Transmission & Prevention
· Transmission of SARS-CoV-2 via fomite, especially cold chain, should not be ignored. In this letter to the editor, authors from the Jilin Provincial Key Laboratory of Animal Embryo Engineering in Changchun, China, review the hardy nature of SARS-CoV-2, stating the virus has an average half-life of 6 hours on plastic and stainless steel, increasing to even longer at colder temperatures (8 hours at 37 °C, 96 hours at 22 °C, and 14 days at 4 °C). This information is especially important when discussing protocols to decrease transmission of SARS-CoV-2 in settings such as live-stock processing plants and cold-chain produce factories. The authors suggest the importance of strict disinfecting, regular testing, and adherence to personal protective equipment to reduce local and global spread of SARS-CoV-2 in these cold-chain settings.
Adjusting Practice During COVID-19
· Time to treatment initiation for breast cancer appear to be unchanged despite the COVID-19 pandemic. A medical student, oncologists, and cancer care experts from the University of Pennsylvania compared a cohort of patients recently diagnosed with early-stage breast cancer between January 1 and May 15, 2018 (pre-COVID-19; n=202) to a cohort diagnosed between January 1 and May 15, 2020 (COVID-19; n=164). In 2020, fewer diagnoses were made (18.8% decrease) and use of preoperative systemic therapy increased (43.9 vs 16.4%; p<0.001), but there was no difference in time to treatment initiation after diagnosis (p=0.926). Authors believe breast cancer patients diagnosed during the pandemic appear to have received timely care when diagnosed, but the decrease in the number of diagnoses suggests the pandemic may have presented other barriers to care. · What are considerations regarding the timing of elective surgery and COVID-19 now? Anesthesiologists and surgeons in the United Kingdom detail a consensus statement with recommendations to decrease peri-operative COVID-19 complications in both patients and staff. Their recommendations include: shared decision making between patient and care team, halting planned surgeries of infectious patients, limiting surgery of previously infected patients as long as possible given increased risk of mortality with surgery prior to 7 weeks after recovery, involving multidisciplinary care pre and post-surgery, vaccination if available several weeks before surgery, and strict isolation precautions of COVID-19 positive patients should continue within the hospitals. If postponing the surgery of a previously infected COVID-19 patient is a viable option, this may be very beneficial, given the odds ratio (CI 95%) of 30-day mortality is 4.22 when operating 0-6 weeks post infection vs. 1.02 when waiting until at least 7 weeks. This study suggests that as the pandemic continues, surgical prioritization needs to be taken into account in each case to weigh the risks vs. benefits of surgery in that specific patient, as well as the risk of exposure and transmission to all staff involved.