KE McBride,^1,2 KGM Brown,^1,2,3 OM Fisher,^1,4 D Steffens,^3,5 D. Yeo,^1,3,4 CE Koh^1,2,3,5

• ¹ RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales
• ² Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
• ³ Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
• ⁴ Department of Upper Gastrointestinal & Hepatobiliary Surgery, Royal Prince Alfred Hospital, Sydney, Australia
• ⁵ Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia

The evolving COVID-19 pandemic represents an unprecedented and largely unanticipated challenge to the delivery of surgical care in Australia and New Zealand. The first confirmed COVID-19 case in Australia occurred on 25 January 2020. Since then, 2675 patients have been diagnosed nationally, resulting in 12 deaths (at the time of writing). New South Wales (NSW) has been the most affected state based on case volume, with 1219 documented cases. During the initial response in NSW, all patients with confirmed COVID-19 requiring hospitalisation were managed at a nominated COVID-19 centre (Westmead Hospital). As the pandemic evolved and the confirmed cases increased, a second COVID-19 centre was established at Royal Prince Alfred (RPA) Hospital on 4 March 2020. RPA is a 900 bed teaching hospital located in metropolitan Sydney, which provides surgical care for the local community but also serves as a quaternary referral centre for complex surgical services including advanced gastrointestinal (GI) malignancy, complex cardiovascular and neurosurgery, and renal and liver transplantation. As the third week of the response period at RPA comes to an end, this article aims to share our initial experience as a dedicated COVID-19 centre by describing the issues faced in providing acute and elective surgical care, the broad impacts on staff and the early strategies adopted to address these challenges.

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