Experience of Orthopaedic and Spine Center Pakistan During COVID-19
Condition: Orthopaedic Disorders
MeSH terms: COVID-19
Study type: Observational

Summary: 
      After the frightful outbreak in the city of Wuhan, China and its evidence of being
      contagious, governments around the world particularly United States in an effort to stop the
      transmission- imposed travel restrictions to and from China. Though it's a novel virus and
      little is known about it, the spread was drastic across the world. In fact the spread was so
      rapid that by end of February 2020, the number of new cases outside China had leveled up to
      13 fold as compared to the number of cases in China. Moreover, the number of infected
      countries with COVID-19 tripled. The first two reported cases in Pakistan were from Karachi
      and Islamabad on 27 February 2020. These two cases presented with a recent travel history
      from Iran. The current statistics showed the confirmed cases in Pakistan reached upto 284,121
      till 9 August 2020.

      During the lockdown period most of the public hospitals and trust closed their Outpatient
      departments and started to deal with emergency cases only. However even in such situation
      there are some trust hospitals worth mentioning who never closed their services and worked
      day and night to entertain their patients by observing all the precautions and safety
      measures. Ghurki trust teaching hospital is one of them. This hospital adopted a SMART
      STRATEGY or SMART hospital lockdown.

      Since 19th March 2020 till 13th July 2020, the period of lockdown, two thousand one hundred
      and sixty surgeries were performed by the orthopaedic team of Ghurki hospital. The breakup of
      surgeries during lockdown was as follows: 1514 cases of trauma, 173 procedures of spine, 51
      for arthroplasty, 51 for arthroscopy, 21 for tumors and 350 miscellaneous. The team was
      available 24 hours, 7 days a week under the supervisor of Professor Amer Aziz, to play their
      part in these terrible circumstances.
    

Detailed description: 
      After the frightful outbreak in the city of Wuhan, China and its evidence of being
      contagious, governments around the world particularly United States in an effort to stop the
      transmission- imposed travel restrictions to and from China. Though it's a novel virus and
      little is known about it, the spread was drastic across the world. In fact the spread was so
      rapid that by end of February 2020, the number of new cases outside China had levelled up to
      13 fold as compared to the number of cases in China. Moreover, the number of infected
      countries with COVID-19 tripled. The first two reported cases in Pakistan were from Karachi
      and Islamabad on 27 February 2020. These two cases presented with a recent travel history
      from Iran. The current statistics showed the confirmed cases in Pakistan reached upto 284,121
      till 9 August 2020.

      Regarding the Pakistan's government response to COVID-19, quick steps were taken to curtail
      the transmission of virus as China is in northeast of Pakistan and also shares its borders
      with Iran where the number of cases are increasing exceptionally. As an initial response
      Pakistan closed its borders with China and implies strict methods at the Pakistan-Iran
      border. Still, in the initial days of pandemic Pakistan lacked the diagnosis kits and relied
      on China and Japan for testing purpose. However, later Pakistan was able to receive kits and
      started testing samples.

      Pakistan's federal government along with the Ministry of Health (Moh) initiated a plan known
      as "National Action Plan for Corona Virus Disease Pakistan". The basic motive behind
      developing this plan was to generate policies and methods to combat with the deadly virus
      across Pakistan. MoH managed to deliver crucial supplies like masks, gloves and suits to the
      doctors and paramedical staffs working at frontlines. A state of confusion existed at
      different levels in health care system in Pakistan, particularly in Orthopaedic departments
      of hospital where elective and emergency services were severely affected during the lockdown
      period that started from 19 March 2020.

      Orthopaedic and Spine Center Ghurki Trust Teaching Hospital Lahore:

      During the lockdown period most of the public hospitals and trust closed their Outpatient
      departments and started to deal with emergency cases only. Even the private hospitals were
      reluctant to perform elective and emergency orthopaedic procedures. This attitude was may be
      due to the information published from other countries on the post operative complications and
      reduction of orthopaedic procedures during the period. The closure of orthopaedic health
      services brings a great shock to poor people for whom trusts and foundations is the last hope
      as they cannot afford the private setups for their health care facilities. However even in
      such situation there are some trust hospitals worth mentioning who never closed their
      services and worked day and night to entertain their patients by observing all the
      precautions and safety measures. Ghurki trust teaching hospital is one of them. This hospital
      adopted a SMART STRATEGY or SMART hospital lockdown. The orthopaedic department divided the
      members into five teams performing a 1:5 rotations. Each team comprised of one professor, one
      assistant professor, one senior registrar and ten trainee residents. Similarly the other
      departments like anesthesia, paramedics, nurses and physiotherapists were also subdivided.
      Out of two hundred staff, thirty were tested positive for COVID-19 but they all were managed
      and returned to normal after home quarantine.

      Orthopaedic Surgeries during COVID-19:

      Since 19th March 2020 till 13th July 2020, the period of lockdown, two thousand one hundred
      and sixty surgeries were performed by the orthopaedic team of Ghurki hospital. The breakup of
      surgeries during lockdown was as follows: 1514 cases of trauma, 173 procedures of spine, 51
      for arthroplasty, 51 for arthroscopy, 21 for tumors and 350 miscellaneous. The team was
      available 24 hours, 7 days a week under the supervisor of Professor Amer Aziz, to play their
      part in these terrible circumstances. The team started their day with recitation of Quranic
      prayer which is translated as "In the name of Allah by whose name harm cannot be done by
      anything in the earth or in heavens. He is All-Hearing, All-Seeing" (Tirmidhi, Hadith: 3388).
      The smart approach utilized was that the patients were operated as soon as possible
      preferably within first twenty four hours and discharged them early also one to two days post
      op in most cases with complete education. All the patients were screened for COVID but
      Polymerase Chain Reaction test (PCR) and Pulmonary High-Resolution Computed Tomography (HRCT)
      was not done in all the patients unless if they presented with suspicious history.
      Fortunately, none of the patient tested positive pre operatively. Strict asepsis was observed
      during the period.
    

Intervention name(s): Orthopaedic Surgical Procedures
Intervention type(s): Procedure
Intervention description(s): Intramedullary nails, Dynamic Compression Plate, Dynamic Hip Screw, Manipulation Under Anaesthesia POP, Ilizarov, Cannulated Screw Fixators, Bipolar Hemiarthroplasty, Locking Compression Plate, AO External fixators, Tension Band Wiring Patella, Pelvis and Acetabulum Fixations, Elbow Reconstructions, K wiring, Disc Excision, Spine Fracture i-e TPSF, Posterior Cervical Decompression and LMS, Dura repair, AD cage,Bilateral Total Hip Replacement, Unilateral Total Hip Replacement, Bilateral Total Knee Replacement, Unilateral Total Knee Replacement, Knee Arthroscopy for Mensicectomy, Arthroscopic Anterior Cruciate Ligament reconstruction,Removal of Implant, Amputations, VAC dressings,Wound wash, Arthrotomy for Septic Arthritis, Biopsy
Observational model: Other
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patient ≥ 18 years old in which urgent elective and emergency orthopaedic surgical
        procedures were needed during COVID-19 lock down period in Pakistan.
      
Keywords: COVID 19; Orthopaedic conditions; Orthopaedic Surgeries; Pakistan