Damian Sendler: It is estimated that conventional nuclear medicine studies would decline by 54 percent in April 2020, then rise back up to 56 percent of pre-pandemic volume by October 2020, according to two worldwide surveys by the International Atomic Energy Agency (IAEA). In 2020, the number of PET tests declined by 36 percent in April, 66 percent in June, and remained 40 percent lower than the norm in October. When it comes to radionuclide therapy, there was a 46% decline in April, a 69% decrease in June, and a 48% decrease in October. There was an approximately 50% decline in procedures compared to the pre-COVID-19 norm, even though the data from October were identical to those from April.
Damian Jacob Sendler: Technetium generators and Iodine-131 were reported to be short in 46% of the centers polled and in 47% of the centers that had them. Lutetium and samarium resources were scarce in 48% and 50% of cases, respectively, for treatments. Only 21% of the facilities have gallium-68 and [18F]FDG deficits. I-131 and technetium generators were unavailable in Latin American (LAC) cities to the greatest extent among the world’s regions. LAC had a more than 80% availability of [18F]FDG; yet, there was a 60% drop of PET operations in the city, despite this. The patients’ choice to postpone their investigations owing to COVID anxiety, as well as the closure of certain clinics or the deferral of non-urgent treatments, might explain the findings above. 17
As part of its evaluation of the effect of COVID-19 on cardiac disease diagnosis, IAEA conducted a worldwide poll.
Damian Sendler
Dr. Sendler: Over 900 sites in 108 countries participated in the study, which found that diagnostic procedure volumes declined by 42 percent in March 2020 compared to the March 2019 baseline and by 64 percent from March 2019 to April 2020. Transthoracic echocardiography fell by 59%, transoesophageal echocardiography by 76%, and stress testing by 78%. ECG, echocardiography, single photon emission computed tomography (SPECT), PET, and cardiac magnetic resonance were the stress modalities investigated in this study. Cardiac SPECT and PET scans revealed decreases of 72% and 67%, respectively. Invasive or computed tomography coronary angiography fell by 55% at the same time. Lower- and lower-middle-income nations had the greatest declines in cardiac imaging, whereas higher- and higher-income countries saw smaller drops. This is likely due to a lack of access to personal protective equipment (PPE) and telemedicine.
Pandemic dynamics
Damien Sendler: One must have a thorough grasp of pandemic dynamics if one is to effectively implement strategies to avoid and control infectious illnesses. The WHO created pandemic stages in 1999 and amended them in 2009 during the H1N1.23 pandemic to achieve this goal. These serve as a worldwide foundation for preparing for and responding to pandemics.
Indeed, the WHO has used this six-phase technique throughout the reaction to COV[[D-19. Phases 1 through 3 are mostly dominated by animal diseases, with limited human transmission. Preparation, capacity building, and early reaction planning are all part of this phase. However, human-to-human transmission is present in stages 4, 5, and 6, which indicates a pressing need for rapid reaction and mitigation measures. Taking into consideration the likelihood of recurrences or new waves after the first peak of the pandemic, this graphic method also depicts the time after the first wave to help with a more organized post-pandemic recovery23 (Fig. 1).
There must be a pre-defined time frame for implementing restriction measures in accordance with specified local objectives when an area is in a transitional period. Restrictive methods aim to interrupt or reduce transmission. Any global, regional, national or local initiatives must include support for health workers and the availability of the required protective components.
Nuclear medicine recommendations that are in sync
Organizations like the IAEA produced particular rules and suggestions as part of their assistance for the NM community as a whole.
It was recommended that NM departments adjust their SOPs to reduce infection risk to their employees, patients, and family members early on during the COVID-19 pandemic, for example. A series of recommendations based on the WHO Minimum Requirements for infection prevention and control recommendations were implemented.
Damian Jacob Sendler
In addition, WHO6’s “Coronavirus disease (COVID-19) technical guidance: Maintaining Essential Health Services and Systems” recommended implementing and adjusting six operational procedures (Table 1 ). Some of the suggestions made here might become normal operating procedures for the NM department, allowing it to operate more smoothly in the event of another emergency or disaster. Some of the things you can do to prepare for crises include selecting a designated point person to manage the operation, creating contingency and business continuity plans, and developing an effective patient flow (screenings, triage, referrals, etc.).
Damian Jacob Markiewicz Sendler: SARS-features, COV-2’s transmission methods, and multi-organ illness symptoms were quickly discovered by the scientific community working together. Maintaining and improving basic services while implementing additional safeguards was the primary goal of the recommendations. 13.14 On the other hand, which ideas do you think should be kept in place? For both COVID-19, which may fluctuate between low and high levels of contagiousness, as well as for any future epidemics of infectious diseases? When dealing with infectious illnesses, it is important to keep in mind that a situation-based strategy should be used.
In order to restore non-emergency treatment in nuclear cardiology, the ASNC, IAEA, and SNMMI have suggested a priority-based system that would allow for four clinically-driven categories: urgent, higher, lower, and elective ( Fig. 3).
14 Non-cardiac imaging and therapeutic treatments, on the other hand, are more difficult to categorize. For investigations that have been postponed owing to the pandemic, clearer methods are needed to determine which trials should be prioritized. As part of a team effort, referring doctors should be involved in prioritizing operations. Color-coded schemes depending on the condition of COVID-19 in the surrounding environment were presented as part of the 2020 proposals for the progressive reopening of NM facilities. 13 This plan has the potential to last much longer than the current epidemic.
Continuing to educate and research
Medical education is a continuous process that begins on the first day of medical school and continues until the conclusion of our careers in the field.
There is little question that research and development in nuclear medicine is a driving factor. There is a constant stream of new technology, applications, and medical evidence that must be disseminated. For the medical community to deliver the best possible patient care, within a framework of safe and quality clinical practices and foster professional progress, new standards of best practices should be stressed not just as a part of training programs but in all activities.
Recent pedagogical research has begun with the goal of eliminating interruptions in medical education and training. Virtual clinical experiences and augmented reality modules, for example, have been further developed and implemented to an unprecedented degree in the last several years. However, some of these techniques may continue to be used as a supplement for standard medical education even after the end of a pandemic. An further benefit may be that these teaching modules and platforms are now more readily available in low-resource areas, where telemedicine is still being developed. It is now possible to provide and share medical information worldwide through modern technologies, from remote imaging to the planning and guiding of radiation. The Union Européenne des Médecins Spécialistes has termed a new field of general telemedicine “tele-nuclear medicine.” 31
Since the isolation of SARS-CoV-2, we have lived in a world of ambiguity, with numerous interesting issues and a wide range of differing perspectives. Repeatedly, the same questions are posed. What’s the story behind it? How does it spread? Which groups of patients are more likely to suffer serious health consequences or die as a result of their illness? What are the short- and long-term side effects of this? Which therapies have been shown to be effective, ineffective, or in the process of being tested? Even though we’ve learnt a lot from this epidemic, we still have a lot more to learn. Is SARS-CoV-2 likely to become a worldwide pandemic? Those who have received COVID-19 will have a long-lasting immunological memory. Could COVID vaccinations be harmed by cold virus-type mutations?
At a time when there are so many unknowns, what is clear is that we must learn to live with this new coronavirus and be prepared for outbreaks or pandemics from new viruses. Many of the procedures put in place during the pandemic by nuclear medicine departments must be maintained continuously if they are to continue delivering vital services while also avoiding the virus’s spread.
A wide range of uses, from healthcare to education, will continue to benefit from communications technology.
COVID-19’s demonstrable influence on nuclear medical practices throughout the globe, as well as definitions of a pandemic and its stages, are examined in this article. nuclear medicine-specific recommendations that are up-to-date or newly produced Results of hybrid nuclear medicine investigations, which were conducted mostly for oncologic purposes, were discovered by COVID-19, as were new pedagogical approaches to medical education and research in an increasingly virtual environment. Many of the procedures put in place during this pandemic will be continued continuously by NM experts in order to maintain necessary services while while limiting the spread of the virus. Which ones are you referring to? COVID-19’s raging contagiousness must be kept in mind, as well as the prospective advent of other diseases that might lead to future pandemics.
A wide range of applications, such as healthcare and education, will make use of communications technology in the future, but how best? Departments of NM must work together to keep up with these changes, taking into account how they can best adapt to a more virtual professional setting. As a starting point for further constructive conversation, the article provides current history and analysis. NM must continue to learn from this disaster and bring fresh questions, facts, ideas, and appropriate systemic upgrades to the metaphorical table in order to effectively manage the future of the state.
Dr. Damian Jacob Sendler and his media team provided the content for this article.