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Table of Contents
EDITORIAL
Year : 2020  |  Volume : 17  |  Issue : 2  |  Page : 64-65

COVID-19 pandemic and the surgeons


Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India

Date of Submission26-Apr-2020
Date of Acceptance08-May-2020
Date of Web Publication18-Jun-2020

Correspondence Address:
Raju Vaishya
Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi - 110 076
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_29_20

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How to cite this article:
Vaishya R. COVID-19 pandemic and the surgeons. Apollo Med 2020;17:64-5

How to cite this URL:
Vaishya R. COVID-19 pandemic and the surgeons. Apollo Med [serial online] 2020 [cited 2020 Sep 28];17:64-5. Available from: http://www.apollomedicine.org/text.asp?2020/17/2/64/287088



Disasters and pandemics pose unique challenges to healthcare delivery. COVID-19 pandemic has similarly put several challenges to the surgical community, across the world. It is becoming apparent from the reports across the world that the healthcare workers (HCWs) are at greater risk of acquiring this dreaded infection. Hence, the safety of HCW is of paramount importance, during this pandemic. If not protected by personal protective equipment (PPE), they have a high chance of getting infected, forcing them to drop out of the workforce and infecting others. The higher incidence in the HCWs could be due to higher viral load in the hospital setting and long working hours, leading to increased exposure and fatigue.[1] Severe fatigue among the orthopedic surgeons during 2 months before the outbreak was found to be a risk factor for COVID-19 infection. Fatigue from overwork, less sleep, and mental stress are the issues for orthopedic surgeons, under many “normal” circumstances.[2] It is becoming apparent from the reports from across the world that the long duty hours of the HCW is a major risk factor for them to acquire an infection, and hence, it is mandatory they work in shorter shifts, based on a strict rota.

In India, the surgical outdoor and emergency departments in the hospitals are often flooded with the patients, requiring emergency and nonemergency care. The situation has become even more challenging after the COVID-19 outbreak. The numbers of intensive care unit (ICU) beds are also disproportionately low in the Indian hospitals, and seeking such a bed for a surgical emergency patient is becoming challenging these days. A significant proportion of patients requiring surgery (e.g., orthopedic services) are elderly and may require ICU backup for the surgery.

Despite increased risk of acquiring the COVID-19 disease, the doctors, including the surgeons, are providing continuing care to their patients. In most countries, the nonemergency surgeries have been postponed and the consultations for nonemergency patients are being done through telemedicine, to avoid the hospital visits of these patients and unnecessary exposure.[3] During this pandemic, our goal should be to preserve all the vital resources, including staffing, PPE, ventilators, medications, and ICU beds.[4] The surgeons may be given an additional task of doing administrative work and also the nonsurgical work, such as looking after the ICUs, for which they are not trained.

In a Chinese study [5] of 10 COVID-19-infected patients with fractures, it was found that four (40%) of them died within 2 weeks and the prognosis of COVID-19 patients with fractures tended to be more severe than those without a fracture. Hence, the surgical treatment should be carried out judiciously and a nonoperative care should be preferred in the majority, during this pandemic. In a survey of hospitals in Wuhan,[6] a total of 26 orthopedic surgeons from eight hospitals were found having COVID-19. The suspected sites of exposure were mostly from the wards followed by the public places at the hospital, operating rooms, the ICU, and the outpatient clinic. There was a transmission from these doctors to others in 25% of cases, including to family members, colleagues, patients, and friends. Importantly, participation in real-time training on prevention measures had a protective effect against COVID-19. Not wearing an N95 respirator and severe fatigue were found to be the risk factors. The orthopedic surgeons are at a higher risk as many orthopedic procedures generate aerosol particles, especially using pulse lavage and power instruments (drill, saw, burr, and reamers), in patients in whom COVID-19 is suspected as these particles may facilitate airborne transmission, if inhaled.[6] Neglected trauma in India is a huge problem,[7] and due to COVID-19 outbreak, the neglected trauma patients will likely to increase and we anticipate more number of cases after this outbreak.[8]

If the surgical procedure is unavoidable, then it is imperative to screen patients and the surgical team members. It is desirable that a dedicated COVID-19 operating theater complex, with a separate entry and exit, be set up for these patients. The operation theaters should have an induction room, separate from the main operation theater, and should ideally have negative pressure. As far as possible, the surgeries should be planned as day-care cases, aiming for an early discharge. It is important of emphasize here that the interventions be performed only if the documented treatment effects are far superior to the nonoperative management.

Most of the known surgical organizations, e.g., The American College of Surgeons, The Royal College of Surgeons of the UK, Associations of Surgeons of India, and Indian Orthopedic Association, have developed guidelines for their member surgeons to follow during this pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vaishya R, Vaish A. Roles and responsibilities of the orthopedic community and the Society during COVID-19 pandemic. Ind J Orthop 2020;54:98-9. doi: 10.1007/s43465-020-00105-7.  Back to cited text no. 1
    
2.
Guo X, Wang J, Hu D, Wu L, Gu L, Wang Y, et al. Survey of COVID-19 disease among orthopedic surgeons in Wuhan, People's Republic of China. J Bone Joint Surg Am 2020;102:847-54. doi: 10.2106/JBJS.20.00417.  Back to cited text no. 2
    
3.
Liang ZC, Wang W, Murphy D, Hui JH. Novel corona virus and orthopedic surgery: Early experiences from Singapore. J Bone Joint Surg Am 2020:e000236. doi: 10.2106/JBJS.20.00236. Online ahead of print.  Back to cited text no. 3
    
4.
Halwai MJ, Wang DD, Hunt TR. What's important: Weathering the COVID-19 Crisis: Time for leadership, vigilance, and unity. J Bone Joint Surg Am 2020;102:759-60. doi: 10.2106/JBJS.20.00419.  Back to cited text no. 4
    
5.
Mi B, Chen L, Xiong Y, Xue H, Zhou W, Liu G. Characteristics and early prognosis of COVID-19 infection in fracture patients. J Bone Joint Surg Am 2020;102:750-58. doi: 10.2106/JBJS.20.00390.  Back to cited text no. 5
    
6.
Wong KC, Leung KS. Transmission and prevention of occupational infections in orthopaedic surgeons. J Bone Joint Surg Am 2004;86:1065-76.  Back to cited text no. 6
    
7.
Jain AK, Mukunth R, Srivastava A. Treatment of neglected femoral neck fracture. Indian J Orthop 2015;49:17-27.  Back to cited text no. 7
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8.
Jain VK, Vaishya R. COVID-19 and orthopaedic surgeons: The Indian scenario. Trop Doct 2020;50:108-10.  Back to cited text no. 8
    



This article has been cited by
1 Challenges in providing surgical care during and after COVID-19 pandemic
Saseendar Shanmugasundaram,Abhishek Vaish,Raju Vaishya
Apollo Medicine. 2020; 0(0): 0
[Pubmed] | [DOI]



 

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