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Evidence, not eminence, in coronavirus disease 2019

Surgeons are familiar with crisis management, with spontaneous innovations being developed when put under pressure. The recent unfolding pandemic of coronavirus disease 2019 (COVID-19) has stretched the resilience of not only surgeons, but also all clinicians, government and health systems. Outside of Australia and New Zealand, hospitals have been overwhelmed with COVID-19 patients, limited resources and difficult decisions needing to be made. With the unknown wave of disease that is COVID-19, Australasian health systems needed to prepare for the worst and hope for the best. Earlier reports from the UK suggested laparoscopic surgery was dangerous and all surgeries should be open. Personal protective equipment was projected to be in short supply, particularly if the European experience was to develop in Australia and New Zealand. In both countries, the best options to prioritize surgery in a COVID-19 environment were unclear. The three publications in this edition of the ANZ Journal of Surgery provide guidance in these three important areas of surgical care: open versus laparoscopic surgery, personal protective equipment and triaging of surgical care. These reports are evidence-based rapid reviews providing an alternative to what was, on occasions, misplaced expert opinions that were offered in the early stages of the pandemic. The availability of a highly experienced evidence assessment team that resides within the Royal Australasian College of Surgeons is well illustrated by the prompt response which was provided to this crisis. Surgeons need to be able to respond reliably and promptly to not only the unforeseen challenges presented by COVID-19, but also the constantly changing innovations and approaches that are part of ‘modern surgery’. An informed and enlightened surgical community is vital to manage the demands of the economic, human and knowledge challenges occurring in Australian and New Zealand surgical practice. As the evidence surrounding COVID-19 develops and is reported, the publications in this edition will no doubt need to be revised. In our current world of instantly accessible information, including from websites and online publication, this will continue to occur. What is needed, however, is critical review of the new evidence so it can be presented to government, surgeons and patients in a way that clearly separates anecdotal reports from established scientific observations and data. Many ‘experts’ are ultimately proven to be wrong. In 1984, the United States Health and Human Services Secretary, Margaret Heckler, declared that a vaccine would be available for acquired immunodeficiency syndrome within 2 years. This still remains unachieved despite outstanding progress in human immunodeficiency virus management, treatment and outcomes. No one can predict what will be the outcome of COVID-19 in Australia and New Zealand, or the planet more generally. What is known is that without evidence, agility and wisdom, our community will suffer far more than necessary, as has occurred in other jurisdictions.