Orthopaedic Surgery during COVID pandemic and consequent Changes in our professional environment

Excerpt

The medical profession was thrilled and faced in first line the changes of the society during the coronavirus crisis and pandemic. [1,2,3,4,5,6] The world experienced stupor and slowdown of major economic activities. Political and social regulations were imposed. All medical specialties had to adapt and observations from our corresponding members and authors worldwide pointed out the changes in our ways of managing different medical conditions including emergency, trauma, transplantation [7] and tumor [8], cases that could not wait. The lockdown and changes in the workflow of medical centers created new challenges for the teams in all specialties, mainly in centers responsible for trauma or tumor and that were supposed to manage patients with unknown infection status. Anesthesiologists were at risk as they were supposed to act on the upper respiratory ways, intubate and ventilate cases with unknown viral charges. This resulted in casualties and morbidity by viral infection in several colleagues and some colleagues sadly and tragically lost their lives. The medical profession paid a high tribute to the pandemic with lethal cases and major stress exposure for the colleagues in the teams. [9,10,11] A special issue was released in August 2020 and included scientific reports from colleagues working in pandemic conditions [12] . All papers showed that the activity decreased, by one side because of the lockdown that kept industry and car traffic at the lowest rhythm but also because hospital regulations that imposed work shortages and security issues. Scheduled procedures were postponed but also "not life threatening trauma" resulting in unfair access to health care in many services and finally creating secondary pathologies that ware even more difficult to treat in a later phase such as pseudarthrosis, malunions, impaired bone and joint function [13]. The decision to postpone or to treat conservatively these cases was finally the surgeon's responsibility because the real deciders, hospital administrators, health management public leaders and insurance companies were presenting the decisional process as something that was more related to a "recommendation" and that finally each health professional was free to decide on the treatment choices. This lack of precision resulted in a significant number of cases that required additional treatment, revision or reconstruction and here we could also include cases of tumor or dysplasia pathologies that were declined or postponed treatment resulting in life-threatening situations. Cases like "this patient have a severe fracture but he is virus-positive, asymptomatic, what should we do, how we proceed?" Some services with a good logistic cover were able to proceed to chest CT-scan screening for all the cases requiring emergency treatment and this is probably one logic and humanitarian attitude in offering equal access to health care [14,15], others did the convenient treatment including surgery to all the patients managing from the medical side all the cases as they were potentially virus-positive and taking the appropriate anesthesiology and prevention methods. However, many services including big and well-equipped centers just postponed the surgery, waiting for the appropriate time to proceed. Overall the lockdown resulted in changes of methods in patients care, including the augmentation of virtual and internet clinics, decrease of consultations and clinics for degenerative or orthopaedic pathologies and ultimately decrease of the scheduled surgical activity. This non-contact policy resulted in the upgrading of the computer tools for virtual clinics, virtual meetings and the use of the artificial intelligence for prevention. [16,17,18] …