Cook and Harrop-Griffiths survey the damage of a health system stretched to its limits in response to the UK's COVID-19 crisis, and how elective surgery could be carefully recommenced – particularly considering that the pandemic is far from over.

"....this has been achieved ‘by the skin of our teeth’ and until very recently, the threat of insufficient ICU beds, ventilators, and the need for triage were all anticipated: a few hospitals were overcome by the surge of critically ill patents."

They highlight several priorities as the NHS looks to return to a 'new normal' of healthcare provision:

• Support ICU needs of those with COVID.
• Make hospitals safe for patients both with and without COVID.
• Returning staff and services to pre-pandemic areas as possible.
• Protect staff with adequate personal protective equipment.
• Appropriate surgical case triage.

"Having weathered the COVID‐19 storm, we are now being asked to assess the damage done, pick up the pieces and rebuild. However, this storm will rage for many months. Flattening the epidemic curve does not reduce the total number of cases but spread their burden over a longer period of time..."

Of particularly note is the challenge of ensuring COVID positive patients do not undergo non-essential surgery, known to be associated with a high post-operative mortality. They explore the complexities of pre-operative isolation and testing (PCR or CT), and the inherent limitations of these.

"The move from a health service focused on one single disease to one that continues that challenge while also addressing all the other health needs of the population may be even harder than that the crisis phase that preceded it."

summary

• T M Cook and W Harrop-Griffiths.
• Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
• Anaesthesia. 2020 Oct 1; 75 (10): 1273-1277.

no abstract available

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