A Urology Department's Experience at the Epicenter of the COVID-19 Pandemic

Abstract

Since the first reported case of the novel coronavirus disease 2019 in Washington State, 1 the United States has become the global epicenter of the pandemic. With many predicting critical shortages of hospital beds, ventilators, and health care providers in New York City (NYC), the NewYork-Presbyterian Hospital and Columbia University Irving Medical Center (CUIMC) quickly implemented system-wide changes to prepare our response. As of May 26, 2020, NYC itself had 204,111 cases and 20,795 deaths, the latter only surpassed by 5 countries outside the United States. 2 In this correspondence, we summarize the CUIMC Department of Urology's experience at the global epicenter of COVID-19 to guide other departments in the response to this and future pandemics. CLINICAL EXPERIENCE RedeploymentIn early March 2020, our department held twice-weekly phone conferences to address the spread of COVID-19 to NYC. All urology faculty, residents, and administrative personnel participated, allowing all parties to ask questions and give input regarding the frequent changes in protocols. These calls ensured immediacy, transparency, and fidelity of information during a rapidly evolving situation. The volume of COVID-19 patients was quickly increasing and many front-line providers were being quarantined for symptoms and/or exposure. It was clear that redeployment of our staff was imminent.To increase available personnel, equipment, and physical space, all elective surgical cases at CUIMC were suspended on March 13. On the evening of March 25, our chairman called an emergency phone conference. Hospital leadership had declared that our emergency rooms (ERs) were overrun and in need of assistance − redeployment had been activated.

The Impact of the COVID-19 Pandemic on Urology Residents: a Narrative Review

“…Notably, those with high-risk comorbidities, pregnancy, or an immunocompromised state were often excluded from covering COVID-19 units [ 8 ]. One New York hospital system recruited urology residents and faculty to volunteer for redeployment on an “opt-in” basis, with all volunteers redeployed in pairs of 1:1 residents-to-attendings [ 9 ]. A survey of residents in all Accreditation Council for Medical Education (ACGME) accredited urology programs in March 2020 found that urology residents who felt institutional support and shared responsibility with attendings were more likely to agree to voluntary redeployment [ 2 ].…”

“…In Europe, urology residents underwent refresher courses on basic and advanced life support, and respiratory support and treatment in anticipation of redeployment [ 15 ]. One New York hospital urology department coordinated with medical colleagues to develop a novel “Emergency Department-Intensive Care Unit” to care for ED patients that required ICU-level care [ 9 ]. In anticipation of future pandemics, institutions should provide urology residents with training on assessment/management algorithms, airway and ventilator management, palliative care resources, personal protective equipment (PPE) conservation, and clinical trials [ 23 ].…”

“…Urology PDs and faculty can regularly interact with residents and allay trainee concerns by offering support, keeping lines of communication open, and demonstrating appreciation for residents’ work. To monitor residents’ mental health, recurring forums or town hall meetings can be held to allow for open discussion of the pandemic’s challenges, evaluate mental well-being, and provide access to mental health resources [ 1 , 9 , 23 ]. This became a widely adopted practice, as programs in the US initiated regular video “check-ins” to evaluate resident well-being and discuss ever-changing hospital protocols [ 31 ].…”

“…Telehealth is also novel for many patients as demonstrated by a 2019 survey which found that only 10% of Americans had used telemedicine as a means for care [ 45 ]. With the increased use of telemedicine during the pandemic, many patients have likely now become more comfortable with the technology [ 9 ].…”

The Impact of COVID-19 Disease on Urology Practice

“…The false-negative rates of the early COVID-19 tests and the presence of asymptomatic carriers did not allow to create a "COVIDfree" space. 19 To recover the urology departments from an extraordinary level of suspended activity, urologists were obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. 20 The new condition with the COVID-19 pandemic obliges urologists to conform to the guidelines that appear on a daily basis formulated by multidisciplinary surgical groups to manage urological emergencies.…”