Neurosurgical Dilemmas During the Emergence of Covid-19 in Sabah, Malaysia

Abstract

Neurosurgeons in Sabah were in a dilemma when Covid-19 became a pandemic and manpower was diverted into becoming front-liners at screening centers. Careful screening was introduced for cases requiring admission to the ward. We labelled our patients who are going for surgery into high and low risk categories. Level 3 PPE was used for high risk cases only. Emergency and semi emergency cases were continued with careful consideration. Elective cases were postponed based on the idea that we don't clog up the intensive care unit(ICU) beds and ventilators which might be needed for ill Covid-19 patients or avoidable usage of blood products which are in acute shortage during this pandemic. All outpatient clinic cases were screened by neurosurgeons and only those awaiting surgeries or those recently discharged home after major procedures were seen while others were managed via tele-medicine. Staff were divided to ensure that if someone becomes a positive contact, then it is easier to quarantine them. We believe that this is the first neurosurgery related article to the management of patient care during this pandemic in eastern Borneo and the approach we have taken can serve as a guide to most neurosurgeons during this unexpected time of Covid-19 pandemic.