Covid-19 Pandemic: Resumption of Orthopedic Care and Medical Education

Abstract

Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.

Standard care of management in orthopaedic patient during COVID 19 pandemic: An institution based guideline

“…There is significant decrease in number of patients coming to OPD, IPD admission, elective surgeries and number of total surgeries. Number of patients presenting to emergency department has also decreased due to lockdown and lless number of RTAs [12] . The decrease in amount of orthopaedic surgeries was seen around the world.…”

“…There was 44% reduction in surgeries and decease in orthopaedic intervention in upper limb. Lower limb fractures and also replacement surgeries [12] . However there was increased in number mortality in proximal femoral fractures in elderly age group.…”

Strengthening medical education during the post-COVID-19 era for building an effective healthcare workforce: A narrative review

“…Furthermore, medical schools might utilize this situation and frame a pulsating and comprehensive training structure to aid the students in attaining abilities and expertise in clinical skills during the pandemic [27]. In addition, recent studies stated that there is a need to organize the training programs for faculty members and students of medical schools in utilizing digital platforms during the pandemics [28,29]. Besides, virtual learning could be powered in cardiovascular medicine and extensive medical education to offer comprehensive, active, and fair training for the present and next generation of physicians during and after the COVID-19 period because of different digital learning solutions, infrastructure requirements, and implementation of strategies improving participant engagement [30].…”

“…Also, training on evaluation tools in clinical clerkships such as virtual objective structured clinical examination, viva-voce, and patients is a prerequisite during the pandemic [32]. At the same time, it was stated that blended learning needs to be continued during the post-COVID-19 period with fair distribution of teaching hours to students at various academic levels [28]. Certain medical teachers also recommended that traditional and online virtual learning combinations be highly robust and sustainable in the long run [33].…”

Vascular Care Services during the Covid-19 Pandemic in a South Asian Country: Implications for Limb Salvage

“…However, with improving conditions, healthcare system in many countries did attempt a watchful return to normalcy. This was particularly true for European countries [8][9][10]. Vascular surgery is a relatively small but rapidly flourishing discipline in Bangladesh.…”