The Japanese government confirmed the first case of coronavirus disease (COVID-19) in the country on January 16, 2020, in a resident who had returned from Wuhan, China.1 This was the second confirmed COVID-19 case outside of China. Currently, the spread of COVID-19 has affected all clinicians in Japan.
Over these six months, we, the Japanese neurosurgeons, have had to adjust to the new lifestyle, by avoiding the so-called “3Cs” (closed spaces, crowded places, and close-contact settings, referred to as “San-Mitsu” in Japanese: “San” means three, and “Mitsu” means close and crowded situations).2
As all neurosurgeons know, the 3Cs are the significant elements of clinical neurosurgical practice.
We regularly work in closed operating theaters to perform daily operations. To share the experiences of experts and discuss treatment decisions, we gather closely in a conference room or hospital ward. Furthermore, as a part of the team, the medical staff establish closed communications to achieve treatment success. Moreover, socializing outside the hospital environment is recommended to strengthen teamwork.
To combat the recent COVID-19 pandemic, within six months, we have had to change our daily practices and behaviors drastically.
For the safety of the patients and medical staff, the Japan Neurosurgical Society released the “Guideline for the Neurosurgical Management in COVID-19 Pandemic” on May 15. In this guideline, the committee released six items that not only outlined infection control, but also the mental preparation required to manage the pandemic and adjust to the “new normal” lifestyle. Additionally, it emphasized the importance of continuous academic efforts, despite these trying times. For the sake of patients needing neurosurgery, medical practice, scientific activity, and education cannot come to a standstill.3
Subsequently, how should we prepare for the new normal in the COVID-19 era?
Within the first six months, we conducted polymerase chain reaction (PCR) assays for all scheduled surgical patients. To enhance the sensitivity of detecting COVID-19 infection, both PCR test and chest radiographs/computed tomography scans were recorded in each patient.
“Safety first” is most crucial. We need to keep ourselves safe to avoid the collapse of our healthcare system. If the medical staff is infected, the work force required to maintain public health would reduce.
Next, we renovated the operating theaters into negative pressure units for the emergent cases (Figure 1). It takes a relatively longer time, as much as 3 hours, to check the PCR results in our hospital. To activate the response system for the suspected COVID-19 emergent cases, we also established an in-hospital cooperative structure for the medical staff. Additionally, we shared as much information as possible regarding infection control, such as appropriate use of personal protective equipment, concept of zoning, and hand hygiene. Previously, Japanese neurosurgeons were unfamiliar with this custom. Nevertheless, it is vital that all neurosurgeons working in this new era are aware of these precautions.
Third, we applied the ever-developing information technology to change our daily practices effectively. Daily grand rounds were held using the WEB conference. In order to teach medical students safely, we applied remote virtual reality (VR) technology (Figure 2). Even if the students were restricted from entering the hospital ward, we offered similar experiences of clinical clerkship. Regardless of this pandemic, the daily medical practice and education continue.
Fourth, we promoted a new working style involving division of work and task shifting.
Previously, emergency physicians and acute care neurosurgeons believed that working overtime was a good thing. However, to avoid collapse of the work force and hedge the risk of infection, we actively changed this idea to include sufficient rest intervals. For the new normal, continuity and sustainability are needed.
As Jonathan Swift rightly said in his novel Gulliver’s Travels, “Necessity is the mother of invention.” We believe that we shall not only overcome the COVID-19 pandemic, but also win the battle. However, to be a real victor, we should learn from this painful experience, and create innovations to set a positive legacy for the next generations living in the new era.
To avoid spreading infection, physical distancing should be maintained, but our minds must never be apart.
Be together and be strong.
We, the Japanese neurosurgeons, hope that everyone stays safe and healthy.
References
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1. World Health Organization: Emergencies preparedness, response. Novel Coronavirus – Japan (ex-China) 16 January 2020. https://www.who.int/csr/don/16-january-2020-novel-coronavirus-japan-ex-china/en/, Accessed Aug. 1st, 2020.
2. Prime minister’s office of Japan, Ministry of Health, Labour, and Welfare of Japan.
3. Important notice for preventing COVID-19 outbreaks. https://www.mhlw.go.jp/content/10900000/000615287.pdf Accessed Aug. 1, 2020.
4. The Japan Neurosurgical Society released “Guideline for the neurosurgical management in COVID-19 pandemic” (in Japanese). https://jns.umin.ac.jp/topics/20200720/11507 Accessed Aug. 1st, 2020.
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