Vascular Care Services during the Covid-19 Pandemic in a South Asian Country: Implications for Limb Salvage

Research Article

Austin J Surg. 2021; 8(5): 1279.

Vascular Care Services during the Covid-19 Pandemic in a South Asian Country: Implications for Limb Salvage

Bashar AHM1,2*, Rahman MM1,2, Islam MF1,2, Ghosh SK1, Reza S1, Mahmud S1, Ahmed SMP1,2, Sabah MN1, Islam MM1,2, Jamil MS1,2, Hossain SZ2 and Rahman MM1

1Department of Vascular Surgery, National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh

2Department of Vascular Surgery, Bangladesh Specialized Hospital Limited, Dhaka-1207, Bangladesh

*Corresponding author: Abul Hasan Muhammad Bashar, Department of Vascular Surgery, National Institute of Cardiovascular Diseases and Hospital, Dhaka, Bangladesh; Department of Vascular Surgery, Bangladesh Specialized Hospital Limited, 21, Mirpur Road, Dhaka-1207, Bangladesh; Email: ahmbashar@gmail.com

Received: August 09, 2021; Accepted: October 06, 2021; Published: October 13, 2021

Abstract

Objective: Covid-19 continues its negative impact on limb salvage in patients with limb ischemia and vascular trauma. Bangladesh fought the 1st and 2nd waves of the Covid-19 pandemic during April through August, 2020 and in April-May, 2021, respectively. Infections have been rising once again since early June 2021 to reach a positivity rate over 30%. With limited resources, vascular surgical care during the pandemic has been an unprecedented challenge for a developing country like Bangladesh. As a small vascular community, we have adopted a strategy focused on conserving essential resources including manpower while delivering essential vascular care. The present study evaluates the effectiveness of our pandemic-time guideline-based working strategy with a focus on limb salvage.

Methods: Essential vascular services were provided by customized teams throughout the Covid-19 pandemic at two referral centers according to our working guidelines. Data were analyzed and key limb salvage outcomes compared between the two pandemic waves by chi-square test.

Results: A total of 1792 vascular surgical cases were addressed during the pandemic- over 90% of which involved limb or life-saving procedures. Overall mortality was 0.6% and overall limb salvage rate for acute and Chronic Limb Threatening Ischemia (CLTI) were 95.3% and 76.8%, respectively. Limb salvage rate for CLTI was significantly higher in the 2nd wave compared with the 1st (P<0.05). Rate of Covid-19 infection among vascular workforce was about 20%.

Conclusion: Emergency-focused altered working guideline has produced satisfactory results in terms of continuing emergency vascular services, improving limb salvage and safeguarding vascular workforce during Covid-19 pandemic in a developing country. Conservation of resources including manpower remains relevant in the context of a highly probable 3rd wave of infection.

Keywords: Covid-19; Limb salvage; Third wave; Vascular emergency services; Health care workers; Customized team approach; Bangladesh

Introduction

Severe Acute Respiratory Syndrome (SARS) corona virus disease or Covid-19 situation continues to linger worldwide. While the pandemic has been brought under control in Europe and North America, it prevails at considerable intensity in South America and Asia [1]. A dangerous second wave recently swept across the Indian subcontinent, particularly India which remained the center of attention of the pandemic world for the most part of May, 2021 as she recorded more than 3,00,000 new cases and over 4000 deaths every day [2,3]. With over 30 million cases and 4,00,000 deaths, India has been one of the worst to suffer from the pandemic. Bangladesh is a small and densely populated developing country of the Indian subcontinent [4] where the pattern of Covid-19 infection had been somewhat different from the rest of the subcontinent. The maximum intensity of the disease in Bangladesh was in June through August, 2020 with a test vs case ratio of around 25%. New infection and death subsided toward the end of the year 2020. Just when everything appeared under control, the 2nd wave started to become apparent with the beginning of the summer. Test vs case ratio which had fallen below 3% jumped to more than 20% in the early weeks of April 2021 [5]. Covid treatment facilities including Intensive Care Units (ICU) once again became full to their capacities within a short span of time. Though a downward trend was achieved in late May, 2021, infection and death have once again started to rise since the beginning of June (Figure 1). Experts believe that Bangladesh is now going through a 3rd wave of the pandemic which has already proved far worse than the previous waves as the demand for essential treatment resources including ICU and oxygen continues to soar.