Pros and cons of implementation of strategic response to COVID-19 pandemic in endoscopy unit: Single tertiary center experience

Introduction: In March 2020, the WHO declared COVID-19 as a global pandemic It was clear that this rapidly evolving virus would have a broad impact on clinical care and GI practice which is our main concern Aims & Methods: We aimed to describe Mansoura University Endemic Hepatology and Gastroenterology Department experience in endoscopy unit preparation for COVID-19 pandemic and patient care during this unprecedented time In this descriptive study, based on the WHO recommendations, international guidelines, national policy of the Egyptian Ministry of Health and capabilities of our institute, we promptly developed a response strategy to deal with the situation This strategy outlined 4 crucial issues to be addressed: 1-Development of competent surveillance team to observe, screen and notify the relevant authorities to take the WHO recommended actions 2-Development of action plan to prepare the hospital for the anticipated gush of suspected cases with a well equipped health isolation area, operated by dedicated medical teams to deal with this cohort of patients Upon confirmation of COVID-19 status, the cases are transferred to the quarantine hospitals to receive required health care service 3-Starting intensive infection control course to ensure spreading the awareness among health care workers (HCWs) regarding the adherence to infection control measures 4-Adoption of 'Minimizing policy' to reduce the number of patients attending the endoscopy unit for non-urgent reasons Results: Through collaborative efforts and lessons learnt from other institutes worldwide, our surveillance team was able to early recognize the burden of suspected cases and take the proper actions to deal with the problem Being one of the biggest hospitals in Egypt in terms of capacity, our institute was able to reduce the pressure on other nearby health care facilities and to redistribute the flow of patients in a manner compatible with the degree of readiness Throughout 1203 endoscopies performed between August 2019 and April 2020, endoscopy room capacity was significantly reduced between these 2 months respectively (n=196;16 3 % vs n=8;0 06% p< 0 0001) Knowing that the average hospital cost of diagnostic upper/lower GI endoscopy per patient in our institute is ∼25 US dollars, our minimizing strategy seemed to be cost-effective in achieving significant reduction in endoscopy monthly costs between pre (August:December 2019) and post (January:April 2020) COVID-19 era respectively (n=25175;83 7% vs n=4900;16 3% p< 0 0001) Satisfaction of HCWs with the quality of personal protective equipment and infection control training programs reached 93% and 95% respectively through survey involving all HCWs in our hospital Additionally, wise HCWs involvement in the work process through 2 weeks on, 2 weeks off strategy, has achieved its ultimate goal not only in terms of minimizing the risk of infection but also maintaining the optimum level of psychological health which is substantially valuable during these times One unpleasant finding in this study is that degree of satisfaction with endoscopy training among 22 trainees was significantly low (n=6;27 3% vs n=16;72 7% P=0 0029), measured by satisfaction scale questionnaire ranging from 0 (not satisfied at all) to 3 (very satisfied) This could be explained by significant reduction of the number of elective endoscopies which represent the core of endoscopy training schedules Conclusion: Development of a design taking into account the infrastructure, manpower and redistribution of resources, is the key factor to adequately respond to a global crisis like COVID-19