BACKGROUND/INTRODUCTION: COVID-19 pandemic has been at its peak for the past 6months and has affected more than 215 countries around the world. India is now the 2nd most-affected nation with more than 48,00,000 cases and 79,000 deaths. Despite this, and the fact that it is a lower-middle-income nation the number of deaths is almost 1/3rd of the USA and ½ of Brazil. There has, however, been no experience published from non-COVID designated hospitals where the aim is to manage non-infected cases with neurosurgical ailments while keeping the number of infected cases to a minimum. METHODS: We analyzed the number of neurosurgical cases (non-trauma) done in the past 5 months (March- July 2020) in our institute which is the largest neurosurgical center by volume in southern India and compared the same to the concurrent 5 months in 2019 and 5 months preceding the pandemic. We also reviewed the total number of cases infected with COVID-19 managed during this time. RESULTS: We operated a total of 630 cases(non-trauma) in these 5 months and had 9 COVID-19 infected cases operated during this time. There was a 57% (p=0.002) reduction in the number of cases operated as compared to the same 5 months in the preceding year. We employed a dual strategy of Rapid Antigen testing and surgery for cases needing emergency intervention and Reverse Transcriptase-Polymerase chain reaction test for elective cases. The hospital was divided into three zones (red, orange, and green) depending on infectivity level with minimal interaction. Separate teams were designated for each zone and thus we were able to effectively manage even infected cases despite the absence of pulmonology/medical specialists. CONCLUSION: We present a patient management protocol for non-COVID designated hospitals in high volume centers with the constraints of a lower-middle-income nation and demonstrate its effectiveness. Strict zoning targeted testing and effective triage can help in management during the pandemic.
Management of Neurosurgical Cases in a Tertiary Care Referral Hospital During the COVID-19 Pandemic: Lessons From a Middle-Income Country