key: cord-0765059-11jtgppm authors: Alyami, Ali H.; Alyami, Alyazeed A.; AlMaeen, Bandar N. title: Impact of COVID-19 on orthopedic surgery: Experience from Saudi Arabia date: 2020-06-11 journal: Ann Med Surg (Lond) DOI: 10.1016/j.amsu.2020.05.048 sha: f59d108e978ea699ca995505ea73ab7abe1004f9 doc_id: 765059 cord_uid: 11jtgppm nan In December 2019, cases of pneumonia of unknown cause were detected in the city of 5 Wuhan in the Hubei Province of China, and a report by the Chinese authorities to the World 6 Health Organization (WHO Country Office) in China identified a new virus, severe acute 7 respiratory syndrome coronavirus 2 (SARS-CoV-2), to be the cause of these cases [1, 2] . The 8 outbreak was declared a public health emergency of international concern in late January 9 2020 [3,4]. On February 11,2020, the disease caused by SARS-CoV-2 was officially named 10 2019 novel coronavirus (COVID-19) by the WHO [5] . 11 On March 2, 2020, Saudi Arabia announced its first case of COVID-19 when its Ministry of 12 Health detected the disease in a Saudi national returning from Iran via Bahrain [6] . As of 13 May 9, 2020, there have been more than 4,010,537 confirmed cases worldwide and at least 14 275,960 deaths involving more than 215 countries, areas, or territories. As of the same date in 15 Saudi Arabia, there have been 35,432 confirmed cases, of whom 229 have died and 9,120 16 have recovered, giving a case fatality rate of 0.6% and a recovery rate of 23.1% [7] . 17 The authors of a study published on May12, 2020, estimated that a total of 28,404,603 18 elective operations would be canceled or postponed worldwide during 12 weeks of disruption 19 due to COVID-19 and ata rate of 2,367,050 operations per week [8] . Globally, their best 20 estimate of the orthopedic surgery cancellation rate was approximately 82.0%, representing The rationale for deferring elective surgeries was to (1) increase the ability of hospitals to 39 accommodate patients with COVID-19 in the event that a crisis point was reached and (2) 40 limit the throughput of traffic within health care institutions to reduce the risk of cross-41 infection among health care workers, which was a major concern for all stakeholders.The bed 42 capacity in our intensive care units is crucial at this time and stopping elective surgeries will 43 reduce the occupancy rate. in most instances, tests for COVID-19 were negative and these staff members were able to 50 return to work after being cleared by the infection prevention and control department. 51 Thereafter, oncology surgery was resumed; however, only two operating rooms have been in 52 use to preserve more functioning theater teams in the event of further cross-infection among 53 theater staff. 54 Orthopedic surgery has been continued for oncology and emergency cases during the 55 COVID-19 pandemic. Saudi Arabia has high rates of polytrauma and fractures related to 56 motor vehicle accidents. However, these rates have been low during the COVID-19 57 pandemic, probably because of the lockdown. In Saudi Arabia, most cities went into partial 58 lockdown that progressed to full lockdown for a few weeks and then subsequently returned to 59 a partial lockdown again. 60 No routine preoperative testing for COVID-19 has been performed, likely for logistic 61 reasons. As part of the Best Care system (an electronic medical record system), an acute 62 respiratory illness screening tool has been applied for all hospital admissions, including all 63 patients scheduled for surgery, to detect potential cases. Patient escorts are also screened. If 64 the score is high, the patient or escort is swabbed and tested before surgery. Measures have 65 also been taken in the operating room to deal with confirmed cases, including use of a 66 negative pressure room, wearing of full personal protective equipment to protect staff, 67 reducing traffic throughput, and removing all but essential staff members from the room 68 during aerosol-producing procedures (e.g., during intubation). Medications can be prescribed remotely and delivered to patients without the need to visit the 95 pharmacy. Health care workers, patients, and escorts undergo a temperature check upon 96 World Health Organization. Pneumonia of unknown cause -China World Health Organization Clinical features of patients infected with 2019 novel 172 coronavirus in Wuhan Who declares COVID-19 a pandemic Vital 176 surveillances:the epidemiological characteristics of an outbreak of 2019 novel coronavirus 177 diseases(COVID-19)-China World Health Organization. Naming the coronavirus disease (COVID-19) and the virus 180 that causes it-China guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it 183 Hajj in the Time of COVID-19, Infection, Disease & Health Saudi Arabia. Coronavirus Cases.Accessed Elective surgery cancellations due to the COVID-19 pandemic: 188 global predictive modelling to inform surgical recovery plans entering the main hospital or the ambulatory care center, where antiseptic preparations and 97 sanitizers are available in all areas. Although virtual encounters have been a helpful solution, 98 they may not be an optimal model and some patients may be affected by these changes. 99 100 Impact of COVID-19 on the residency training program 101Unfortunately, our orthopedic residency training has been adversely affected by the COVID-102 19 pandemic. The inevitable pausing of all elective surgeries has limited hands-on practice 103 and exposure to a number of procedures. Although the orthopedic oncology service has 104 continued, this is a limited area within the orthopedic training program, which includes at 105 least nine subspecialties. Trauma surgery has continued but at a much slower rate, most likely 106 as a result of the nationwide lockdown. Running the outpatient clinics in a virtual manner has 107 also reduced the opportunities for residents to perform physical examinations and manage 108 their patients face-to-face. The weekly half-day reserved for academic activity has been 109 converted to twice-weekly virtual learning. The Saudi Orthopedic Association has 110 participated in all virtual learning activities by arranging webinars in the different 111 subspecialties. The Saudi Commission for Health Specialties (SCFHS) has done the same but 112 with more focuson COVID-19-related topics. The SCFHS has asked the program's scientific 113 committee to make recommendations regarding how the SCFHS should handle the residency 114 programs during this critical period. The orthopedic scientific committee has recommended 115 counting the 3-month rotation in the second quarter of 2020 as a general orthopedic rotation 116 for junior residents and as an elective rotation for senior residents. If the pandemic continues, 117 further recommendations will be made. For the time being, dozens of teams have created at 118 our center as part of the staffing plan to cope with a crisis if one eventuates. The residents are 119 part of these teams, including in orthopedics, but will not be involved unless we reach crisis 120 mode.