LAUSR

The recent ongoing outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spreads around the world. By March 31, this global pandemic has infected about 700,000 cases in more than 203 countries/regions and 33,257 people have lost their lives. A recent study reported that only 2.16% (965/44,672) of infected patients were aged 19 years or younger [1]. Although children are supposed to be less susceptible to COVID-19, the true infected rate of children may be understated because some children with asymptomatic and mild infections are unlikely to be tested [2]. Besides, in addition to the COVID-19 itself, the relative shortage of medical resources caused by a surge in the number of coronavirus patients and accompanying economic downturn may also affect the diagnosis and management plan for children with surgical disease. Hence, the treatment plans for pediatric surgical disease during the COVID-19 outbreak deserve attention. For confirmed/suspected SARS-CoV-2-infected children, although some of them may present as mild or even symptomless infections, the virus may “awaken” and the symptoms may worsen with the progression of SARSCoV-2 infection. Besides, although it remains unclear whether infected children with cancer are associated with poor prognosis, it seems that the tumor itself and its corresponding treatment may weaken the immune response to pathogenic microorganisms, and further make the COVID19 worse. Hence, a priority of treating the COVID-19 and a short delay in surgical treatment (or oncotherapy) may be an optimal option for those infected children without presenting a surgical emergency. In a recent report about infected children from Wuhan, 18 of 20 children were cured with an average stay of 12.9 days (8–20 days) [3]. Hence, the delay may not seem long. The incubation period from exposure to symptoms for most patients with COVID-19 varies from 3 to 14 days [4], suspected infected children should be, therefore, quarantined for at least 14 days to ensure safety. However, for those who developed a life-threatening emergency (such as the acute abdomen and severe hydrocephalus), although emergent operation may be a risky practice in children with concurrent SARS-CoV-2 infection, it may still be the only life-saving method when conservative treatment fails. It is recommended to simplify the surgical procedure and to minimize the trauma to children. The “radical surgery” should be chosen cautiously after a multidisciplinary assessment. In surgical treatment recommendations for confirmed/suspected adult, laparoscopic surgery is considered dangerous because it may carry the risk of aerosol transmission [5]. However, the balance between the real risk of cross-infection and the benefits of minimally invasive surgery should be carefully assessed [6]. Appropriately reducing the pneumoperitoneum pressure, preventing the gas leakage from the trocar sites, and slowly removing the “aerosol” via aspirator after pneumoperitoneum may be possible solutions to lower the risk of cross-infection. Preventing SARS-CoV-2 infection and giving the necessary treatment should be the main treatment principles for treating children with pediatric surgical diseases but without COVID-19. Elective operations (such as cosmetic procedures) could be postponed modestly as invasive procedures as well as anesthesia may influence the children’s immunity, which increases their susceptibility. However, the outbreak may last for months, for urgent and some “time-sensitive” diseases, unduly delay in surgery may miss the “critical * Long Li [email protected]