key: cord-0835882-zzsoqq65
authors: Ong, Michael Tim-Yun; Ling, Samuel Ka-Kin; Wong, Ronald Man-Yeung; Ho, Kevin Ki-Wai; Chow, Simon Kwoon-Ho; Cheung, Louis Wing-Hoi; Yung, Patrick Shu-Hang
title: Impact of COVID-19 on Orthopaedic clinical service, education and research in a University hospital
date: 2020-08-14
journal: Journal of orthopaedic translation
DOI: 10.1016/j.jot.2020.08.001
sha: f771690a8944a76b6a2f371e7804938f353727a1
doc_id: 835882
cord_uid: zzsoqq65

Abstract The medical system of Hong Kong has been heavily affected by COVID-19. Adaptations are necessary to continue clinical care, education, and research, while minimising the risk of infection of our staff and students. Here, we report our early experience in response to the challenge posed by the COVID-19 pandemic. The Translational Potential of this Article This perspective can help to disseminate knowledge from an orthopaedic unit in a university hospital on overcoming the challenges of the COVID-19 pandemic, including clinical practice, education of medical students, and research.

coronavirus. The first confirmed case of COVID-19 identified in Hong Kong was on 23 20 January 2020. The Hong Kong government, in response, heightened the emergency level 21 with the suspension of schools and hospital visiting arrangements on the 25 January 2020 in 22 an attempt to reduce the regional spread of the virus. The first COVID-19 death was reported 23 on 4 February 2020, and the hospitals adjusted their non-emergency medical service to 24 reduce crowding of hospital areas on 12 February 2020. Even when faced with the threat of a 25 second wave of COVID-19 cases arising from import-related infection starting on 19 March 26 2020, with the number of confirmed cases exceeding 1000 on 11 April 2020, Hong Kong's 27 handling of the pandemic was a relative success. However, since July, Hong Kong has been 28 facing a third wave of COVID-19 infections. To date (18 July 2020), there have been 1886 29 confirmed cases, with 12 deaths, and 1294 patients have successfully completed treatment 30 and been discharged. With meticulous care and stringent infection control, to date, there have 31 been no confirmed cases of health care workers contracting COVID-19 from the workplace. 32

Throughout this pandemic, the medical system of Hong Kong has inevitably been heavily 33 affected, including orthopaedics services. 34

University hospitals have a responsibility to society, with objectives including clinical 35 patient care, education, and research [1, 2] . Although orthopaedic surgeons are not amongst 36 the front-line staff in the fight against COVID-19, we must make changes to our practice in 37 order to keep our staff and students safe. As the Department of the Orthopaedics and 38 intubation [3] and operations that require a power saw, power reaming, or pulsatile lavage 57 [4] , the use of N95 respirators with full PPE is required, while personnel within the operating 58 theatre during these procedures are minimised. Towards the end of June 2020, we have 59 accumulated over 300 postponed operations. Since April 2020, with a more stable supply of 60 N95 respirators and PPE, elective surgeries have gradually been reinstated. The first elective 61 surgeries to resume were the non-emergency but debilitating conditions, including patients 62 with anterior cruciate ligament (ACL) tears requiring ACL reconstructions and patients with 63 spinal stenosis for decompressive surgeries. In the months that followed, accompanied by the 64 absence of outbreaks in Hong Kong, elective surgeries have resumed their normal numbers 65 and scopes. The backlog cases have yet to be fully cleared, but our University Hospital, the 66 J o u r n a l P r e -p r o o f Regarding orthopaedic in-patient testing of COVID-19, as of July 2020, the 69 departmental policy is for liberal testing of all suspicious cases. Thus, all febrile patients 70 admitted to the orthopaedic ward will undergo COVID-19 tests. Test results are now 71 available within several hours, and patients are isolated in the single-bed cubicle whilst 72 awaiting the results; once negative, they will be allowed back into the general cubicle. An 73 initial proposal to routinely test all pre-operative patients was not adopted due to the cost-74 effectiveness issues. Regarding resuscitation and major trauma call situations, all staff are 75 required to be fully geared in PPE and N95 respirators while performing CPR or assessing a 76 trauma patient in the Accident and Emergency Department (AED) resuscitation room. 77

The specialist outpatient clinic service has been maintained, but the attendance has 78 dropped by around 40% due to the hesitation of patients coming to the hospital. The Clinical 79

Management System (CMS), Hospital Authority, which allows clinicians to view patient 80 electronic records, also had an additional travel history indicator implemented to prevent 81 inaccurate reporting of travel history from patients. The indicator has information from the 82 Hong Kong Immigration Department as a reference to facilitate taking patient travel history 83 in the past 30 days. If TOCC is positive and fever is present, the patient is escorted to the 84 written papers, and surrogate patients were trained for the objective structured clinical exam 116

Telemedicine is the practice of remote patient care with the aid of modern technology. 118

The use of telemedicine is not official for clinical use in our unit, but we are able to use it for 119 the teaching of medical students. Our unit has set up the teaching of medical students via 120 online clinics, with consent from patients. Due to COVID-19, hospital guidelines have set up 121 restrictions for medical students, leading to a significant decrease in the amount of clinical 122 exposure in wards and clinics. With the use of a live-feed camera at our clinic, we are able to 123 see patients together with our medical students. The students also have the opportunity to 124 take histories and to discuss real-time management with the patient and tutor. The COVID-19 pandemic has brought exceptional challenges to Hong Kong, 155

including an economic toll. The Hong Kong government has responded to the needs of the 156 public and society by providing anti-epidemic funds to help businesses stay afloat, to keep salary reductions, it is of great importance for the hospital to continue providing quality 165 health care that is affordable to the public in these difficult times. 

We acknowledge Gene Chi-Wai Man, the Scientific Officer of the Evidence-Based References 186

Fulfillment of administrative and 187 professional obligations of hospitals and mission motivation of physicians

The missions of medical schools: the pursuit of health in the service of 190 society

Aerosol generating procedures 192 and risk of transmission of acute respiratory infections to healthcare workers: a 193 systematic review

Current concepts review: transmission and prevention of 195 occupational infections in orthopaedic surgeons

Short review of the flipped classroom 198 approach

Educational strategies for teaching evidence-based practice to undergraduate health 201 students: systematic review

Introduction of virtual patients onto 203 a final year anesthesia course: Hong Kong experience

Joint statement: early provisional registration for final year medical students

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