Lessons Learned and Experiences Shared From the Front Lines: Milan and Madrid.

Under the aegis of the American College of Surgeons (ACS), the senior author (SDW), a member of the Board of Regents of the ACS, interviewed 3 of his international colleagues in colon and rectal surgery who found themselves dealing with a flood of patients from the COVID-19 pandemic. Each was in a "hot spot" where the outbreak overwhelmed the capacities of the hospitals. Professor Antonino Spinelli of Milan dealt with the sudden increase in COVID-19 patients that threatened to push all other emergencies and urgent cancer cases aside. Providers lacked the personal protective equipment to be adequately safe in the environment. In Madrid, Dr Julio Mayol recounted how 10%-15% of the workers in his hospital were incapacitated by the virus, many of them doctors providing direct care to patients. The disease is so prevalent that all emergency patients are treated as though they have the infection. Having practices in Saudi Arabia and Spain, Dr Delia Cortés-Guiral saw how the former country controlled the epidemic through a strict lockdown of travel and closure of holy pilgrimage sites and social gatherings. In contrast, upon her return to her native country, she experienced the near-breakdown of the health care system by the suddenness of the outbreak. "There are now no specialists now, she says." All of the specialties are treating COVID-19 patients and all of us are learning at the same time how to deal with this disease."It is a nightmare now here in Spain".