COVID -19

Created - 22.03.2020

BSIR Advice regarding Covid 19 pandemic.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel Coronavirus that has quickly spread causing Coronavirus disease 2019 (COVID-19).  On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic.

Given the importance of protecting healthcare workers during the pandemic, the BSIR is releasing guidance for Interventional Radiologists (IR’s) to help plan for the management of IR during the COVID-19 pandemic and deal with Covid-19 positive patients. This is a rapidly changing situation, and information will be updated as new information is released.

Interventional Radiology has variable availability within the UK, with highly trained specialists able to provide therapy to a broad range of conditions in the urgent and emergency setting. With the likelihood of little access to ventilators, IR will become central to deal with the majority of acute surgical emergencies that would perhaps traditionally be treated with GA surgery. These would include, but not limited to:- EVAR, nephrostomy, difficult vascular access, PTC, abscess drainage and acute haemorrhage e.g. trauma or GIB.

It is therefore essential that Trusts have detailed plans on how IR departments will continue to function to ensure that this small highly skilled workforce remain able to deal with these urgent and emergency interventions over the coming weeks to months as well as support the Covid-19 patients. Interventional radiology (Image guided surgery - IR) is integral to all aspects of hospital-based care. It is imperative that IR plays its role to protect public safety by reducing public contact during the pandemic and follow social distancing recommendations.

BSIR recommends consideration to the following to ensure that service is maintained during these unprecedented times: -

1. Cancel all IR procedures except for urgent and emergency cases.
2. Liaise with referring teams regarding elective cancelled cases.
3. Determine procedures that can be delayed/re-scheduled in case of worsening local infection rates.
4. Follow social distancing guidance for the UK Government to reduce social interaction in order to reduce the transmission of COVID-19. Work from home where possible and avoid gatherings in public spaces.
5. Use telephone and online services for consultations and meetings.
6. Optimise staffing in the IR department to that which is absolutely needed and consider the following: -
   1. Development of IR teams/rotas to provide IR services.
   2. Teams may include 1-3 IRs (consultant IR and SpR’s), radiographer and nurses to provide IR services.
   3. IR’s and neuro interventionists should support one another where possible.
   4. Teams to rotate using a locally agreed Covid 19 rota.
   5. Back-up teams available to be mobilised as the situation demands.
   6. Non- essential teams and staff to maintain social distancing and stay off site. It is likely that as the pandemic progresses there will be staff loses that need replenishing, therefore it is essential to keep the majority of non-essential healthcare workers away from risk.
   7. Consider risk stratification amongst your IR staff related to age and co-morbidities to reduce an individual’s risk of contraction. There is an increased risk related to IR age, with over 50yrs appearing to be the start of the upward curve with this group more likely to have additional co-morbidities e.g. CVD & HT. NICE have recently published advice on increased death rates with individuals taking NSAIDs and ACEI for hypertension. Plus, there seems to be a male predominance.  Most evidence at this stage is anecdotal and fluid.
7. Mobilise other members of the diagnostic radiologists that have ultrasound skills and can help provide some interventional procedures support e.g drainages and line access. Consider including these members in the IR teams.
8. Whenever possible, provide support to diagnostic colleagues as part of overall department arrangements.
9. IR and / or IR teams to have a team leader that is directly involved with local Trust Covid-19 planning on a daily basis.
10. IR’s can support difficult interventions in Covid 19 positive patients in ITU / CCU and provide support for simple interventions where required e.g. central line insertion. In the majority of trusts IRs do not have the workforce to provide these services and there are many better placed doctor groups who are trained to do this in an ITU / CCU environment.
11. IR’s will still be required to provide non-Covid 19 emergencies that will still occur in the community.
12. Identify designated IR rooms for procedures to be used for procedures on COVID-19 patients
13. Ensure adequate PPE is available on hand and securely stored with staff trained and educated on usage. FFP3 masks available for all procedures where there is a risk of aerosol generating procedures. Follow local protocols.
14. Develop plans for terminal cleaning with approved cleaning products of procedure rooms and portable IR equipment used to treat COVID-19 patients.
15.  Ensure proper cleaning supplies are available for re-usable eye protection (e.g. leaded glasses) and lead/lead-alloy/alloy aprons. Lead glasses are not sufficient eye protection and additional protection should be worn.

Stress & Coping:

• Covid 19 outbreak is likely to be stressful for people including healthcare workers.
• Fear and anxiety can be overwhelming and cause strong emotions in adults.
• Taking care of yourself, your friends, your colleagues and your family can help you cope with stress.
• Take breaks from reading, listening or social media about the pandemic.
• Take care of your body – eat healthy, keep hydrated (drink plenty of water), sleep plenty.
• Take time to unwind and relax.
• Communicate with others to discuss feelings.
• Exercise and keep fit

Dr Ian McCafferty, President BSIR

Dr Phil Haslam, VIce President BSIR

Prof Mo Hamady, Secretary BSIR

Dr Hilary White, Treasurer, BSIR