BJS commission on surgery and perioperative care post-COVID-19

Autores da FMUP

• João Manuel Palmeira Rocha Neves

  Autor

• Hugo Miguel Teixeira Ferraz Santos Sousa

  Autor

Participantes de fora da FMUP

• Abahuje, E
• Abbas, A
• Abd El Aziz Abd El Maksoud, M
• Abdelhady, A
• Abdelhamid, S
• Abdelkarem Ahmed Faraj, H
• Abdelqader, B
• Abdou, H
• Abdullah, A
• Abedua Harrison, M
• Abem Owusu, E
• Aboalazayem, A
• Aboulhosn, R
• Abu Oda, S
• Abubakar, A
• Abutaka, A
• Acevedo Fontalvo, D
• Acuna, S
• Adefemi, A
• Adegbola, S
• Adenuga, T
• Adeyeye, A
• Adil Hilmi, A
• Aditya, K
• Adjeso, T
• Aftab, R
• Afzal, A
• Aggarwal, V
• Aggarwal, A
• Aguilera, R
• Aguilera-Ar?valo, M-
• Aguirre Salamanca, EJ
• Aguirre-Allende, I
• Ahari, D
• Ahmad, H
• Ahmad Rauf, F
• Ahmad Zartasht Khan, A
• Ahmed, S
• Ahmed Fieturi, N
• Ahmed Mohamed, S
• Ahmed-Bakhsh, Z
• Ahsan Javed, M
• Akano, L
• Akbar, A
• Akhbari, M
• Akhmedov, P
• Aksit, G
• Akula, Y
• Al Majid, S
• Al Mukhtar, O
• Al Omran, H
• Al-Asali, N
• Al-Azzawi, M
• Al-Habsi, R
• Al-Iraqi, H
• Al-Naggar, H
• Alameer, E
• Albirnawi, H
• Aldulaijan, F
• Alejandro Miranda Ojeda, R
• AlHasan, A
• Ali, S
• Ali, A
• Ali Khan, M
• Alimova, Y
• Aljanadi, F
• Aljubure, R
• Allopi, N
• Almedbal, H
• Almubarak, M
• Alqaidoom, Z
• Alselaim, N
• Alshaar, M
• Alshammari, R
• Altaf, K
• Alt?ner, S
• Altunpak, B
• Alvarez Lozada, LA
• Amal Nahal, E
• Amer, A
• Amin, K
• Aminu, U
• Amisi Numbi, N
• Amjad, T
• Amoah, R
• An, Y
• Anastasopoulos, N-
• Andr?s Urrutia, J
• Angarita, F
• Angarita, K-
• ?ngel Freir?a Eiras, M
• Antypas, A
• Anwar, MA
• Anwar, H
• Apampa, TO
• Apostolou, K
• Aquina, C
• Arachchige Adithi Himika Randeni, R
• Archila God?nez, MI
• Arez, O
• Armonis, P
• Arshad, S
• Arshad Salman, M
• Arshid, A
• Arteaga Asensio, PC
• Arthur, T
• Arumuga Jothi, A
• Aryo Damara, F
• Asensio Gomez, L
• Ashcroft, J
• Ashraf, S
• Asif, A
• Atif, M
• Attaullah Khan, M
• Avellaneda, N
• Awad, S
• Awadh, M
• Axiaq, A
• Ayad Mohammed Shuwayyah, A
• Ayalew, D
• Aytac, E
• Azam, F
• Azevedo, J
• Azhar, B
• Aziz, J
• Aziz, A
• Azzam, A
• Baba Ndajiwo, A
• Baig, M
• Baker, D
• Bakko, F
• Balachandran, R
• Balachandran, G
• Balagizi Mudekereza, J
• Balai, E
• Balci, B
• Balduzzi, A
• Balhareth, A
• Bandyopadhyay, S
• Banerjee, D
• Bangalore Mahalinga, D
• Bankhead-Kendall, B
• Bankole, NDA
• Banwell, V
• Baris Bengur, F
• Baris Ozmen, B
• Barnard, M
• Barnett, R
• Barreras Espinoza, JA
• Barrios, A
• Bass, G
• Bass, M
• Bausys, A
• Bavikatte, A
• Bayram, J
• Beamish, A
• Beattie, C
• Belia, F
• Bellato, V
• Bellikatti, S
• Benjamens, S
• Benlice, C
• Bennedsgaard, S
• Bennett, S
• Bentounsi, Z
• Bergenfeldt, H
• Bhandoria, G
• Bhatia, M
• Bhatti, MT
• Bilgili, Z
• Bislenghi, G
• Bisset, C
• Biswas, S
• Blake, J
• Blanco, R
• Boccalatte, L
• Boden, R
• Bojanic, C
• Boland, M
• Boland, P
• Bollen, E
• Bonci, E-
• Booth, A
• Borakati, A
• Borunda Escudero, GE
• Bosco, SJ
• Bostr?m, P
• Botelho de Alencar Ferreira Cruz, P
• Bouchagier, K
• Bouhuwaish, A
• Boutros, M
• Boyce, K
• Boyle, C
• Bradshaw, L
• Brandl, A
• Brar, A
• Brenkman, H
• Brennan, C
• Brines, C
• Brookmyre, A
• Brosnan, C
• Brouwers, L
• Brown, A
• Brown, L
• Brown, C
• Brown, J
• BS, V
• Buksh, M
• Bunani Emmanuel, M
• Burbano, D
• Burelli, A
• Burke, A
• Burke, J
• Burlov, N
• Burns, A
• Burton, O
• Butt, A
• Buzra Ozkan, B
• Cabrera Silva, L
• Caicedo, EY
• Calderbank, T
• Cambridge, W
• Campelo, G
• Can Tatar, O
• Carbone, F
• Carrano, F
• Casallas, D
• Casanova Portoles, D
• Casciani, F
• Cassimjee, I
• Casta?eda Ram?rez, OA
• Catal?n, V
• Caviedes, J
• Cayetano, L
• Ceresoli, M
• Chan, M
• Chan, V
• Chandrasinghe, P
• Chapman, S
• Chaturvedi, A
• Chaudhry, D
• Chaudry, H
• Chen, HW
• Cheng, A
• Chernykh, M
• Cheruiyot, I
• Cheung, J
• Chia, C
• Chica, J
• Chinai, N
• Chirwa, A
• Chiwaligo, J
• Choi, A
• Choi, J
• Chowdhury, MR
• Christopher, E
• Christou, N
• Chu, T
• Chua, D
• Chua, HW
• Chung, C
• Cihat Yildirim, A
• Cillo, M
• Cioffi, S
• Claireaux, H
• Clermonts, S
• Clifford, R
• Climent, M
• Clynch, A
• Coelen, R-
• Col?s-Ruiz, E
• Collar, A
• Collard, M
• Connelly, T
• Connor, K
• Correia de S?, T
• Co?gun Acar, N
• Costa, T
• Couch, D
• Cowper, S
• Creavin, B
• Crook, B
• Curell, A
• D?alessio, R
• Dale, J
• Damgaard Eriksen, J
• Dario Martin Gonzalez, I
• Darwish, A
• Das, M
• Das, R
• Das, K
• Dave, R
• David, SO
• Davies, T
• Davis, C
• Davison, S
• Davletshina, V
• Dawidziuk, A
• Dawson, A
• de Andres Crespo, M
• de Berker, H
• de Dieu Ngo, P
• de la Caridad Espinosa Luis, R
• de Lacy, B
• de Montserrat Medina Sifuentes, A
• De Silva, S
• del Rio, C
• Delaune, V
• Dell, A
• Demirba?, I
• Demirli Atici, S
• Deniz Tepe, M
• Derebey, M
• Desai, G
• Desai, M
• Devarakonda, S
• Deveras, N
• Di Franco, G
• Di Martino, M
• Di Marzo, F
• D?az, ?
• Diaz del Gobbo, G
• Diaz-Castrillon, C
• Dick, L
• Dickinson, K
• Diego, E
• Dimasi, I
• Dingemans, S
• Dixon, L
• Dixon, B
• Doherty, W
• Dooreemeah, D
• Dornseifer, M
• Dossa, F
• Dossou, W
• Drake, T
• Drami, I
• Drevin, G
• du Plessis, MC
• Dudi-Venkata, N
• Dudley, R
• Duffy, S
• Duklas, D
• Dumbrava, B-
• Duygu Avlar, F
• Dworzynska, A
• Ebrahim, W
• Ebrahim, A
• Efr?n Lozada Hern?ndez, E
• Ehigie, N
• El Boghdady, M
• El Hasnaoui, C
• El Sheikh, M
• El-Hussuna, A
• Eldurssi, O
• Elfeki, H
• Elhadi, M
• Elhassan, M
• Elhissi, A
• Elliot, B
• Elsenbroek, C
• Elsolh, B
• Elson, N
• Eltyeb, H
• Emerson, H
• Endalle, G
• English, W
• Ercisli, C
• Espinosa, G
• Essam Abdelraheem, M
• Essangri, H
• Etienne, P
• Evans, T
• Ezeme, C
• Ezzahraa, F
• Fadalla, T
• Fagan, J
• Fahmy, M
• Fairfield, C
• Falade, O
• Famularo, S
• Faqar-Uz-Zaman, F
• Farid, Y
• Farooq, A
• Farooq, H
• Farooqui, F
• Farquharson, B
• Faruqi, A
• Faulder, R
• Faut, M
• Fechner, K
• Feenstra, T
• Fehervari, M
• Fernandez, L
• Fern?ndez Alberti, J
• Ferrario, L
• Field, D
• Fiore, L
• Fleming, N
• Fleming, C
• Florial, E
• Fok, M
• Fokin, D
• Foley, M
• Forero, MP
• Fornasiero, M
• Fowler, H
• Fowler, G
• Franchi, E
• Franklin, L
• Fredriksson, ?
• Fruhling, P
• Fuentes Navarrette, G
• F?l?p, A
• Furtado, M
• Galbraith, N
• Gana, T
• Gaskin, E
• Gasparini, M
• Gatan, RG
• Geary, E
• Gelaye Wudineh, K
• Gemenetzis, G
• Georgi, M
• Ghalige, H
• Ghareeb, W
• Ghatwary Tantawy, T
• Ghomsi, C
• Ghuman, A
• Giannakis, P
• Giron, F
• Gjengedal, K
• Gkotsis, E
• Glasbey, J
• Godahewa, S
• Godula, D
• Goffredo, P
• Goh, S
• Golriz, M
• Gomez, L
• Gomez Gomez, D
• Gonzalez, R
• Gonzalez, D
• Gonzalez Gutierrez, E
• Gopar, D
• Gordini, L
• Gori, A
• Gort?zar, S
• Gousy, N
• Gowda, R
• Gowda, M
• Gqada, J
• Grechenig, M
• Greer, J
• Greg?rio, L
• Grigorova, A
• Grimes, H
• Groot, V
• Gruber, R
• Gr?ter, A
• Guest, R
• Gujjuri, R
• G?l?ek, E
• Gulcu, B
• Gull, K
• Gulmez, M
• Gupta, V
• Gutlic, A
• Guven, T
• Gwatirisa, T
• Gwini, G
• Gwodog, P
• Gysling, S
• Habib, M
• Hafeez Bhatti, AB
• Hallesmith, J
• Hamza Sadiq, M
• Haney, C
• Hanna, N
• Hanna, L
• Hannington, M
• Harbjerg, J
• Haribaskaran, D
• Harran, N
• Harrington, B
• Hasan, R
• Hashmi, S
• Hassan, M
• Hassan, A
• Haverkamp, L
• Hazen, S
• Heer, B
• Heil, J
• Helliwell, J
• Henriksen, N
• Henshall, D
• Hermanson, M
• Hermena, S
• Hettiarachchi, D
• Hextall, C
• Hidalgo, M
• Hidayat, H
• Hider, A
• Higgins, P
• Hirani, D
• Hirpara, D
• Hisham, I
• Hite, M
• Hoh, SM
• Holmberg, C
• H?lmich, E
• Holst, F
• Hossam, A
• Hossam Elfallal, A
• Howard, P
• Huaman, E
• Huang, Y
• Huang, L
• Huang, D
• Huber, T
• Hugh, J
• Hughes, J
• H?ttner, F
• Huynh, R
• Hylands, A
• Iannuzzi, J
• Ielpo, B
• Iftikhar Talib, A
• Ignacio, J
• Ignatavicius, P
• Ike, S
• Ikwu, C
• Inama, M
• Ing, A
• Isik, A
• Islam, N
• AlHasan, AJMS
• Perez Rivera, CJ
• J?come, F
• Jaffer, T
• Jagiella-Lodise, O
• Jain, M
• Jain, K
• Jakubauskas, M
• Jalal, M
• James, H
• Jang, Y
• Janssen, B
• Jansson, H
• Jariod-Ferrer, ?
• Javanmard, H
• Javed, S
• Jayarajah, U
• Jayasuriya, I
• Je, J
• Jessop, Z
• Jia Lin Tang, E
• Jiang, H
• Jiayan, Y
• Jih Huei, T
• Jimenez-Rodriguez, R
• Joh, D
• Johnson, A
• Jones, N
• Jones, C
• Jordan, C
• Jos?, J
• Jos? N??ez Ju, J
• Jos? Pizarro, M
• Jose Salazar, C
• Joseph, J
• Justiniano, C
• Kabir, T
• Kalfountzos, C
• Kalogiannaki, E
• Kalyanasundaram, K
• Kamarajah, S
• Kamil Quraishi, M
• Kapila, A
• Kapila, V
• Karagiannidis, G
• Kashif, M
• Kathiravelupillai, S
• Kathiravelupillai, A
• Katsogridakis, E
• Kaur, K
• Kaur Sekhon Inderjit Singh, H
• Kausur, N
• Kawka, M
• Keehan, G
• Kehlet Watt, S
• Kelly, M
• Kelvin Egbuchulem, I
• Kembuan, G
• Khajeh, E
• Khaled Elfaitur, A
• Khan, MF
• Khan, S
• Khan, M
• Khan, D
• Khan, H
• Khatkar, H
• Khaw, R
• Kim, B
• Kishore Siddiraju, K
• Kitua, D
• K?r?mtay, B
• Kmezi?, S
• Knight, S
• Ko?ter, T
• Koh, A
• Koh Hong Xiang, F
• Kojo Anyomih, T
• Kokelaar, R
• Koliarakis, I
• Kolli, S
• Kong, J
• K?nig, D
• Koshy, M
• Kourdouli, A
• Kowal, M
• Kraima, A
• Kramer, F
• Kryzauskas, M
• Kuchynskyi, I
• Kuemmerli, C
• Kuiper, S
• Kumar, A
• Kumar, L
• Kumar, H
• Kumar, N
• Kumar, S
• Kumar Bandyopadhyay, S
• Kumar Garg, P
• Kumar Venkatappa, S
• Kung, J
• Kural, S
• Kushairi, A
• Kuuzie, E
• Kvietkauskas, M
• Kwek, I
• La, J
• Lai, L
• Lakpriya, S
• Lam, K
• Lami, M
• Lapolla, P
• Larsen, H
• Latif, J
• Laudari, U
• Laurnezi, A
• Lawal, A
• Lawday, S
• Lederhuber, H
• Lednev, A
• Lee, R
• Lefevbre, G
• Lesmus, M
• Leyva Moraga, FA
• Leyva Moraga, E
• Leyva Moraga, F
• Li, HL
• Li, Z
• Licardie, E
• Light, A
• Lin, A
• Lincango, E
• Litta, F
• Liu, H
• Lofthouse, B
• Londo?o, MA
• Lopes, R
• Lopes de Freitas, R
• Lopez, L
• L?pez, AI
• Lopez-Gomez, J
• Lopez-Pena, G
• Lowe, R
• Lowe, D
• Lowey, M
• Loy, G
• Lozanovski, V
• Luzon, J
• Lynn, P
• Maccabe, T
• Machielsen, A
• Mafla Herrer?a, CA
• Maggino, L
• Mahmood, D
• Mahmoud, M
• Mahtani, K
• Maitra, I
• Maji, S
• Majiet, I
• Mal, L
• Malherbe, J
• Malhotra, K
• Malkomes, P
• Man, E
• Manan Sheikh, A
• Manjunath, S
• Manzano Nu?ez, R
• Manzoor, S
• Maqsood, R
• Marchegiani, G
• Marchegiani, F
• Mar?n, D
• Marin, A
• Marks, I
• Marson, E
• Martensen, A
• Martin, D
• Mart?n Mart?n, G
• Martin-Perez, B
• Martinez, P
• Marwaha, P
• Mashauri, C
• Mashbari, H
• Masior, ?
• Masri, R
• Masud, L
• Masudi, S
• Mateu Calabuig, G
• Math, S
• Matrachisia, A
• Mazingi, D
• Mazzotta, A
• McAlinden, J
• McCabe, G
• McColm, L
• McElvaney, H
• McGivern, K
• McGovern, J
• McGuinness, E
• McInerney, N
• Mckay, S
• McKee, C
• McKenna, M
• McKenna, N
• McLean, K
• Mediratta, S
• Medkova, Y
• Medzhidov, O
• Mehraj, A
• Mekhael, M
• Mekinde, O
• Mellenthin, C
• Melucci, A
• Mentor, K
• Merchant, J
• Messias, H
• Meza, C
• Mhango, P
• Miladinov, M
• Milagros Niquen Jimenez, M
• Miller, P
• Mills, E
• Milton, A
• Mischlinger, H
• M?ckli, B
• Modi, R
• Mohamed, HM
• Mohamed, M
• Mohamed Abulghasm, T
• Mohammad, SA
• Mohammed, TO
• Mohammed, A
• Mohan, H
• Mohan, M
• Moin, I
• Mok, V
• Molina, G
• Moloney, J
• Moneim, J
• Monfort Mira, M
• Montcus? Ventura, B
• Montouri, M
• Moossdorff, M
• Mora-Guzm?n, I
• Moran, B
• Mor?n, RAR
• Moreno-Ordaz, S
• Morera, ?
• Morgan, R
• Morley, R
• Moro-Valdezate, D
• Moros, S
• Moss, J-
• Moynihan, A
• Moy?n, M
• Muduli, N
• Mugla, N
• Mugla, W
• M?ller, P
• Mun, G
• Mundhada, R
• Munir, I
• Mu?oz, F
• Mu?oz, E
• Mu?oz, A
• Mu?oz Balderas, DC
• Murgitroyd, E
• Murray, V
• Murthy, S
• Mushiwokufa, W
• Mustafa, H
• Mustakimov, B
• Mutambanengwe, P
• Myint, P
• Nadkarni, S
• Nahar, S
• Naidoo, P
• Nam, R
• Nandhra, S
• Nanjappa, N
• Narasimhan, V
• Nardi, W
• Nasir, M
• Naughton, A
• Naumann, D
• Navarro, S
• Nawaaz Karimbocus, M
• Nazir, A
• Ndereya, S
• Ndong, A
• Negoi, I
• Nel, D
• Nelson, D
• Nepal, S
• Neufeld, J
• Ng, D
• Ng, CE
• Ng, J
• Ngaserin, S
• Ngu, L
• Ngwenya, E
• Fhearaigh, RN
• Nikolousakis, T-
• Ninkovic, M
• Nita, G
• Nitschke, C
• Noren, E
• Noton, T
• Novikova, A
• Nowinka, Z
• Nyakunengwa, T
• Nyalundja, A
• Nzenwa, I
• Kristensen, H?
• O?Brien, L
• O?Brien, S
• O?Reilly, J
• O?Rourke, S
• O?Sullivan, M
• O?Dwyer, M
• Ochieng, L
• Oderoha, E
• Oh, KE
• ?hlberger, L
• ?l??m, M
• Olkina, A
• Omkumar, M
• Omnitel, B
• Oncel Yakar, D
• Ong, K
• Ong Wei Lin, L
• Ooi, R
• Ooi, S
• Oomman, A
• Oon Tyjet, D
• Opiyo, S
• Oscullo Yepez, JJ
• Osei-kuffour, N
• Osunronbi, T
• Ottlak?n, A
• Oussama Kacimi, S
• Ovaere, S
• Ozair, A
• Pachler, F
• Pai Oo, S
• Paiella, S
• Panaiotti, L
• Panda, N
• Pandarinath, S
• Pandey, D
• Pandrowala, S
• Papa Mamadou, F
• Paranathala, M
• Park, J
• Parmar, C
• Parvez, A
• Pasovic, L
• Pasquer, A
• Pasumarthy, N
• Pata, F
• Patel, T
• Patel, N
• Patel, M
• Patel, P
• Patron Uriburu, N
• Patrone, R
• Paul, A
• Pavan Kumar, OM
• Pavithran, A
• Pedraza Ciro, M
• Peloso, A
• Pe?a Gallardo, MT
• Pe?a Velazquez, A
• Perea, J
• P?rez-S?nchez, LE
• Perra, T
• Perrotta, G
• Petersson, P
• Petra, G
• Petrucciani, N
• Pickin, C
• Pino, V
• Pinotti, E
• Pinto, F
• Plum, P
• Podesta, F
• Pollini, T
• Pompeu S?, M
• Ponce Leon, F
• Ponniah, HS
• Ponte de Sousa, X
• Ponton, J
• Pontula, A
• Popa, M
• Portilla, AL
• Posner, F
• Potolicchio, A
• Pouwels, S
• Povo, A
• Prasad, P
• Preciado, S
• Preece, R
• Proud, D
• Pulido Segura, JA
• Puliyath, N
• Qui, M
• Quimbaya Rodr?guez, AS
• Raby-Smith, W
• Racovi??, A
• Radwan, R
• Rafaih Iqbal, M
• Rafik, A
• Raguan, B
• Rahi, M
• Rahiri, J-
• Rahme, J
• Rai, L
• Raj, A
• Raj Saksena, A
• Raja, M
• Ramirez, J
• Ramzi, J
• Rao, C
• Rashid, A
• Ratnayake, B
• Rattanasirivilai, K
• Raubenheimer, K
• Ravikumar, N
• Ravn, S
• Razoz, N
• Rea, W
• Regan, A
• Rela, M
• Remme, A
• Rey Chaves, CE
• Reyes, A
• Riad, A
• Rice, D
• Rios Quintana, K
• Ritter, A
• Roals?, M
• Robinson, D
• Rodriguez, J
• Rodr?guez, F
• Rodriguez, MC
• Rogers, A
• Rohila, J
• Romanyuc, D
• Romic, I
• Rommaneh, M
• Rompianesi, G
• Rosa, F
• Roscio, F
• Rose, A
• Rotimi, T
• Ruiz, H
• Ruiz Yucuma, J
• Ruiz-?car, E
• Ruslan, M
• Ruteg?rd, M
• Ryan Harper, E
• Ryckx, A
• Rydbeck, D
• S?-Marta, E
• Sadien, I
• Safari Nteranya, D
• Sagoo, K
• Sakata, S
• Saladino, E
• Saleem, A
• Saleem, S
• Salehi, M
• Salih, S
• Sallinen, V
• Salvans, S
• Sam, ZH
• Samadov, E
• Emile, SH
• Sampaio Alves, M
• Sanad, A
• S?nchez Fonseca, S
• Sanchez Teran, A
• Sanchez Ussa, S
• Sandli, O
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Unidades de investigação

• Biomedicina

• Cirurgia e Fisiologia

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues? experiences and published evidence.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.</jats:p> </jats:sec>