key: cord-0832315-bws820tz
authors: Blackhall, Kristian K.; Downie, Ian P.; Walsh, Stephen; Burhan, Rawa; Ramchandani, Parkash; Kusanale, Atul; Srinivasan, Badri; Brennan, Peter A.; Singh, Rabin P.
title: Comparison of Provision of Maxillofacial Emergency Service During the Two COVID-19 National Lockdowns in the United Kingdom
date: 2020-12-29
journal: Br J Oral Maxillofac Surg
DOI: 10.1016/j.bjoms.2020.12.016
sha: 432fd539cd1469236858ce6eb9fda7b2919bc91b
doc_id: 832315
cord_uid: bws820tz

We previously published a study on the provision of emergency maxillofacial services during the first UK COVID-19 pandemic national lockdown. We have repeated the study during the second lockdown, and present our findings highlighting the main differences and learning issues as the services have evolved during the pandemic.

The global Coronavirus Disease (COVID-19) pandemic continues to be a burden to healthcare systems around the world. Following a resurgence in infection rates, the UK instituted a second national lockdown to control virus spread from 5 November to 2 December 2020. 1,2 We analysed the pattern of presentation and management of maxillofacial emergencies during the second lockdown, comparing the findings from the first lockdown. 3

This study included five maxillofacial units based at National Health Service (NHS) trusts: University Hospital Southampton, Western Sussex Hospitals (Chichester), Salisbury Hospital, Poole Hospital and Portsmouth Hospitals. All emergency patients during the lockdown period were included, and data was collected prospectively utilising a custom programmed online live database, published in the first study. 3 Table 1 .

There were a number of interesting differences in the provision of maxillofacial services during the two lockdowns. The like-for-like data comparison showed a higher daily rate of patient attendance (8/day in the first, 12/day in the second), and a much higher proportion of patients presenting with injuries sustained outside the home environment during the second lockdown. This is possibly explained by the public being less compliant with government advice of staying indoors during the second lockdown, further supported by the finding that there were significant increases in road traffic accident-related injuries ( Figure 1 ). Educational institutions also remained open during the second lockdown which may have contributed to these findings.

A number of studies (including ours 3 ) have demonstrated the value of remote consultation in healthcare. 4, 5, 6, 7 Despite the clear benefits and viability of remote consultations during the first lockdown, it is surprising to find that remote consultation was poorly utilised by hospital trusts during the second lockdown. As the pandemic has progressed, patients as well as clinicians may have become more comfortable with face to face meetings as Personal Protection Equipment (PPE) became readily available.

The use of FFP masks reduced significantly compared to the first lockdown period, with only 24 instances of their use logged when undertaking initial examinations, representing a 7% utilisation (Figure 2 ). This appears linked to increased confidence in patient interactions with a greater level of understanding of viral transmission risks and what constitutes an aerosol generating procedure (AGP). Further guidance was available to healthcare providers, including risks of AGP, fallow times, use of PPE and ventilation, with lessons learned from the first lockdown and ongoing research. 8, 9, 10 The cases related to domestic violence and self harm appear to remain relatively high in the second lockdown, perhaps reflecting the ongoing impact of the pandemic on mental health. We observed an increase in interpersonal violence and incidence of facial fractures compared to the first lockdown, possibly related to increased socialising outside the home. The number of dental emergencies also increased despite dental providers remaining open during the second lockdown, highlighting the need for further PPE support in primary care.

As we predicted in our previous study, the management of facial fractures appear to have reverted back to the principles used before the pandemic. Where required, facial fractures were treated by open reduction and internal fixation compared to more conservative management during the first lockdown. Staff rotas and redeployment were not utilised by hospital trusts in our region during the second lockdown, allowing for better use of resources and personnel to cover on-call and trauma.

The continuing and evolving nature of COVID-19 necessitates our flexibility and adaptability as a specialty. The main differences in the two lockdowns reflect improved preparedness by clinicians and patients in dealing with the virus as the pandemic progresses. Improved understanding of transmission may have resulted in management of maxillofacial emergencies in a similar way to before the pandemic started. This is reassuring as we continue through the pandemic with continued risk of further waves in future. It is important that NHS trusts recognise the value of remote consultation which should be embraced during the pandemic and possibly beyond.

We have no conflicts of interest.

Institutional approval was obtained for the study. Patient consent is not required. 

Maxillofacial education in the time of COVID-19: the West Midlands experience. British Journal of Oral and Maxillofacial Surgery

Clinicians' and patients' acceptance of the virtual clinic concept in maxillofacial surgery: a departmental survey

New recommendations for primary and community health care providers in England

COVID-19: infection prevention and control (IPC)

SDCEP -Mitigation of Aerosol Generating Procedures in Dentistry. A Rapid Review [Internet]. NHS Education for Scotland

We would like to express our gratitude to all Core & Foundation trainees, Specialty registrars and Consultants of Health Education Wessex who supported and helped with this study.

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