Due to the Covid-19 pandemic, my practice was closed from March 16 and all scheduled consultations and operations were canceled until the end of lockdown. For patients, this announcement was met with disbelief, even stress, and deception. With Coronavirus, it is important to review the medical challenges for all.
Why cancel appointments?
Coronavirus SARS-CoV-2 is extremely contagious and can be spread by a person with absolutely no clinical signs of infection. A person contaminated with the virus can be contagious before developing any signs of infection and one-third of carriers of Coronavirus SARS-CoV-2 are probably asymptomatic but likely to spread the virus and worsen the pandemic.
In this context, it was necessary to avoid as soon as possible bringing patients together in the same place and to limit the number of daily contacts with patients to avoid being a link in the transmission chain of the virus.
Our duty as physicians is firstly to do all we can to stop the epidemic and this begins with not being a vector through our daily practices.
Why cancel all operations?
Once again, it is important to avoid spreading the SARS-CoV-2 virus. From March 15, 2020, healthcare facilities were instructed by the ARS (Regional Public Health Agency) to cancel all non-urgent procedures. Only vital or emergency procedures were authorized (peritonitis, open fracture, breast cancer…). For example, slow-growing skin carcinomas had to be postponed to limit the number of people in healthcare establishments and thus limit the spread of Coronavirus.
In addition, all private healthcare establishments were ready to receive patients in their ICU and operating rooms were ready to be used for patients requiring resuscitation. If there are not enough beds in resuscitation for patients in the coming days, the operating rooms will be turned into ICU.
When will the Covid-19 pandemic peak?
Covid-19 is not a virus but a new disease caused by the new Coronavirus SARS-CoV-2 rampant in France since February 2020.
The symptoms of Covid-19 vary considerably and none are found systematically. The main potential symptoms are a dry cough, a high temperature, an aching body, digestive disorders, a headache, problems with taste and smell (anosmia, ageusia), and extreme tiredness. Covid-19 can progress toward severe acute respiratory distress that can rapidly result in death.
After 15 days of lockdown, a peak in Covid-19 cases is predicted around the end of March beginning of April. Indeed, lockdown has limited the spread of Coronavirus for the time being but as the incubation period can be up to 15 days, subjects contaminated before lockdown will develop symptoms of Coronavirus in the coming days.
It is essential to comply with the lockdown to try and stop the current pandemic as quickly as possible. Indeed, if the lockdown is observed correctly, there should be no more new cases in the weeks following the expected peak at the end of March.
What future for patients who have been canceled?
For all patients who had a consultation or operation canceled, once the date of the end of lockdown is known, procedures and consultations will be rescheduled as soon as possible. A plastic surgery procedure is the culmination of much thought and careful consideration. Even if it is frustrating to have to reschedule a long-awaited project, precautionary measures take precedence and no risk must be taken for any procedures that are not vital or urgent.
What about post-operative follow-up for patients who have already undergone surgery?
During the pandemic, for all patients who underwent surgery in the weeks before the lockdown, post-operative follow-up will be conducted via video call or with photos to assess post-operative recovery and specific treatments that may be necessary. The continuity of care is essential. Any questions can be asked by email if there are any queries regarding post-operative progression.
Can plastic surgeons be requisitioned?
For the time being, plastic surgeons are not requisitioned as each person is called upon depending on their skills. The career path of a plastic surgeon requires several years of studies (at least 13) but after the first six years, the path of each physician is very specific depending on their specialty. Resuscitation or emergency is a specialty that requires physicians to know how to manage life-threatening conditions. This very specific field of medicine, also known as intensive care medicine, requires very specific training and experience.
A surgeon does not have the necessary skills to manage intensive care, which is why it appears plastic surgeons will not be requisitioned to manage medical care during this Covid-19 crisis.
In France, the first sentence of the Hippocratic Oath that each physician must pledge to be recognized by their peers is the following: Upon being qualified to practice medicine, I promise and swear to abide by the laws of honor and probity. My primary concern will be to restore, preserve or promote health as a whole, physical and mental, individual and social. »
Like all physicians, plastic surgeons remain available at any time to help the healthcare staff who are fighting Coronavirus on the front line every day.
We must fight from day to day, each as we can, even if that means staying home for some. All that needs to be done to stamp out this pandemic must be done by each of us. Every action counts.