COVID-19 leads to disruptions in urological care and anxiety among HCPs

A recent global cross-sectional survey by the Chinese University of Hong Kong shows that urological services, particularly those for benign and non-urgent conditions, have been substantially deferred worldwide as a result of the coronavirus disease 2019 (COVID-19) pandemic. The results also reveal deployment of additional manpower to provide COVID-19 care and shortage of personal protective equipment (PPE) during the pandemic.

COVID-19 had a global impact resulting in urological service cut-down, especially in North and South America, West and South Asia, North and West Africa, and part of Europe. [Eur Urol 2020; S0302-2838(20)30371-7; doi: 10.1016/j.eururo.2020.05.025]

Cut-downs were reported across different types of services, with an 81–100 percent cut-down in 37 percent of outpatient (OP) clinic service, 40 percent cut-down in OP investigations and procedures, and 48 percent cut-down in urological surgeries, respectively. The degree of service cut-down was proportional to the severity of COVID-19 outbreak – an observation consistent across various types of urological services.

A greater reduction was observed in services for benign conditions, such as benign prostate hyperplasia, and non-urgent investigation and procedures, including urodynamic study and uroflowmetry, compared with services for malignant conditions.

Service delay of >8 weeks was reported in 28 percent of OP clinics, 30 percent of OP investigations and procedures, and 31 percent of urological surgeries, respectively. Although 47 percent of healthcare professionals (HCPs) who responded to the survey believed that the accumulated workload could be dealt with in a timely manner following the outbreak, half of the respondents felt that the treatment and survival outcomes of their patients would be affected by postponement of urological services.

Forty-one percent of the respondents reported having staff members being diagnosed with COVID-19, particularly among those in Europe and North America (p<0.001). Twenty-six percent of respondents, especially those in Europe (p<0.001), were deployed to provide COVID-19 care on a voluntary or mandatory basis.

Fear of attending work was reported by 47 percent of the HCPs. Half of the respondents felt that training in infectious disease and respiratory care was inadequate, and only 33 percent of respondents felt that adequate PPE was provided.

Of concern, 13 percent of respondents were advised not to wear a surgical face mask for fear of scaring patients, and 21 percent were advised not to discuss COVID-19 issues or concerns on the media.

In the survey, a 55-item questionnaire was developed following literature review of the effects of COVID-19 on health care services and feedback obtained from the UroSoMe working group. The questionnaire was distributed through #UroSoMe platforms (website and Twitter) to practicing urologists, urology trainees, and urology nurses/advanced practice providers. The cumulative number of new cases of COVID-19 in each country was obtained from the European Centre for Disease Prevention and Control, and paired with the respondents according the date they completed the survey.

A total of 1,004 urology HCPs (male, 82 percent; 30–39 years old, 46 percent) responded to the survey. A majority (71 percent) of respondents were consultants/practicing urologists, 56 percent were based in teaching hospitals or academic institutions, and 71 percent were practicing general urology. In terms of geographical distribution, 41 percent, 32 percent and 16 percent of respondents were based in Asia, Africa and Europe, respectively.