The impact of the novel coronavirus disease 2019 (COVID-19) pandemic is catastrophic, with the cumulative number of confirmed worldwide cases reaching 1,610,909 by April 11, 2020. Despite the necessary reassignment of many healthcare resources to the care of patients with COVID-19, gynecologic patients must still receive a diagnosis and be treated. Therefore, guidelines for the safe management of these patients during the epidemic are needed to protect patients and the healthcare workforce.1 The Chinese Obstetricians and Gynecologists Association (COGA) organized experts from all provinces and autonomous regions in mainland China (Wuhan included) to contribute their experience in the diagnosis and treatment during the epidemic, aiming to distribute guidelines regarding the care of gynecologic patients during the COVID-19 outbreak in mainland China.
These guidelines were developed by the Department of Obstetrics and Gynecology at the Peking Union Medical College Hospital (PUMCH) and represent an effort to integrate infection control strategy and promote professionalism in medical practice. The guidelines represent collaboration with experts from 31 provinces over 2 weeks’ time. With the implementation of these guidelines, no nosocomial infections of COVID-19 have been identified at PUMCH. Given that it is not easy to anticipate when the epidemic will peak and the understanding of COVID-19 is still changing, parts of this consensus statement may become obsolete as knowledge about the epidemic evolves.
1. Outpatient
There should be triage for outpatients. Patients suspected of having COVID-19 should go to the fever clinic for further treatment. In principle, suspected cases, probable cases, or confirmed cases should not be allowed to seek medical advice in the outpatient gynecology clinic. Avoid having people gathering in the waiting area. One doctor or provider should treat 1 patient at a time in the consulting room, and the consulting room should be disinfected immediately after use. During the COVID-19 pandemic, we recommend online or remote consultation by telephone as much as practical, to minimize the risk of disease spread by close contact.
2. Operative patient
In emergency surgery with sufficient time available for screening, patients who are clinically stable should be asked the screening questions listed ,have their temperature assessed, and be checked for clinical symptoms to eliminate the possibility of COVID-19. If the possibility of a COVID-19 diagnosis cannot be completely ruled out, patients should go to the fever clinic for further screening . If the patient is clinically unstable or the patient’s condition is life-threatening, an emergency consultation with infection control experts may be useful. The decision may be made to treat the patient as a suspected case or even confirmed case .
In principle, it is recommended to reduce elective surgery during the epidemic. If the decision is made to perform elective surgery, the inquiry (screening questions) and triage protocol should be followed as for “time-limited” surgery.
Planning coordination throughout the hospital system, including the various surgical departments, anesthesia, and nursing services, is important in managing surgical services in the setting of a health emergency. Furthermore, adequacy of the blood supply must be considered when arranging operations. Autologous blood donation, acute normovolemic hemodilution, directed donation, and other methods can be considered as alternatives to allogenic blood transfusion.
3. Nonoperative inpatient
The triage protocol for a newly admitted patient is provided. Recommendations for ward management include the following: First, review the screening questions and take the temperature of patients, visitors, and accompanying persons; any patient with an elective admission or any nonpatient suspected of infection should be refused entry into the hospital.
Second, visiting rules can be modified according to local preference. It is recommended to prohibit visiting, and if visitors cannot be avoided, the number of visitors should be no more than 1. Visitors must be screened. Third, if a patient develops fever that cannot be explained by the primary disease (requires judgment by the attending doctor or professor), a consultation with infectious disease specialists is recommended. Fourth, if a patient is identified to have COVID-19, the patient should be transferred to a facility that can provide an airborne infection isolation room. At the same time, everyone who has had close contact with the patient should be isolated (This is a recommendation from our experience in mainland China. If there is a shortage of local medical staff, the strategy can be modified according to the actual situation.). Fifth, rooms should be reserved for emergency use for patients with infections during the outbreak (for emergency operations and for emergency isolations). Sixth, provide education for patients and close contacts.
Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions and is available in COVID free clinic.