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.