Impact of the COVID-19 Pandemic on Cardiologists in a Country with Limited Resources

Muhammed Elhadi1, Ahmed Alsoufi1, Mohamed Abrahim Bin Zarti1, Siraj Abulmida2, Nafati Alnafati2, Najwa Alfurjani1, Ahmed Khaled1, Munder Mansour1, Ahmed Msherghi1, Ahmed Tarek3 and Hazem Abdelkarem Faraj1 1 Faculty of Medicine, University of Tripoli, Tripoli, LY 2 National Heart Institute, Tripoli, LY 3 Tripoli University Hospital, Tripoli, LY Corresponding author: Muhammed Elhadi (Muhammed.elhadi.uot@gmail.com)


Availability of personal protective equipment (PPE)
Not available 20 16.9 (Contd.) that more than 20 patients waited for revascularization or any type of intervention due to delays caused by the COVID-19 pandemic. Patients with cardiovascular disease are the most numerous patients with co-morbidities that are affected by COVID-19 [5]. There has been a rise in the number of cases that are waiting for procedures due to the shortage of supplies and redeployment of cardiologists in other departments. To our knowledge, this is the first study of the effects of the COVID-19 pandemic in a country with limited resources and restrictions on healthcare settings.
Healthcare systems in countries with limited resources are facing several challenges during the ongoing COVID-19 pandemic. As we approach the second wave, the challenges increase for fragile healthcare systems such as Libya's. These hospitals have allocated their resources to fight the COVID-19 outbreak. Only 13.6% of respondents reported no changes in the stent insertion program while others reported delay or cancellation of this program. Over 70% of participants reported that more than 20 patients in their hospitals were awaiting cardiovascular procedures that were delayed or cancelled due to COVID-19 infection risk and disruption of healthcare services. This is shown by the fact that 70% of participants reported having less than two days allocated per week for catheterization laboratories. In addition, the PPE shortages and the disruption in interventional cardiology departments have decreased the ability of departments to manage these patients, as shown by the decreasing number of patients admitted and the cancellation of outpatient clinics and catheterization procedures. This puts more patients at risk of death or complications of their cardiovascular disease.
We acknowledge several limitations to this work. Indeed, it is intended merely as a preliminary view of a country with specific circumstances. Thus, we assume that future multi-national studies can confirm these findings in a broader way to give generalized results. There is also a need to assess the effects of delay in managing patients with cardiovascular disease, which increases the risk and the burden on healthcare systems, and to weigh the benefits and risks.
Our study was intended to raise awareness of cardiovascular patients affected by the disruption of healthcare services due to the COVID-19 pandemic. Our results emphasize the importance of caring for patients with cardiovascular disease and of allocating resources and efforts to manage these patients despite this disruption. There is a need to support countries with limited resource settings to help them cope with the challenges posed by COVID-19. Otherwise, the consequences could be catastrophic, given the fact that cardiovascular diseases are the most common cause of death worldwide and any disruption in cardiovascular healthcare services can increase the overall mortality and complications of these diseases [6].

Data Accessibility Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics and Consent
The authors confirm that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation, with the Helsinki Declaration of 1975, as revised in 2008. Ethical approval for this study was obtained from the Bioethics Committee at the Biotechnology Research Center in Libya [Reference number: 109.3-2020]. All participants provided written informed consent before participating in the study.

Funding Information
This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.