverage are real. Furthermore, providers may be understandably nervous about providing care outside of their normal scope of practice or working beyond their area of competence. Leadership can help by providing information in a transparent way, expressing gratitude for the commitment to patients and colleagues, and offering reassurance that the system will help protect them and support them and their family.</p><p>As ventilators will be critically inadequate, there will be additional emotional distress when allocating resources and denying care to patients. Facilities should create a committee and utilize standardized risk assessments to determine allocation decisions in advance. The burden of decision making should not be placed on the frontline health care workers, nor made ad hoc at the bedside. There are multiple resources for guiding the complex decision making in resource allocation and rationing in pandemic situations.<sup><xref rid="R39" ref-type="bibr">39</xref>–<xref rid="R44" ref-type="bibr">44</xref></sup> A recent ethical framework made the following priority recommendations,<sup><xref rid="R45" ref-type="bibr">45</xref>,<xref rid="R46" ref-type="bibr">46</xref></sup> amongst others: 1) Aim to both save the most lives and most years of life, giving priority to maximizing the number of patients that survive treatment (maximizing benefit); 2) Critical testing, PPE, ICU beds, therapeutics, and vaccines should go first to front line health care workers and others who keep critical infrastructure functioning due to their instrumental value in the pandemic response and difficulty of replacing (instrumental value); and 3) Avoid first-come first serve approaches and use random allocation such as a lottery instead (equality). The Hastings Center has provided a freely available online resource that is helpful to guide an ethics process: <ext-link ext-link-type="uri" xlink:href="https://www.thehastingscenter.org/ethicalframeworkcovid19/">https://www.thehastingscenter.org/ethicalframeworkcovid19/</ext-link>.</p><p>Communication will be critical, and an effective communication plan within and between facilities, as well as between providers across the health system and even between countries, is essential and should be established immediately. A task force that can oversee this dynamic situation and provide additional guidance and interpretation of directives (from ministries or multinational organizations such as the World Health Organization) can be extremely valuable. A useful tool for health system organization is the Incident Command System, a standardized hierarchical structure that enables a cooperative response and organizes and coordinates activities; online Incident Command System training is available for free: <ext-link ext-link-type="uri" xlink:href="https://emilms.fema.gov/IS0700b/curriculum/1.html">https://emilms.fema.gov/IS0700b/curriculum/1.html</ext-link>.</p><p>Much will be asked of us all in the coming weeks and months, and we may well find ourselves stretched and beyond our comfort zones. We will be remembered for our actions, and how we comported ourselves in the midst of this pandemic. Our most valuable talents—our compassion, our empathy, and our words of comfort—must be dispensed liberally, as they are both free and priceless.</p></sec></body><back><fn-group><fn fn-type="COI-statement"><p>The authors report no conflicts of interest.</p></fn></fn-group><ref-list><title>REFERENCES</title><ref id="R1"><label>1.</label><mixed-citation publication-type="other">World Health Organization: Coronavirus disease 2019 (COVID-19) Situation Report - 71 [Internet]. [cited Apr 1, 2020]. Available at: <ext-link ext-link-type="uri" xlink:href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200331-sitrep-71-covid-19.pdf?sfvrsn=4360e92b_6">https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200331-sitrep-71-covid-19.pdf?sfvrsn=4360e92b_6</ext-link>.</mixed-citation></ref><ref id="R2"><label>2.</label><mixed-citation publication-type="other">Pearson CAB, et al. Projection of early spread of COVID-19 in Africa as of 25 March 2020. 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