Endoscopy Units and the Coronavirus Disease 2019 Outbreak: A Multicenter Experience From Italy

Abstract

U p to 20% of health care personnel (HCP) were found to be infected with coronavirus disease (COVID-19) 1 in the outbreak in northern Italy. 2 Recommendations on patient and HCP protection have been made, such as postponing procedures, triage, use of personal protective equipment (PPE), and creation of differentiated in-hospital pathways. 3,4 However, several barriers against the adoption of these strategies exist, including cultural factors and shortages of medical resources; therefore, there are few reports of real-world experiences and outcomes with their adoption. 5 The aim of this survey was to investigate the burden of COVID-19 on endoscopic activity in a high-risk area of COVID-19 outbreak, approaches to evaluating patients, adoption and compliance of HCP with protective measures, and initial possible viral transmission outcomes from endoscopy units within a large, community-based setting (both between patients and HCP and between HCP). MethodsThe study was conducted as a survey between March 16 and March 21, 2020. Directors of emergency departments in highrisk areas of northern Italy (Supplementary Figure 1) were invited by e-mail to complete a questionnaire (Figure 1 and Supplementary Table 1). Participation was voluntary. Additional methodology is provided in the Supplementary Material. Results Characteristics of the Endoscopy UnitsA total of 42 endoscopy units were invited, of which 41 participated (97.6%). Most respondents (n ¼ 37, 90.2%) were from high-volume endoscopy units, for a total of 968 endoscopy personnel, including 323 endoscopists, 496 nurses, and 149 health care assistants. Changes in Endoscopy Activity Related to Coronavirus Disease 2019All endoscopy units had patients diagnosed with COVID-19 in their hospital. All but 1 center (40/41, 97.6%) reduced Infection Prevention and Control Measures for Coronavirus Disease 2019Regarding the preventive measures taken after the first Italian case (February 18, 2020), 5 (12.2%) endoscopy units did not take any measures, 29 (70.7%) endoscopy units adopted a triage for risk stratification of COVID-19 infection, 7 (17.1%) endoscopy units decreased endoscopic See editorial on page 36.

Impact of the COVID-19 pandemic on gastrointestinal endoscopy in Africa

“…Only two survey participants had examined patients with COVID-19 in an emergency situation. This is in contrast to the results of a survey from Italy in which about half of all endoscopy units were directly involved in emergent or urgent procedures in COVID-19 cases [13]. However, this may not have been the case in other parts of the world that did not experience the same extremely sharp rise in incidence of COVID-19 cases within a short period of time.…”

“…As with all other fields of medical practice, the COVID-19 pandemic has impacted gastrointestinal endoscopy, especially with regards to triage and prioritization of patients and procedures, cleaning and disinfection of equipment as well as protection of health care workers (HCW) [11,12]. A survey from northern Italy showed a dramatic burden of the pandemic on endoscopy units [13]. However, data on the effects of the pandemic on gastrointestinal endoscopy in central and sub-Saharan Africa (SSA) are lacking.…”

Impact of coronavirus pandemic crisis in endoscopic clinical practice: Results from a national survey in Brazil

“…Recently, another survey has been reported by Repici et al [18], conducted in high-risk areas of northern Italy. The coordinators of 41 endoscopic centers responded to the survey but individual endoscopists did not.…”

“…By early March, approximately 20 % of health care providers in Italy had been infected by SARS-Cov-2 [19]. In a survey conducted by Repici et al [18], 12 endoscopy units confirmed infections among nurses and physicians with six of them requiring hospitalization. However, there was no clear evidence of transmission directly related to endoscopic procedures in COVID-19-positive patients.…”

Addendum zu den S3-Leitlinien Morbus Crohn und Colitis ulcerosa: Betreuung von Patienten mit chronisch entzündlichen Darmerkrankungen in der COVID-19-Pandemie – offene Fragen und Antworten

“…Empfehlungsgrad: EL5/ Zustimmungsgrad: starker Konsens (98 %) Das Endoskopiepersonal ist über eine mögliche Inhalation von Tröpfchen und Aerosolen, Kontakt über die Konjunktiven sowie über den Stuhl einem erhöhten Risiko einer Infektion mit SARS-CoV-2 ausgesetzt. Eine vermehrte Transmission der Infektion in Krankenhäusern durch infizierte Mitarbeiter wurde beschrieben [77,78]. Endoskopien stellen einen Ort mit besonders hohem Übertragungsrisiko bakterieller und viraler Infektionen dar, sodass die Mitarbeiter dort in besonderer Weise geschützt werden sollten [79].…”