COVID-19 pandemic, as experienced in the surgical service of a district hospital in Spain

Table 1 Impacts produced on elective procedures in different scenarios[12]

	1	2	3	4	5
Effectiveness of conservativetreatment	None/not available	< 40% of that provided by surgery	40%-60% of that provided by surgery	60%-95% of that provided by surgery	Fully equivalent to that provided by surgery
Impact of a 2-wk delay on disease prognosis	Very severe worsening	Significant worsening	Moderate worsening	Slight worsening	No worsening
Impact of a 6-wk delay on disease prognosis	Very severe worsening	Significant worsening	Moderate worsening	Slight worsening	No worsening
Surgical time (min)	< 30	30-60	60-120	120-180	> 180
Average hospital stay	Minor surgery/major ambulatory surgery	< 24 h	24-48 h	3 d	> 4 d
Likelihood of need for ICU (%)	Unlikely	< 5	5-10	10-25	> 25
Blood required (cc)	< 100	100-250	250-500	500-750	> 750
Members of the surgical team	1	2	3	4	> 4
Location of surgery	None of the following	Upper and lower abdomen, by laparoscopy	Lower abdomen, open surgery	Upper abdomen, open surgery	Head and neck, thorax, gastro-oesophageal complex
Age	< 20	20-40	40-50	50-65	> 65
Chronic lung pathology (COPD, asthma, cystic fibrosis)	No			Treatment on demand	Usual treatment
Obstructive sleep apnea syndrome	No			No treatment	Continuous positive airway pressure
Cardiovascular disease	No		1 drug	2 drugs	3 drugs
BMI (kg/m2)	< 25			25-30	> 30
Diabetes mellitustype 2	No		No medication	Oral antidiabetic	+ Insulin
Immunosuppression	No			Moderate	Severe
Flu syndrome	No				Yes
Contact with COVID-19 in the last 15 d	No		Unknown		Yes

BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; COVID-19: Coronavirus disease 2019; ICU: Intensive care unit.

Table 2 Dynamic scale of hospital response scenarios during the pandemic and impact on surgical activity[11]

Scenario	I (almost normal)	II (initial alert)	III (moderate alert)	IV (high-level alert)	V (emergency)
% of hospital beds occupied by COVID-19 patients	< 5	5-25	25-50	50-75	> 75
Hospital resources	No impact	No impact, but precautionary reserve of resources	Some impact on resources, with precautionary reserve of beds	Some impact on resources and on healthcare personnel	Significant impact with limited access to beds and ventilatory support
Surgical activity	Normal	Emergencies, cancer pathologies and preferential benign pathologies	Emergencies and cancer pathologies for which a 3-mo delay would worsen the prognosis	Only emergencies	Only non-deferrable emergency attention. Status assessment by the hospital’s ethics committee

COVID-19: Coronavirus disease 2019.