A Priori Tumor Grading Scale to Triage and Schedule Post COVID-19 Mohs Surgery Patients

The United States is slowly relaxing stay-at-home orders and reopening businesses to reverse the nation’s ailing economy after the spread of the coronavirus that killed millions of jobs and pummeled the global economy. The virus was initially identified as a cluster of pneumonia cases in Wuhan, Hubei Province of China. Later reclassified as a Novel Coronavirus on December 31, 2019, by the World Health Organization (WHO), and health experts in the US, Canada, Germany, Russia, China, Korea, Japan, and Nigeria declared COVID-19 as a Global Pandemic. During the peak of the COVID pandemic, the Centers for Disease and Prevention, the U.S. Centers for Medicare and Medicaid Services, and professional organizations issued countermeasures to flatten the curve, such as elective surgical procedure cancellation. The coronavirus infections are still on the upswing in Texas, Arizona, Florida, and Utah.

A system to forecast the transmission of the virus based on live and current data is critical (Petropoulos & Makridakis, 2020). Cumulative first wave data aggregated nationally and globally could provide accurate forecasting of probable second wave COVID-19 transmission. While accurate forecasting of the virus’s spread is essential, it is critical to establish guidelines to avoid a Coronavirus rebound and frivolous lawsuits that could stunt economic recovery. In the absence of liability protection that shields medical facilities, and employers, it is critical to developing a scheduling point system that controls the number of patients in the waiting area that could be exposed to the asymptomatic transmission of COVID-19. Even with robust liability protection, negligent facilities could still be punished and be sued for damages. The average wait period is 18 minutes during a medical visit. The patients have enough time to mingle, increasing the probability of transmission of infectious diseases based on the amount and nature of contacts between healthy and infected individuals (Goscé & Johansson, 2018). A priori tumor grading scale in scheduling Mohs patients in the post-COVID period as it relates to the parameters for diffusion is vital for the safety and protection of both the patients and healthcare workers. Depending on the tumor grade, the overall degree of connectivity, comorbidity in association to tumor history using the Labilles “United Paradigm of Cancer Causation” (2017), the patient needs to be seen as the earliest. The grading scale introduced on the “Manual of Frozen Section Processing for Mohs Micrographic Surgery” (2008) is an urgency-scoring system to assist Mohs surgeons, administrators, and staff in triaging surgery patients.

References

Beggs, C. B., Shepherd, S. J., & Kerr, K. G. (2010). Potential for airborne transmission of infection in the waiting areas of healthcare premises: stochastic analysis using a Monte Carlo model. BMC infectious diseases10(1), 247.

Franczyk, B. (2019, July). An Intelligent and Data-Driven Decision Support Solution for the Online Surgery Scheduling Problem. In Enterprise Information Systems: 20th International Conference, ICEIS 2018, Funchal, Madeira, Portugal, March 21-24, 2018, Revised Selected Papers (Vol. 363, p. 82). Springer.

Friedman, E., Friedman, J., Johnson, S., & Landsberg, A. (2020). Transitioning out of the coronavirus lockdown: A framework for zone-based social distancing. arXiv preprint arXiv:2004.08504.

Goscé, L., & Johansson, A. (2018). Analysing the link between public transport use and airborne transmission: mobility and contagion in the London underground. Environmental Health17(1), 84.

Labilles, U. (2017). Pathopoiesis mechanism of smoking and shared genes in pancreatic cancer (Copyright Registration No. TX0008490984) [Ph.D. dissertation, Walden University]. ProQuest Dissertations Publishing.

McCulloch, Hetzer, Geddis, McConnell, Brock, Keating, Labilles, Marino, Beck, Wade & Fisher (2008). Manual of Frozen Section Processing for Mohs Micrographic Surgery. In F. Fish III (Ed.). Labilles, U, Immunohistochemistry (p.1201). American College of Mohs Surgery.

Petropoulos, F., & Makridakis, S. (2020). Forecasting the novel coronavirus COVID-19. PloS one15(3), e0231236.

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