As the United States and nations around the world grapple with the social and economic consequences of COVID-19, doctors are left wondering how they can blunt the devastation caused by this novel virus. For those of us in surgical subspecialties, it is not often that we consider our role in maintaining the broader public health. There are steps, however, that we can take as a profession to help in the public effort to overcome this and future pandemics that we may face.
Efforts to slow the growth of new cases of COVID-19 are critically important in order to maintain the capacity of our health-care system and meet the needs of patients. While social distancing and dedicated hygiene practices will help, the number of patients may exceed our system’s capacity in several locations across the country. This unfortunate reality is why many hospitals are postponing elective surgeries to ensure that resources such as intensive care unit (ICU) beds along with masks, gowns, and gloves are available to care for the surge of patients with COVID-19. Additionally, surgery inevitably places the patient and team of providers in a confined space. This closeness that is required during a surgical procedure is contrary to the goals of social distancing and can be avoided through the safe deferment of cases.
In orthopaedics, we perform surgeries that relieve pain and suffering, leading patients to live happier and more productive lives. While the definition of “elective” can be subjective, depending on the patient’s degree of debilitation, we nonetheless can consider surgeries that are not life or limb-saving to be appropriate for a short-term delay. Postponing surgeries that can wait until our society recovers is just one way that we can help offload the burden that is on our health-care system.
What about orthopaedic problems that require immediate attention? The management of traumatic injuries is an example of care that cannot be delayed. There are countless changes taking place in response to the pandemic that could impact the type and volume of trauma that we see in U.S. hospitals. For example, although the number of motor vehicle accidents may decrease as commuters work remotely, it is conceivable that collisions will be higher-energy as drivers enjoy open roads. Additionally, as children remain home from school during the spring, there could be an influx of supracondylar humeral and forearm fractures requiring emergency department visits and even operative intervention. While there are no immediate data to suggest that changes in injury patterns are taking place, we must consider the potential burden on our health-care system and the role we can play in preventing accidental trauma.
The public health campaign encouraging social distancing must also provide tips for remaining safe from physical harm. The public must consider 2 important consequences of a trip to the emergency department in today’s climate in addition to the harm created by the injury itself: (1) as the virus spreads, they are putting themselves at risk of exposure as providers triage and care for those with the disease; and (2) the time and resources it takes to care for injuries will create additional strain on our hospital system.
In addition, while most tips to remain safe reflect common sense, it is important to remember that all human beings tend to become complacent with time. This fact is one reason surgeons use the preoperative “timeout” to check that the procedure and location are correct prior to starting an operation. The same logic applies as we seek to keep the public safe from seemingly innocuous circumstances in and around their homes. With more than 25,000 orthopaedic surgeons in practice in the United States1 caring for patients of all ages and demographics, there are specific steps we can take in order to help the public prevent hospital visits and take extra precautions to remain safe while social distancing. For example, an email or letter to patients could serve as an important public safety reminder as many Americans grow restless from spending their days at home. Reminding elderly patients to use assistive devices when walking if they have a gait impairment and to remove tripping hazards from the floor may prevent unnecessary falls among our most vulnerable population. Instructing parents to discourage their children from playing on climbing structures and trampolines will help keep families away from the hospital during a time of national crisis. Additionally, trauma centers can ask local and state officials for stricter enforcement of speed limits to encourage safer driving.
While each of these examples may only make a small dent in the number of unnecessary hospitalizations, taken in total, we may be able do our part in maintaining our health-care system’s capacity. As some take a break from the operating room in the coming weeks, our expertise and outreach can be utilized to help the public overcome the current circumstances. Furthermore, as the number of cases grows across the country, we will inevitably be called upon to care for injuries in patients with a known or suspected COVID-19 infection. We must remain ready and available to continue treating injuries regardless of the duration and severity of this pandemic.
1. American Academy of Orthopaedic Surgeons. Orthopaedic practice in the U.S. 2018. AAOS Department of Clinical Quality and Value. Jan 2019. Accessed 2020 Apr 2. https://www.aaos.org/globalassets/quality-and-practice-resources/census/2018-census.pdf