Snapshots of AO Spine members experiences at the height of the pandemic
Feng Wei
Orthopaedic Spine Surgeon, Beijing, China
17 April 2020
"Beijing entered a state of emergency already in January and the wards only accepted emergency patients. I went to the clinic once a week. In 2 months, I performed 4 emergency surgeries, 2 acute lumbar disc herniation with cauda equina injury, and 2 cases of thoracic spine metastasis with acute paralysis. After March 20th, the epidemic was brought under control, and the hospital wards were reopened. But three-person rooms could only be used as single rooms. I could only schedule 2 surgeries a week. I give priority to patients with spinal tumors. It is estimated that this state may continue until the global epidemic is effectively controlled.
In 2003, I had experienced SARS, so I was not particularly panicked; this time the situation was handled much better. Very strict restrictions were imposed on to the community, which makes us feel safe. We can buy things on the internet and logistics companies deliver to the gate of the community. I do occasionally go out, but always strictly wearing a mask. I enjoy time with my family, I cook for the family, and help my daughter with her homework. This was too rare in the busy life before.
When the epidemic began to spread around the world, I was very worried about our AO Spine friends. I wrote letters to some, and I was happy to know that they were all good. How time flies, yet another month has passed! I hope everyone is well, and I look forward to the day when we will meet again and toast to our health!"
Christina Goldstein
OrthopaedicSpine Surgeon, Denver,Colorado, USA
22 April 2020
"On March 19, 2020 Governor Jared Polis of Colorado ordered a halt of all elective surgery in our state to prevent the spread of COVID-19. This, in addition to the fact that, almost 15 years out of medical school, I am no longer qualified to work on the front line, assessing patients in the ED or managing ventilators in the ICU, means that I have limited ability to help my colleagues and my community during this public health crisis.
This has been extremely hard for me, as I am sure it has been for all of us. Spine surgeons aren’t the kind of people who sit on the sidelines while others shoulder the burden. We also typically enjoy doing things with our hands.
This has always been true of me; as my closest friends and family know, one of my favorite hobbies is knitting and crocheting. Interestingly, it is this last trait that has provided me an outlet to satisfy both my desire to keep my hands busy as well as to do something for the people around me.
Not long after Governor Polis’ announcement, and in response to the local shortage of PPE, I started sewing cloth facemasks. As of today, I have been able to make almost 150 masks for my colleagues, friends, and family. I know this is a small contribution in the grand scheme of things and I will be happy when I am able to get back into the OR, once again putting my surgical skills to good use. But right now, I am extremely grateful to have the sewing skills my mom passed down to me that allow me to continue helping others, showing the people in my life that I care about them."
David Fernando Servin Carmona
Orthopaedic Spine Surgeon, México City, Mexico
14 April 2020
"I had planned a vacation, a family trip through France and Italy, which of course had to be cancelled. I could notchange my vacation, so I stayed home with my family.
Without elective surgery, I have an average of 10 consultations per week in my private practice instead of the normal 60, with only post-surgical patients and some with a level of urgency.Real emergencies are handled in a separate area from the COVID-19 affected patients.
I also work in a public high-specialty trauma hospital. As it is not a COVID-19 reference hospital, the government did not provide any PPE. We had to buy our own with our own resources to treat trauma patients, who were COVID-19 positive or suspected, or with relatives who may have been infected.
The biggest issue to me is related to the government, who downplayed the issue and did not properly plan resources or strategies when the first cases were detected. The second issue is the large number of people working in the "informal economy" who do not pay taxes or have social security, as well as the self-employed small business workers who live on what they earn on the day. It is impossible for them to stay at home.
Something unpleasant is the "blackmarket" for PPE. In January, an N95 mask cost around USD 1.20; currently you can buy one for USD 15. A doctors' safety does not matter, only the highest bid.
We are also seeing violence against healthcare professionals. In some places they are prevented from getting home or not allowed to use public transport for unfounded fear of contagion.
Everything starts with good planning. If we had different scenarios in place from the start, we could better plan the purchase and distribution of supplies. As we are dealing with a new highly contagious virus with no cure or vaccine, the appearance also in Mexico was imminent. The actions to restrict population mobility should be stricter.
This will surely change the way we travel, shop, and work. It will lead to greater automation of processes, robotics for example in medicaments administration, and telemedicine.
I hope everyone is well, that this period ends soon!"
Alice Baroncini
Spine Resident, Aachen, Germany
26 April 2020
"Spring 2020, the plan: start an AO Spine Fellowship in Milan, give a podium presentation at an international spine conference, visit the hidden gems of northwest Italy with my partner.
What happened: lockdown!
I am an Italian resident in spine surgery, living and working in Germany. My family is in Italy, while my partner lives in Australia, so travel for work and leisure has always been a big part of my life. Now, suddenly everything changed.
Dealing with the pain and suffering in my home country as well as across the world is challenging. However, I believe we must not miss this opportunity for positive change.
I found myself with a generous amount of time on my hands. An incredible luxury in a society that constantly demands more time and more productivity. Attending webinars, writing papers, but also reading books, exercising, and connecting with loved ones, are some of the ways I am training myself to become a better surgeon and a mindful human being.
From a “planetary” perspective, isn’t it incredible how we are facing an economic crisis because we are consuming only what we really need? Isn’t it beautiful to watch nature flourish in our cities again?
If we can transform this time of uncertainty to a time of reflection and personal growth, starting from the smallest things andf ocusing on our core values, we will have nothing to fear for the future. As the cheerfully uplifting phrase goes around in Italy, #andratuttobene, aka #allwillbewell."
Lali Sekhon
Neurosurgeon, Reno, Nevada, USA
14 April 2020
"The COVID-19 pandemic has been devastating to North American spine surgery private practices. Many have furloughed staff, fired staff, reduced hours, and made efforts to control overhead. Most surgeons are forgoing salary so that staff can be paid. Elective surgeries, which pay the bills and keep the lights on, have been curtailed. The economic effect has been profound and if this continues too long, some practices may not recover. To say the situation is grim for private practice is understating things. Private practice physicians are like corner stores—we are not on a salary.
Our practice has reduced to 32 hours a week and moved to telehealth for 99% of consultations to reduce patient contact. It’s better than nothing and patients are appreciative. Screen sharing allows us to show imaging to patients. We digitized all our handouts and send patients emails with these after the consultations. We are at 50% volume in our clinics but are still managing to stay open.
Everyone’s concern is not getting COVID-19 and those unlikely younger patients who seem genetically predisposed to severe disease, without risk factors. We are socially isolating, supply chains are starting to get disrupted, and like everywhere, PPE is an issue. Most of us have 1, maybe 2 masks. We have not yet been asked to help out with COVID-19 patients but that may happen.
The only bonus is time spent at home with family and being grateful for what we have. We are blessed this happened in the digital age where streaming media, deliveries and internet access make life at home very easy. I feel for our elderly patients because right now there is only so much we can do.
We will probably socially isolate for a long time. Antibody testing to show immunity will be important soon. This will be back in the fall. Many things will change, from healthcare delivery too onshoring of supply chains to the ushering in of telehealth."
Davide Bizzoca
Resident in Orthopedics and Traumatology, Bari, Italy
28 April 2020
"I was participating in an AO Spine fellowship at the Schulthess Klinik, in Zürich when COVID-19 outbreak was depicted in Northern Italy in late February 2020. My work routines progressively changed: social distancing was introduced, meetings were cancelled, and the canteen reorganized. I successfully concluded my fellowship and, despite Italy being in complete lock-down, could return home.
Back in Apulia, I was compelled to self-isolation. I spent this time performing research. Through my window, I saw my town change radically: the streets were empty, bars and restaurants closed, the car noise was gone. It reminded me of the novel “Blindness” by José Saramago.
Once back at work, the Polyclinic of Bari was completely reorganized to admit COVID-patients and our clinical and surgical activity changed: elective surgery was stopped, and the outpatient clinic was limited to urgent cases only.
When writing this, Italy is still in lock-down and all medical meetings and courses have been cancelled. Hence, online learning is highly encouraged, and an abundant webinar program has been developed to guarantee residents’ education.
This scenario raises several questions and concerns. Could delays in diagnosing non-COVID diseases (i.e. screening for cancer or scoliosis) affect patient outcomes? How will self-isolation affect frail people’s mental status? How to prevent the lack of health equity in low-income countries? How will COVID pandemic impact globalization?
The pandemic has drastically changed our lives and we must accept this new reality to prevent future pandemics. Telemedicine will play a central role in future clinical practice; artificial intelligence will be implemented in medical decision-making; national and international congresses might be converted into virtual events. And online learning will represent the mainstay of future medical education."
Philip Louie
Spine Surgery Fellow, New York, NY, USA
2 April 2020
"For many of us, we have never faced a pandemic similar to COVID-19. The current outbreak has resulted in widespread work stoppages, hospital-wide reorganizations, drastic changes in societal norms, and has raised new amounts of anxiety and uncertainty for everyone.
As such, we are constantly glued to various media outlets in hopes of learning as much as we can about how others are being impacted by this health crisis and how they are responding to the pandemic.
I am right in the middle of my spine fellowship. Which means, that I have completed my residency training in orthopaedic surgery and am devoting one year specifically to train in spine surgery. So, the COVID-19 outbreak has been selfishly stressful in that it is greatly impacting my surgical training.
Interestingly, I also live in New York City which is likely the COVID-19 metropolitan epicenter of the world currently. Here in NYC, we are facing immense struggles with a rapidly growing number of patients and decreasing availability or hospital beds, PPE, healthcare workers, and ventilators. As such, I am grateful for my health and the opportunities that my hospital has granted us trainees to fight this battle alongside our colleagues in whatever capacity is needed."
Gladys Monserrat Pavon
OrthopaedicSpine Surgeon, Quito, Ecuador
9 April 2020
"My son lives outside the city and my elderly parents live in a different neighborhood. I have not been able to visit them since the isolation began. Family birthdays are suspended. We have always been quite close, and this is hard.
Some post-operative patients have not been adequately controlled since they live in other provinces and cannot travel. I work in private practice and all appointments and scheduled surgeries have been suspended. First steps are taken to establish telemedicine. Only 3 spinal trauma surgeries have been performed in neurologically compromised patients.
Unfortunately, we were not prepared to deal with this, due to lack of implementation of health and safety policies. We are short of human resources and equipment. We don't have the capacity to store corpses. Limited awareness and education have led to people not fully accepting social distancing or voluntarily quarantine.
The colleagues I work with are mostly emergency doctors, internists, pulmonologists, intensivists who deal with the hardest part along with the paramedical staff. There are several positive COVID-19 doctors, and many have died.
For many reasons, people are abandoning their pets and that creates problems in the streets.
It's complicated. There is no transparency in numbers of the infected, deceased, or shortcomings, and politicians control the information. It seems to me that the social isolation measures should have been tougher, total isolation for everybody. We need to learn to work together at all levels of the state.
In isolation you get to know yourself better, you learn to enjoy your own company, you spend more time reading, studying, praying. We also quickly made use of technology to communicate. There are more changes coming to our lives, and speaking for myself, this includes better relationships with family, colleagues, and taking better care of the environment."
Cordula Netzer
Orthopaedic Spine Surgeon, Basel, Switzerland
22 April 2020
"My perspective from Switzerland, where—due to the proximity to Northern Italy and France—the seriousness and urgency of the situation was probably more obvious than in many other countries.
Swiss government reacted fast and rigorously, and suddenly, we weren't allowed to proceed with elective spine surgery or outpatient clinics anymore. Patients signaled understanding.
Our entire scientific program was put on hold. The ethical committee prohibited all clinical trials. National and international meetings, congresses and events were all cancelled gradually. Our whole “life” was stopped abruptly.
However, the deep cut into our daily routines was obviously successful, seeing now the decreasing numbers of COVID-19-patients. It's by far not over yet, but we could learn how to deal with it. Now we need to find a way back to a “new normality”.
We learned the importance of having strategies on how to deal with unexpected but predictable situations, as we are experiencing now. Within the shortest time, we organized online meetings and video consultations for our patients to keep on track with running projects and to provide healthcare treatment. Overall, we were forced to re-evaluate “all of our actions” which could also mean a great chance."
Vafa Rahimi-Movaghar,
Neurosurgeon, Tehran, Iran
16 April 2020
"COVID-19 significantly affected our plans, work, and practice. Not only the neurosurgery department, but the whole hospital shifted from elective and routine programs to prepare only for COVID-19. The move was based on the percentages of affected in the society. Some countries had less, however, when the percentage of affected population is as high as here, almost all elective case admissions stopped abruptly and only emergent cases are admitted and operated.
My greatest concern when resuming full clinical care will be continued social distancing. With masks and gloves, you cannot be as sympathetic with your patients as before.
The biggest issue back home was the danger of transferring COVID-19 from patient to patient, to personnel, and care providers. The advice to our colleagues is really to prepare infrastructure for electronic practice and distance care, and to patients not to come to hospital and clinics at all unless in emergency situations.
The situation is universal, this is the true meaning of 'globalization'. We are learning a lot and understanding that people all over the world can be affected very easily. And we are realizing that the reaction of people in difficult situations is so similar!
Many things have changed. There is no way for hugging, kissing, or even shaking hands! And many more changes will come..."
Gaurav Raj Dhakal
Spine Surgeon, Kathmandu, Nepal
14 April 2020
"On 23rd March, Nepal also went into a lockdown! Directives were issued to postpone all elective surgeries. I had a few patients admitted in the ward waiting for surgery, some immediate postoperative, and patients booked for surgery for the next two months.
I work in a government hospital in Kathmandu which serves as the referral trauma center and a center for non-traumatic spine care. I had to discharge the post-operative patients, convince the patients waiting for surgery to go home and re-schedule surgery for the rest.
Despite the lockdown, we did perform surgery on spine trauma patients. We were not a designated COVID-19 hospital, but there was always the fear of contracting the virus while working. Knowing there could be asymptomatic carriers, was always playing in the back of my mind. Returning home from work to my family has been a distressing situation, and I always ask myself the question, am I bringing the virus home?
The hospital management has been supportive, they distributed masks and sanitizers, and provided training for using protective equipment.
Online learning and webinar sessions substituted all academic disruptions. The difficult scenario will be when the lockdown is lifted: how will we cope with the patient flow and be able to protect ourselves?"
