An Exit Strategy for Resuming Non-Emergency Neurosurgery after SARS-CoV-2: a UK Perspective.

Hill, Ciaran S.; Muirhead, William R.; Vakharia, Vejay N.; Marcus, Hani J.; Choi, David

Abstract Introduction Substantial healthcare resources have been diverted to deal with the effects of the Coronavirus SARS-CoV-2 pandemic, and non-emergency neurosurgery has been effectively shut down. As we start to emerge from the crisis, we need to deal with the backlog of non-emergency neurosurgical patients whose treatment has been delayed, whilst remaining responsive to further possible surges of infection. Aims & Method This article aims to identify core themes and challenges that limit resumption of a normal neurosurgical service after the SARS-CoV-2 pandemic, and to provide pragmatic advice and solutions that may be of utility to clinicians looking to resume non-emergency neurosurgical care. We reviewed of relevant international policies, a wide range of journalistic and media sources, and expert opinion to address the stated aims. Results We present and discuss a range of factors that may act as potential barriers to resuming full elective neurosurgical provision, along with important steps that must be overcome to achieve pre-COVID-19 surgical capacity. We also explore how we may overcome these challenges and outline key requirements for a successful neurosurgical exit strategy from the pandemic. Conclusion Recommencing non-emergency neurosurgery can start once minimum criteria have been fulfilled, these must include: 1. A structured prioritization of surgical cases 2. Incidence of virus infection should fall sufficiently to release previously diverted healthcare capacity 3. Adequate safety criteria met for patients and staff including sufficient personal protective equipment and robust testing 4. Maintenance of systems for rapid communication at organizational and individual levels