Letter: The Risk of COVID-19 Infection During Neurosurgical Procedures: A Review of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) Modes of Transmission and Proposed Neurosurgery-Specific Measures for Mitigation

Abstract

To the Editor:The novel coronavirus disease of 2019 (COVID-19) is a disease caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2). It was first reported in December 2019 as a series of cases of pneumonia with an unknown etiology clustered around a food market in Wuhan City, China. 1 The infection spread quickly and was declared a pandemic by the World Health Organization (WHO) on March 11, 2019. 2 By March 30, more than 782 365 confirmed cases were reported and a third of the world population were living in confinement to try to contain the virus. 3 While the disease itself is often mild, approximately 11% of cases require acute medical care, and this cohort quickly overwhelmed healthcare systems around the world. 4 In anticipation of such a demand, hospitals in many countries quickly stopped all nonurgent visits, procedures, and surgeries, freeing up beds, equipment, and workforce. 5 While neurosurgeons are not on the frontline of COVID-19 management and treatment, they commonly care for critically ill patients who will continue to present with subarachnoid hemorrhages, subdural hematomas, brain tumors, traumatic brain injuries, spinal cord injuries, and compressive myelopathies while the pandemic occurs. While public health measures such as quarantine and social distancing are proving effective at slowing the spread, 6,7 surgeons remain in direct contact with their patients throughout their operations. Protecting the surgical team from contracting COVID-19 is of utmost importance as they are both a potential vector for patient contamination and a scarce resource that cannot be easily replaced.The goal of this paper is to briefly review how SARS-CoV-2 is transmitted and propose measures that could be implemented to minimize the risk of contaminating the operating room (OR) personnel during the most common neurosurgical procedures. Methods and ethical considerations are discussed in the Supplemental Digital Content. SARS-COV-2 TRANSMISSION Sites of EntryPhylogenetic analysis revealed that the SARS-CoV-2 virus probably evolved from the bat SARS-like CoV (bat-SL-

COVID-19 and its Modes of Transmission

“…The disease, unless combined with other comorbidities or other preexisting diseases, is usually mild. Approximately 11% of cases require acute medical aid [2]. Broadly, two modes of transmission of COVID-19 exist-direct and indirect [3].…”

Results of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany

“…These published papers and web-based statements contain precise recommendations for the performance of certain surgical procedures (e.g., tracheostomies) [9][10][11][12][13][14][15][16][17]. Others provide general protection advice for ORLs [18][19][20][21][22][23][24][25][26][27] or similarly atrisk disciplines [28,29]. Out of an abundance of caution, some otorhinolaryngological procedures like anterior rhinoscopy or the use of rigid or flexible endoscopes [30][31][32][33] were advised to be avoided unless absolutely necessary.…”

Minimising aerosol spread during endoscopic sinus and skull base surgery. Experimental model evaluation of the efficacy of the microscope drape method

“…27 Current evidence suggests that SARS-CoV-2 in the community setting is transmitted primarily through respiratory droplets and fomites (touching a contaminated surface and then touching one's mouth or nose). 28 Airborne transmission is defined as 'the spread of an infectious agent caused by the dissemination of droplet nuclei that remain infectious when suspended in the air over long distances and time'. Airborne transmission of SARS-CoV-2 remains controversial, but a growing number of recent papers support its feasibilityalthough rarein favourable conditions such as AGPs (an opportunistic airborne pathogen).…”