CIRSE president: “We need more of a European focus” to protect against viral outbreaks

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president“Europe, including the European Union (EU) and the leaders of its nation states, needs to prepare better for future pandemics. I think we must develop a Europe-wide contingency plan providing clear guidance on effective measures,” says Afshin Gangi, president of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Speaking with Interventional News, he outlines the society’s response to the coronavirus pandemic, as well as measures taken by his own institution.

What is CIRSE doing currently to support its membership amidst the coronavirus pandemic?

The health of our members, congress goers, and industry partners has always been our top priority. This is why CIRSE reacted quickly following the outbreak of COVID-19 in Europe, moving our spring meetings to later dates in the year. The European Conference on Interventional Oncology (ECIO) 2020, which was planned for 26–29 April, has been moved to 2–5 November, in Nice, France. The European Conference on Embolotherapy (ET) and the International Conference on Complications in Interventional Radiology (ICCIR) were both going to take place in Austria in June, but since the restrictions on travel and gatherings will still be in place then, they have also been postponed. ET 2020 will take place 16–19 December in Vienna, Austria, with ICCIR 2020 running in parallel at the same congress centre from 16–18 December. The courses of the European School of Interventional Radiology (ESIR) are also being moved to autumn and spring 2021, hopefully once again enabling participants from around the world to join us for the comprehensive two-day courses on specific procedures.

With regards to the CIRSE annual congress, we are moving ahead with CIRSE 2020 to take place as planned in Munich, Germany, from 12–16 September.

In addition to these event-related activities, and in order to ensure that the exchange of experiences and medical education does not stop, we have put into action a series of measures to support online information exchange between interventional radiology (IR) professionals. Within a very short timeframe, a CIRSE/Asia Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) working group put together a joint CIRSE-APSCVIR checklist to prepare IR departments for COVID 19. My special thanks go to main authors Bien Soo Tan and Kiang-Hiong Tay, both from Singapore General Hospital, Singapore, for sharing the knowledge they gained from both the SARS and the COVID-19 pandemics.

As the coronavirus continues to spread, it is key to be prepared to carry out emergency procedures in this new environment and treat possibly infected patients. Our knowledge in this regard is increasing by the day, which is why CIRSE is also planning to offer a series of freely available webinars in which front-line doctors will share their experience. In the first of these webinars, taking place on Monday 20 April at 5pm (CEST), Lorenzo Monfardini and Vittorio Pedicini from Milan, Italy, will talk about bedside procedures IR provides to COVID-19 patients. I encourage everybody to participate and use this unique opportunity to submit questions for this first CIRSE webinar. For more information please visit the CIRSE website at www.cirse.org

In addition, seven fully CME accredited CIRSE Academy courses have been made freely available, as have almost 200 lectures from previous CIRSE congresses via the CIRSE Library. We are confident that by taking these steps, we will be able to continue providing excellent IR education and supporting information exchange by an increased internet offering for the time being, and again in person once the pandemic has subsided.

CIRSE had to pull together a comprehensive resource centre very quickly. How did this come about? What needed to be prioritised, and how did you identify key stakeholders to work with?

In an effort to offer a concise and useful information hub amidst the myriad of online content on the pandemic, the CIRSE publications department has put together a collection of the most relevant links. These include the main stakeholders on an international scale, such as the World Health Organisation and the European Centre for Disease Prevention and Control, as well as articles, webinars, and checklists of particular relevance to interventional radiologists. Many thanks go to the CIRSE team. They really did an excellent job in putting all this together in such a short period of time.

In general, I think the internet is one of the big advantages we have during this pandemic and compared to past outbreaks. Even in comparison to SARS in 2002/2003, today it is so much easier for medical professionals to quickly share information and their experiences with colleagues from around the globe.

Is there a COVID-19 learning you wish to share with the interventional community?

I can only report on my own experiences in Strasbourg. The first major impact of the COVID-19 crisis was the cancellation of many elective interventions. Unfortunately, among the procedures that were classified as “not urgent” were many oncologic interventions, as well as benign pain management interventions. The delay in receiving their scheduled therapies is very stressful for patients and it will be important to start the interventional service again as soon as possible. I really admire how patients have reacted when learning that their therapies have been postponed. At the moment there is a lot of understanding and strong support for the medical community. However, it is not good to put them off from week to week and I hope that this situation will not persist for too long.

I think another important learning was that we are able, in a very short period of time, to change our work flows and patient pathways. Levels of safety and hygiene needed careful scrutiny and refinement to protect non-infected patients and hospital staff. Sadly, even with our immediate measures, it was impossible to avoid that some colleagues got infected and to my deepest regret a few colleagues even lost their lives.

I want to say that the medical and paramedical staff have been remarkable in this crisis, and I have the feeling that we are now even more united than before. In Strasbourg it seems that the peak has been reached and the situation is slowly starting to ease. However, we all know that this pandemic is far from over. We need to be careful not to provoke a second wave until medication, and hopefully a vaccination, against COVID-19 has been developed. Until that time, we will have to get used to our “new normal”.

Another important learning is that we need more of a European focus, not less. Europe, including the European Union (EU) and the leaders of its nation states, needs to prepare better for future pandemics. I think we must develop a Europe-wide contingency plan providing clear guidance on effective measures. Maybe there were good intentions from the EU leadership to introduce such a system after SARS in 2002/2003, but it seems that far too little was put into action. Among the many things that need improvement, I think, is that Europe should rebuild its infrastructure critical to the production of pharmaceuticals and medical equipment. This is essential, and would allow us to be independent and more proactive in the future.

What procedures are interventional radiologists still undertaking in this period?

In my experience, apart from the conventional emergencies such as bleeding, thrombectomies, or abscess drainages, we have of course also noticed more complications in the intensive care units related to COVID-19 patients with epistaxis or vascular damages.

In Strasbourg we also have seen an increase in thrombosis, but not necessarily in thrombectomy cases.

How has your personal daily practice been impacted by the pandemic? What measures has your hospital implemented?

Our department in Strasbourg has six operating rooms; three of them have been put out of function, with the removal of all anaesthesiologic devices and tools. We are fortunately still able to work in two angiography suites and one CT-angiography suite. Unfortunately, we have reduced collaboration with our colleagues from anaesthesiology. Outside of emergencies we currently receive their support only once a week. Additionally, all of our nurses have been assigned to other departments dealing with COVID-19 patients. Also, our medical staff has been temporarily reduced.

We are now preparing for the comeback and will be ready to catch up on the many postponed interventions once a regular IR service will again be possible.

What message would you like to give to the wider medical community at this time?

I think that the exchange of information is crucial. This is the first time that we have been confronted with a pandemic of this scale. We are gathering experience and seeing what works in real time, while at the same time having little to no data available on how exactly the virus works, and how it affects the body. We must therefore share all newly gained knowledge as quickly as possible. Each of us adding a piece of the puzzle on how to respond to and defeat this dreadful disease. It is a great challenge, but I am confident that we will get through this together, emerging stronger as physicians and a community.

Afshin Gangi is an interventional radiologist at the University Hospital of Strasbourg, Strasbourg, France, and is the president of the Cardiovascular and Interventional Radiological Society of Europe.


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