La pandemia del COVID-19 es una situación inusitada para la comunidad médica. Las políticas de distanciamiento y el intento por crear ambientes de contagio de bajo riesgo han llevado a que los centros de salud cambien sus funciones para reducir los estragos del virus, tanto a nivel local como mundial. Además de la amenaza de la pandemia, éste es un reto mayor a la medicina para cambiar gran parte de sus prácticas.
Este suceso biológico ha llevado a que cambie el funcionamiento de los servicios de salud. Aunque estos siempre han tenido que garantizar el bienestar de la sociedad y sus procedimientos son un modelo para las prácticas de higiene y salubridad del resto de la población, estas responsabilidades se han intensificado con el crecimiento de la epidemia. Hoy más que nunca, debe de existir rigor en los protocolos de los hospitales y en las clínicas de atención médica para atender a los pacientes y promover la cultura de prevención del contagio.
Un nuevo mundo
Esta crisis mundial ha puesto en pausa sectores de diversas industrias que han decidido seguir políticas de distanciamiento social. En los servicios de salud, sin embargo, los alcances de este tipo de medidas son sólo parciales. A pesar de su impacto, COVID-19 es una sola entre cientos de enfermedades y pacientes con necesidades médicas que requieren de atención imperativa.
La demanda de otro tipo de atención probablemente vaya en incremento conforme se aminoren las políticas de distanciamiento social. Y una cirugía realizada a tiempo a menudo significa la diferencia entre la vida y la muerte. Por eso mismo, ahora se ha vuelto determinante seguir lineamientos de alto rigor que permitan que el mundo quirúrgico permanezca en marcha y que al mismo tiempo se reduzcan los riesgos de contagio (o de agravio) de COVID-19.
¿Qué cambios podemos esperar?
Un aspecto que tiene que ser central para hacer cirugías electivas en el mundo de la “nueva normalidad” es que tenemos que garantizar, ante cualquier circunstancia, que el paciente no presente ningún síntoma de COVID-19. De acuerdo con datos recopilados en Wuhan, varios pacientes operados a finales del año pasado sufrieron más los estragos del virus debido a estar pasando por un proceso de recuperación quirúrgica cuando se presentaron los síntomas. Además, el índice de mortalidad en este grupo (34-83 años) se estimó en 20% de los casos. Es un riesgo que no podemos soslayar. Por esto se tiene que tener como prioridad el evitar, a toda costa, un procedimiento quirúrgico en personas que presenten infección activa.
En primera instancia, todos los pacientes que requieren de un procedimiento quirúrgico deben de ser sujetos a una prueba de detección de COVID-19 por PCR, de preferencia 48 hrs antes de la cirugía. No obstante, es importante que atendamos al hecho de que el índice de falsos negativos oscila entre el 10 y el 30%. A causa de esto, es importante que todos los involucrados en el procedimiento quirúrgico se encuentren en un estado de “hipervigilancia” en torno al paciente.
Asimismo, es imperativo que el paciente no presente ningún síntoma de COVID-19 el día de la cirugía. En caso de detectar algún síntoma en el paciente, se recomienda la recalendarización de la cirugía. Esto no sólo garantiza el bienestar del paciente sino también de todos el equipo médico involucrado. En caso de llevar a cabo la cirugía, es importante que busquemos que el paciente ingrese y egrese lo más rápido posible del hospital. Además, es fundamental que los cirujanos y los miembros de sus equipos, sean sujetos a pruebas recurrentes de PCR de manera casi rutinaria.
Una de las responsabilidades de la comunidad médica es mantener su propia salud en un estado óptimo. También debemos de seguir prácticas de distanciamiento social para la protección de los sectores más vulnerables de la población.
En primer lugar, tiene que volverse una norma el no dar consulta o asistir a los hospitales en caso de presentar síntomas de cualquier enfermedad. Es una responsabilidad social que asegura el bienestar colectivo. Por ello, se recomienda que los profesionistas de la salud con la posibilidad de trabajar a distancia encuentren las formas de hacerlo, aunque sea sólo una primera aproximación para dar consultas médicas.
Telecongresos
Otro aspecto muy importante del mundo quirúrgico es el constante intercambio de conocimiento entre pares. Por lo tanto, es de esperar que el mundo de los congresos se traslade a plataformas virtuales. Esto puede tener muchas ventajas. Una de ellas es el abrir al acceso a más personas a este mundo y que el diálogo entre profesionales de la salud se lleve a cabo de una forma dinámica y horizontal.
En este sentido, The Surgery Hub se ubica como un modelo educativo de punta, para transmitir de una manera innovadora, directa y eficiente, en un ambiente de aprendizaje óptimo, los principios fundamentales para ejercer la cirugía general y mínimamente invasiva de una manera segura, como tema principal, y muchos temas de actualidad médica.
Educación a distancia
Uno de los sectores más afectados por los cambios en el mundo quirúrgico será el de los médicos residentes. La formación de muchos de ellos podría verse mermada debido a la reducción del número de cirugías de este momento y también a que estas serán llevadas a cabo solamente por el número mínimo de personas. Sin embargo, podrán aprovechar las nuevas tecnologías para lidiar con este rezago. Estamos en un momento inusitado para la formación de nuestros cirujanos. Por ello, la educación especializada a distancia es imperativa para toda una generación de cirujanos. La salud de las poblaciones presentes y futuras depende de ello.
El COVID-19 representa un reto de dimensiones descomunales para el mundo de la cirugía. No obstante, sí contamos con la inteligencia para darle la vuelta, este momento puede ser una gran oportunidad de refortalecimiento de la práctica de la medicina, desde aspectos educativos hasta protocolos de operación.
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