Because many of you are experiencing the effects of the novel coronavirus and have questions about how to handle the anticipated onslaught of cases, the American College of Surgeons (ACS) has developed a twice-weekly newsletter from the Bulletin to keep you informed and updated on best practices. The information in the newsletter was conceived and compiled by members of the ACS Board of Regents and Officers and is published under the aegis of our Division of Integrated Communications. During this time, we will be pausing My ACS NewsScope and ACS NewsScope. We will resume publication of these newsletters when the demand for information regarding COVID-19 slows. In the meantime, we anticipate you will find this newsletter useful in providing optimal care to your patients.

In this first issue of COVID-19 Updates, we provide answers to frequently asked questions regarding management of COVID patients, links to journal articles addressing the topic, and federal and regulatory updates, and other updates on the issue.

Our goal is to keep you informed on how to address this ever-evolving pandemic using the best available information. The Regents and staff look forward to receiving your feedback.

Check our website and social media channels for frequent updates.

Subscribe to the Bulletin: COVID-19 Newsletter

The American College of Surgeons (ACS) is committed to the health and well-being of surgeons and the health care community. During the Coronavirus Disease (2019) COVID-19 pandemic, it is important to create space to care for oneself amidst the increased demands of caring for patients, providing additional support to hospital systems and staff, managing workload, and navigating the impact COVID-19 has on individuals, families, communities, hospitals, and our world.

ACS encourages you to take advantage of the curated resources and tools focused on well-being below. 

Tips

• Check with your hospital or practice to see if an Employee Assistance Program (EAP) is available for any additional support. EAPs typically include assessments, counseling, and referrals for additional services to employees with personal and/or work-related concerns, such as stress, financial issues, legal issues, family problems, office conflicts, and alcohol and substance abuse.
• Use support systems in place, such as reaching out to mentors, peers, colleagues, significant others, family, and friends.
• Remind yourself of the signs and symptoms of stress, fatigue, and burnout:
• • Exhaustion
  • Depersonalization
  • Lack of efficacy

Resources and Tools

• ACS Surgeon Well-Being Index—ACS offers this as a free resource to Fellows, Associate Fellows, and resident surgeons in the United States and Canada. Source: ACS
• Seven things you can do today to help improve your mental health amidst COVID-19. Source: University of Alabama at Birmingham, School of Medicine, Department of Surgery
• Sustaining the Well-Being of Healthcare Personnel during Coronavirus and Other Infection Disease Outbreaks. Source: Center for Study of Traumatic Stress
• Emergency Responders: Tips for taking care of yourself. Source: CDC
• Develop a buddy system: Share in safety and well-being of peers. Source: CDC

Recommendations for Health Care Administrators

The Well-Being Index Team offers ideas for health care administrators to consider implementing to reduce stress. Applying some or all of them will substantially increase the overall well-being of your staff.

• Offer living accommodations for ICU/ER physicians who live with a vulnerable family member, so they do not have to go home (e.g., on-campus, hotel).
• Provide meal credit (e.g., Uber eats, delivery) for those working extra shifts or unanticipated overtime.
• Make dictation and transcription services available to all in the ICU/hospital/ER.
• Redeploy health care workers with known health conditions that place them at elevated risk for complications should they contract COVID-19 to other settings.  
• Require workers to take breaks to recharge and encourage adequate time off between shifts.
• Halt all required online modules and non-essential tasks.
• Provide taxi and ridesharing fare reimbursement to all employees directly engaged in COVID-19 efforts.

Source: The Well-Being Index

If you need more guidance or information, please reach out to Kathleen McCann or Jenny Mohan.

Regionalized trauma systems have been developed to ensure access to care for injured patients who require time-sensitive life-saving interventions and advanced critical care to support recovery. The current worldwide COVID-19 pandemic threatens to overwhelm the healthcare system and thus impact the ability to care for critically injured patients and other surgical emergencies. The intent of this document is to advise trauma medical directors and trauma program managers on factors to consider as the public health and health care sectors prepare for an anticipated surge of critically ill patients related to COVID-19 infection.

This document is not meant to be all inclusive for the planning and preparation required by hospitals and health care systems, but to raise awareness of the importance of preserving capacity to respond to traumatic injuries that routinely occur in our communities.

> Read more on maintaining access

In response to the rapidly evolving challenges faced by hospitals related to the Coronavirus Disease 2019 (COVID-19) outbreak, and broad calls to curtail “elective” surgical procedures, the American College of Surgeons (ACS) provides the following guidance on the management of non-emergent operations.

It is not possible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. While some cases can be postponed indefinitely, the vast majority of the cases performed are associated with progressive disease (such has cancer, vascular disease and organ failure) that will continue to progress at variable, disease-specific rates. As these conditions persist, and in many cases, advance in the absence of surgical intervention, it is important to recognize that the decision to cancel or perform a surgical procedure must be made in the context of numerous considerations, both medical and logistical. Indeed, given the uncertainty regarding the impact of COVID-19 over the next many months, delaying some cases risks having them reappear as more severe emergencies at a time when they will be less easily handled. Following careful review of the situation, we recommend the following

Many of you have asked us questions about the Coronavirus Disease 2019 (COVID-19) outbreak, its impact, and what this rapidly evolving situation means for surgeons, their patients, and the health care infrastructure overall.

To address this need, we are establishing a new surgeon community dedicated to COVID-19. This new community will provide a forum for professional exchange of scientific information and guideline recommendations, as well as a place to share official statements and highlight the coordination of efforts around the pandemic. It will be up and running soon, and we will share a link with you when it is ready.

In the interim, we ask that you post any discussions regarding COVID-19 to the General Surgery community, which any ACS Fellow can join. This will be the primary site for COVID-19 information and discussion until the new community is available. COVID-19 content from the General Surgery community will be migrated to the new community when it is ready.

We remain committed to providing information and new resources that will help you in this dynamic environment. We will continue to communicate with you as we have more information.

David B. Hoyt, MD, FACS
ACS Executive Director

Guided by the trajectory of cases in Italy and other countries, it is very likely that the U.S. health care infrastructure and resources, particularly as it relates to care of the most critically ill patients, are likely to be strained over the coming weeks. Social distancing, crowd avoidance, and other techniques do help to flatten the curve of the dissemination of Coronavirus Disease 2019 (COVID-19), but beyond that, it is appropriate to be forward thinking regarding those patients who will, nevertheless, become infected.The American College of Surgeons (ACS) has additional comments on this issue. Following a careful review of the current situation, we recommend the following

We recently became aware of a malicious website impersonating a credible one dedicated to providing information on the global incidence of Coronavirus Disease 2019 (COVID-19).

The site being spoofed is the live map for COVID-19 Global Cases from Johns Hopkins University. Note: This is a link to the credible website.

Visiting this fake website [corona-virus-map[dot]com] will expose a user to the dangerous AZORult trojan, which steals information, including confidential and sensitive data. This malware has been noted to be found in fake email attachments and posted in online ads, although there are other venues by which you might come across it. 

Unfortunately, this dangerous website may not be the only COVID-19 hoax circulating on the Internet. In recent weeks, there's been a rise in number of website domains registered related to COVID-19, and it is unclear whether they are all legitimate domains or if some are being deployed by cyber criminals. Read more here.

We encourage you to exercise caution when searching online, responding to emails, or opening attachments. Check carefully when opening emails from unknown senders or outside groups even if they appear to be reputable.  

Here are some suggested guidelines on how to protect yourself from these types of online and email impersonators.

With all best regards,

David B. Hoyt, MD, FACS
Executive Director, American College of Surgeons

Brian Harper
Director of Information Technology, American College of Surgeons