COVID-19 WFNS President

The COVID-19 Virus and Our Lives Including Neurosurgery

Franco Servadei
President, World Federation of Neurosurgical Societies Humanitas University and Research Center IRCCS, Milano, Italy

Neurosurgeons are a small community of about 50000 people all around the world. Until now we were a highly technological branch of Surgery with limited collaborations with Neurologists, Neuroradiologists, ENT surgeons, Maxillofacial surgeons, Oncologists and Rehabilitation Physicians.

Since we are dealing with a number of life threating diseases (like trauma, brain hemorrhage, brain and spine tumors….), we thought we are essential for the worldwide care of a large number of patients - and that our technology put us in a privileged position.

The arrival of the COVID-19 pandemic all around the world showed how far we were from reality:

1. The first mistake was made by every single country and continent - we all believed that “We were different”:
   1. “China is far away. COVID-19 will never cross oceans, we will protect ourselves, we are clever and prepared enough.” (WRONG)
   2. “The Italians have bad patient care and the population is old; therefore our mortality (in Spain, France, Belgium, UK) will never be like them.” (WRONG – the mortality has been similar if not higher)
   3. “We (in the USA, Brazil, Sweden) do not need to look down, we are more clever, we wait for mass immunization.” (WRONG - they all changed their minds)
2. “Neurosurgery will be preserved at any time - we are indispensable for a large number of patients.” (WRONG):
   1. Our experience in Italy is such that in the most affected areas (like the city of Bergamo) in a couple of weeks Neurosurgery was shut down and all Neurosurgeons were sent to the care of COVID-19 patients [1].
   2. Therefore we have quickly re-organized patient evaluation and care to preserve at least some emergency activity [2]. The same situation happened in many other countries where the Neurosurgical units were simply swept away by the COVID19 tsunami.
   3. Surgical indications changed greatly: As an example, most of our non-tumoral and non-traumatic spine surgery disappeared from our operating lists and even tumor surgery was re-formatted in this period [2,3].
3. In many countries we had an extremely high number of health care workers (including doctors) infected since at the beginning of the pandemic they did not have sufficient protection. The same story was repeated without learning from others’ mistakes.

But we believe there are also positive messages from this disaster:

1. We realized that we are NOT a separate body - we are Doctors before becoming Neurosurgeons.
2. We learned how to deal with oxygen masks, how to intubate patients, and how to treat them properly.
3. We always care for severely ill patients - we can quickly adapt and help our communities. As an example: the Trauma Section of the AANS/CNS has pulled together essential guidance for neurosurgeons who are being called upon to serve as intensivists during the COVID-19 crisis (see the AANS/CNS website).
4. We showed that we are also able to quickly reorganize our Services to keep neurosurgical emergency care in these difficult times with humility and spirit of service [2-4].
5. We also found many ways of communicating without large or small meetings: we activated webinars, teleconferences, etc.
6. Our background of technology helped us greatly, and our younger colleagues established bridges all over the world.

In conclusion: the future will never be like the past.

We will never forget what we have learned. We will be respectable Doctors first, and fantastic Neurosurgeons after, for all our lives.

References:

1. Bernucci C et al, World Neurosurgery, April, 2020
2. Cenzato M et al, Journal of Neurosurgery, April 2020
3. The Society of British Neurological Surgeons, Guidelines for patient management, March-April 2020
4. Burke JE et al, Neurosurgery, April 2020