The COVID-19 pandemic has had a tremendous impact on our national health care system. During the early part of the pandemic, elective surgical procedures were particularly affected, with the threat that should hospitalizations rise in the future in certain regions those procedures could again be affected in those regions.
Given that brain tumors often straddle the line between elective and emergent procedures, the pandemic has presented unique challenges to the neuro-oncology community. At UCSF and in much of the West Coast, we were fortunate not to experience the severity of COVID-related hospitalizations that affected other regions of the country. However, given the uncertainty around whether there could be a surge in hospitalizations early in the pandemic, we like much of the country were asked to limit elective procedures from March 2020 to May 2020.
Given the rapidly evolving nature of the pandemic, we based the development of protocols on the Delphi system to achieve consensus across a multi-disciplinary panel of experts. Specifically, we used this system to develop (1) a standardized physical examination that could be implemented over tele-medicine and (2) a triage system for surgical cases. Based on this triage system, malignant tumors such as high-grade gliomas moved forward with surgery but decision making for more benign, lower grade tumors was based on consideration of symptoms. In the early days of the pandemic, before routine COVID testing, N95s were worn during all tumor surgeries because of the aerosilization that occurs during the drilling. Once COVID testing became standard for all patients prior to surgery, standard operating room precautions were followed. Other precautions that were implemented included the use of a special draping system to reduce the spread of aerosolized particles during transsphenoidal procedures. Research efforts were largely suspended in the early days of the pandemic; however, protocols for enrollment in clinical trials as well as the resumption of benchwork were also developed.
Accounting for all of these considerations, during the COVID-19 shelter-in-place order between March of 2020 and May of 2020 our department performed 96 surgeries for the resection of brain tumors compared to 127 such surgeries from the three months prior. During this time, using a modified Delphi procedure, we developed detailed protocols to triage tumor cases. Implementation of telemedicine outpatient visits allowed the continuation of the neuro-oncology clinic and, ultimately, the resumption of clinical trials.
Looking forward, as we prepare for potential future outbreaks, these treatment algorithms will help ensure that patients with brain tumors receive the highest level of care independent of COVID-19. We have, of course, learned that even the surgical care for brain tumors that we all viewed as among the highest priority cases prior to the emergence of COVID-19 can become lower in priority when a pandemic fills an entire hospital, as occurred throughout New York City early during the pandemic. Those lessons are humbling and underscore the importance of being prepared, not only for COVID-19 but for future infections that might emerge in the new world we find ourselves in.