Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Background: As of June 19th, 2021, there have been 178,765,626 reported COVID-19 cases and confirmed 3,869,994 COVID-19 related deaths. Despite the mass vaccination campaigns, number of SARS-CoV-2 infection cases continue to rise. Therefore, it’s important to control its spread for which the most potent method remains social distancing. Due to the diversity in the severity of the effect of the pandemic on different countries, it’s imperative to study the social distancing behavior among population in the developed and developing countries where the factors such as socioeconomic status, education, overpopulation, religious beliefs, and misconceptions play a role in altering the population’s behavior. Methods: In this cross-sectional study, a total of 384 participants from 14 different countries were surveyed via an online REDCap form. Results: In this study it was highlighted that although the knowledge regards to COVID-19 pandemic and its related prevention remains high, the overall compliances in both the developed and developing countries remain poor, the lowest being in the senior age group (≥ 65 years). It was found that out of all the age groups, adults aged between 25–64 years were the most compliant to social distancing. (p value = 0.003) Population from the developing countries were more compliant to all preventative measures against COVID-19 spread except for in handwashing compliance where the difference between the two populations remains insignificant. (p value = 0.038, < 0.001, 0.016) Socioeconomic status, prior history of COVID-19 infection or presence of comorbidities did not significantly affect compliance rates however, participants with no prior history of this infection were found to be more compliant to donning a mask in public as compared to those with a positive history of SARS-CoV-2 infection. (p value = 0.044) Additionally, participants with no family history for comorbidities in developing countries had a higher hand washing and mask compliance as compared to those who had a positive family history. (p value = 0.035) Conclusion: Mass campaigns about awareness related to the preventative measures against COVID-19 remain essential in controlling the disease spread as despite having an overall high COVID-19 related literacy, compliance remains subpar in both developing and developed countries.

Background: Despite mass vaccination campaigns, the world has seen a steady rise in the number of SARS-CoV-2 cases, with 178,765,626 cases and 3,869,994 COVID-19 related deaths by June 19th, 2021. Therefore, it is important to enforce social distancing to control its spread. With the variation observed in the severity of the pandemic in different countries, it is also imperative to study the social distancing behaviors amongst the population in developed and developing countries.Design and Methods: In this cross-sectional study, a total of 384 participants from 14 different countries were surveyed via an online REDCap form.Results: In this study, it was highlighted that despite adequate knowledge, the overall compliance to COVID-19 related preventive measures remains poor, the lowest being in the senior age group (≥ 65 years), and the highest being in adults aged between 25-64 years (p-value =0.003). Population from the developing countries were more compliant to all preventative measures against COVID-19 spread, except for handwashing, where the difference between the two populations remained insignificant (p-value = 0.038, <0.001, 0.016). Socioeconomic status, prior history of COVID-19 infection, or presence of comorbidities did not significantly affect compliance rates, however, participants with no prior history of this infection were found to be more compliant to donning a mask in public as compared to those with a positive history (p-value = 0.044). Conclusions: Since compliance remains subpar in both the developing and the developed countries, mass campaigns about COVID-19 related preventive measures remain essential in controlling the disease spread.

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