We live in a time of uncertainty and fear, and sometimes it seems that all our medical knowledge is not useful enough. We are facing something completely new, and we do not know the myriad of clinical presentations, the treatment, the prognosis. These reasons explain why we feel insecure.

There is scarce literature, and the information is sometimes confusing. The most trustable source of data is the experience of the people in the field.

In that regard, the International Society of Intraoperative Neurophysiology (ISIN) has a privileged position, with members that are working in more than fifty countries deployed in the five continents. This international scope is especially relevant, considering that this pandemic has been confronted using different country-by-country strategies.

Unfortunately, some of the strategies have had poor results, a high number of deaths, and human suffering. We have to learn how to protect our patients, ourselves, our equipment, and avoid disseminating the infection. This protection is a work in progress.

This crisis is an opportunity to develop online education and training, extending Intraoperative Neurophysiology expertise to remote areas of our world. At this moment, this is the only way to sustain our scientific and educational activity.

At least three immediate consequences have had the pandemic on the practice of intraoperative neurophysiology; a) A dramatic drop in the number of cases to be monitored, b) Rapid implementation of the protective measures (personal protective equipment) to neuromonitoring in a potential viral environment and c) Cancellation of all the live educational and academic activities, like courses and congresses.

The reasons that explain the significant drop in the number of cases to be monitored are mainly the following:

Almost all healthcare facilities mandated to focus on COVID -19 patient care and postponed all elective surgeries unless there is an absolute necessity. Patients are also reluctant to undergo any elective surgery under the threat of COVID -19 infection. There are reports that even asymptomatic COVID-19 infection increases the risk of surgery. From the perspective of IONM, skull base surgeries might be at the highest likelihood to be exposed to COVID-19.

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1. Kaye K, Paprottka F, Escudero R, Casabona G, Montes J, Fakin R, et al: Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS-COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management. Aesthetic Plast Surg 44.:1014-1042, 2020

2. Nahshon C, Bitterman A, Haddad R, Hazzan D, Lavie O: Hazardous Postoperative Outcomes of Unexpected COVID-19 Infected Patients: A Call for Global Consideration of Sampling all Asymptomatic Patients Before Surgical Treatment. World J Surg:1-5, 2020

3. Workman AD, Welling DB, Carter BS, Curry WT, Holbrook EH, Gray ST, et al: Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol, 2020

The current situation during the pandemic has some real risks because there are well known medical conditions that cannot hold on for a long time. Preliminary reporting suggests that there are adverse effects on morbidity and mortality of those diseases. (Vandoros S, Excess mortality during the COVID -19 pandemic: Early evidence from England and Wales; Social Science & Medicine 258, August 2020

In these very challenging times, ISIN would like to deliver practical advice and educational support.

You are invited to send your question to us about IOM Practice issues in Covid-19 patients; we will try to answer your concerns. Please contact us at


Pneumonia epidemic of unknown cause occurred in Wuhan, China, in December 2019. The agent of this pneumonia was identified as a novel coronavirus that was initially named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease related to it as coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO). And it was declared as a pandemic disease on March 11, 2020.

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Human to human transmission of COVID-19 is mainly by droplet and or close contact between affected person and healthy one1.

The disease is highly contagious, and even it is too early to identify the accurate reproductive number (R0), some studies have estimated the mean R0 in a range of 2.20-3.58. This means that each patient has been spreading the infection to 2 or 3 other people2.
The incubation period for the virus reaches up to 14 days with a mean duration of 5.2 days2.

1- Al-Balas M et al., surgery during the COVID-19 pandemic: A comprehensive overview and perioperative care, The American Journal of Surgery (

2-Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020 (

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2020 LatinAmerican IFCN_Guidance for clinical neurophysiology examination throughout the COVID- 19 pandemic San-juan.pdf