Introduction
Towards the end of 2019 a new disease emerged in Wuhan, China, now known
as coronavirus disease 2019 (COVID-19), caused by severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) (1-3). Approximately
three months later, on March 11, 2020, COVID-19 was announced by the
World Health Organization as a global pandemic. As of May 20, 2020, more
than five million people worldwide were affected by the virus with about
325,000 deaths. Since the beginning of COVID-19 the world has changed
drastically, and various measures have been taken in an attempt to
“flatten the curve”, some of them having an unprecedented effect on
world health systems (4).
Israel was amongst the first countries to close its borders and impose
significant restrictions on its population, comprising personal movement
restrictions, social distancing and cancellation of public
transportation. In early March, schools and stores were closed, and
dedicated units to treat COVID-19 patients were inaugurated. By the time
COVID-19 was declared a pandemic, it had affected approximately 200
people countrywide with no fatalities.
Being a small country, one of the primary goals of the system was to
anticipate the influx of patients arriving at medical centers in order
to prevent a collapse of medical resources, including exhaustion of
personnel, lack of equipment, protective gear, mechanical ventilators,
surgical drapes, and extracorporeal membrane oxygenation (ECMO)
machines. Virtually all medical specialties were required to
significantly reduce their daily routine services. Specifically, cardiac
surgeons were requested to scale down their clinical practice and adapt
to a new hospital policy (4-6). As a result, cardiac surgical programs
engaged into a new reality of patient selection, prioritizing urgent
cases while delaying elective procedures. Similar circumstances are
reported worldwide (1,4,5,7). Additionally, from fear of getting
infected, a new phenomenon of avoiding medical care emerged, and thus,
non-COVID-19 patients requiring cardiac surgery refrained from
requesting help.
While the number of patients undergoing cardiac surgery compared with
previous years has undoubtedly decreased, the actual impact of this
decline is yet to be fully understood. Therefore, the aim of this study
is to characterize the impact of COVID-19 on cardiac surgery discipline
by comparing the same time periods from different years within two major
cardiac surgery departments in Israel.