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Collateral Effect of the Pandemic on Ultrasound.

We have been following publications on ultrasound of the lung in patients with COVID 19 with great interest [1–3]. We also know all the precautionary measures for an ultrasound examination of a patient who has tested positive for SARS-CoV-2. However, this pandemic seems to have an even greater impact on the ultrasound community. As not all patients we see are tested for SARS-CoV-2, we are confronted with additional organizational measures and intensified hygiene protocols in our clinical routine outside the isolation ward. On a daily basis we are reminded that our knowledge of SARS-CoV-2 is still incomplete and that the benefit of some hygienic measures is under debate. Still, the latter are advised or at least recommended from a medicolegal standpoint. In interesting surveys conducted before the SARS-CoV-2 pandemic, the ultrasound decontamination procedures of the ultrasound community were assessed in questionnaires [4, 5]. Regarding surface or endo-cavity ultrasound or interventional procedures, the practice for decontamination was inhomogeneous. Long before this pandemic, some ultrasound societies (e. g. EFSUMB, AIUM) released recommendations for cleaning and disinfecting probes. Nevertheless, we can assume that there were many “different interpretations” of good practice. So maybe this pandemic will lead to a long-term change and improvement of our practice for probe decontamination. However, we have to be aware that proper disinfection may alter our workflow and thus patient traffic. Disinfectants, which are compatible with the materials of the ultrasound system, have different exposure times regarding the germicidal effect. In some cases, this can be 15 minutes, e. g. for the Noro virus or mycobacteria. Switching to disinfectants with a faster effect is advisable ... depending on cooperation with your business director and/or hospital pharmacy. In examinations of patients who cannot wear a face mask (examination of the tongue, oral cavity, small children), wall barriers may be only partly effective. Other safety measures for the examiner are time-consuming and organizationally demanding. It is hard to imagine that a satisfying solution to this problem will be found and will endure after the pandemic. Will our patients change? An interesting side effect of this pandemic with daily reports on various aspects of infectiology and epidemiology is that patient awareness regarding hygiene has probably increased. We may expect well-trained eyes to observe our ultrasound hygiene activities. Social distancing also applies to us. The number of hands-on ultrasound courses has decreased. Webinars and online courses are being offered by numerous societies, companies, individuals, or a combination thereof. Of course, mastering ultrasound requires not only intellectual expertise but also manual skills. Thus, hands-on training is needed to learn and perfect ultrasound. Hospital operators and universities have restricted access for visiting observers, residents from other departments, and students. This will certainly create a significant backlog as trainee positions in ultrasound departments have always been in high demand. Organizing a classic ultrasound course is different from creating an online course. Ultrasound societies should be aware that this “evolutionary pressure” could be a disadvantage for experienced course instructors. Ideally, a neutral ultrasound society would take care of the technical requirements and offer a platform for all instructors, whether tech-savvy or not. Conferences have been cancelled or postponed, and meetings are partly or completely virtual. Although the hybridization of conferences – onsite and online – has many advantages, informal talks between sessions will always be one of the main assets of a meeting and are hard to replace virtually. Of course, these are just some thoughts and cautious extrapolations of our present situation in the ultrasound community. The future is unclear, but the virus certainly helps us to better understand what we do. Dr. Stefan Meng Editorial