No doubt many of you have been swamped with messages from various sources concerning the COVID-19 pandemic. While I do not want to add to this unnecessarily, I do want to reassure you that the OTA is completely committed to ensuring that we can continue to care for our patients in this difficult time. In that regard, we have been made aware of a situation that has occurred in a Level I trauma center that has implications for all of us, whether we are at academic institutions or community based hospitals. We believe it is important to make you aware of this problem, and offer a few practical points to help minimize the impact on your service. This is critically important, as we all know that regardless of any other medical issue occurring such as COVID-19, the trauma patients will continue to arrive at our hospitals.
Orthopaedic trauma services, due to the team nature and need for regular group gatherings (e.g., morning sign-out), are uniquely at risk for large scale exposures and potential mass quarantines. Members should consider dividing and insulating their teams to avoid close contact between team members to every extent possible (definition of “close contact” below). This is to avoid manpower shortage should one team member test positive for COVID-19.
A major medical center/Level I Trauma Center has experienced the following scenario:
- One team member has tested positive for COVID-19
- This individual has been quarantined for at least 14 days
- Other team members, including residents, PA’s, attendings, students, etc., with close contact are quarantined pending test results
- Best case, if all those exposed test negative, is a short-term depletion of the available resources to care for orthopaedic trauma patients
- Worst case, if other team members test positive, is a severe long lasting depletion of manpower at all levels
Some suggestions to mitigate risk:
- Create multiple teams that are 100% insulated from one another
- Create contingency plans within the residency and fellowship programs to provide coverage should a large group of residents require quarantine
- Reduce or eliminate gatherings of any size
- Maximize virtual conferences
- Suspend all non-critical conferences
CDC definition of close contact below
is defined as:
a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case
– or –
b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)
As a critical hospital resource, orthopaedic trauma surgeons are deeply embedded in this crisis, increasingly on the “front line” of care. We have always been, and will continue to be, a dedicated, practical, and hard-working group that I am proud to be a part of. While we are not the definitive source of information on how to deal with COVID 19, we stress that we are here for you with any questions, problems, or solutions that you may have, and please feel free to contact us directly.
Michael D. McKee, MD