The COVID-19 pandemic has recently put a stop to elective surgical procedures across Canada, inherently compounding already lengthy waitlists that exist within most disciplines of surgery. These long waits for elective procedures within Canadian provinces have not been caused by the COVID-19 pandemic; it is an acute-on-chronic issue that has been ex­acerbated by the ongoing COVID-19 pandemic. As hospitals begin to reschedule elective surgeries, patients are likely to be prioritized by clinical urgency using both established and newly created surgical triage severity scales. The objective of this commentary is to discuss issues related to the rebooking of elderly surgical patients during the COVID-19 pandemic within the context of northern medicine. Northern and rural hospitals may already face a multitude of barriers related to the rebooking of surgical patients due to a paucity of available surgical resources, as well as difficulties related to access­ing care at the local level. While current surgical rebooking tools have been developed in response to the COVID-19 pandemic, they fail to explore certain risks related to the older adult population which may lead to increased mortality and morbidity. Review of the literature indicates that redistribu­tion of surgical resources for older adults in the COVID-19 era will require consideration of clinical medical ethics vs. population health ethics regarding who should be prioritized in re-bookings for elective surgical procedures. This should be done in conjunction with encompassing surgical triage severity scales specifically made for older adults in the time of COVID-19.

Background: The Bacillus Calmette-Guerin (BCG) vaccine has long been used for the prevention of tuberculosis (TB) around the world. BCG is also used as an immunotherapy agent for the treatment of non-muscle invasive urinary bladder cancer. This scoping literature review and preliminary data analysis aims to summarize the literature correlating infantile BCG vaccination with the incidence of future bladder cancer. Methods: Studies were identified by a formal literature search of MEDLINE and Cochrane Central Registrar of Controlled Trials following PRISMA guidelines. Preliminary data analysis was conducted on publicly accessible data summarizing the impact of gender, BCG vaccination, and socio-economic effects on crude and age-standardized rates of bladder cancer. Results: As part of our analysis, preliminary regression models demonstrated BCG vaccination status, gender, and socio-economic status to have statistically significant effects on crude and age-standardized rates of bladder cancer incidence. BCG vaccination was associated with a 35-37% lower age-standardized rate of bladder cancer incidence. Conclusions: There is very little literature examining the relationship between prior BCG vaccination and rates of bladder cancer incidence. Our limited data analysis indicates that a relationship does exist between infantile BCG vaccination and later bladder cancer development, although extensive future investigation is needed in this area.

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Introduction: One aspect of health presently not well-explored in the perspective of the pandemic is sexual medicine and its impacts on the urogenital health of older adults.

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