Learnings from Orthopaedists Infected with COVID-19

One serious challenge in responding to COVID-19 is how to better protect healthcare workers and prevent nosocomial infection. A fast-track JBJS Orthopaedic Forum article by Guo et al. provides instructive data about this challenge from 24 orthopaedic surgeons in Wuhan, China who contracted the illness. Orthopaedic surgeons generally don’t work on the front lines of infectious-disease pandemics, but these cases help us understand the overall infection situation of healthcare workers.

Twenty-six orthopaedic surgeons from 8 of 24 investigated hospitals in Wuhan were identified as having COVID-19, and 24 of them completed a self-administered questionnaire. From that information, the authors found that the peak date of onset of orthopaedic surgeons’ infection was 8 days earlier than the peak of the public epidemic, indicating that these surgeons were probably exposed to COVID-19 in the hospitals, rather than in the community. Fifteen surgeons were admitted to the hospital for treatment, and 9 surgeons self-isolated at home or hotels with medicine for at least 2 weeks. All 24 surgeons recovered after treatment.

According to questionnaire responses, the suspected in-hospital sites of exposure were general wards (79.2%), public places in the hospital (20.8%), operating rooms (12.5%), the intensive care unit (4.2%), and the outpatient clinic (4.2%). Three surgeons were exposed during operations on patients who were diagnosed as having COVID-19 several days after the surgical procedures.

This and other findings underscore an already-known but worrisome feature of this disease: many asymptomatic patients with COVID-19 are shedding the virus and unwittingly exposing other people—inside and outside of hospitals—to the risk of infection.

Also worrisome: these 24 orthopaedists infected others in 25% of cases, with a 20.8% transmission rate to family members. The authors therefore recommend that orthopaedic surgeons who work in hospital settings during the COVID-19 pandemic period avoid close contact with family members at home.

Risk Factors for Infection
The authors also conducted a 1:2 matched case-control study to explore possible risk factors for COVID-19 infection. The controls were selected from uninfected orthopaedic surgeons who worked in the same department as the case(s) at each hospital.

Severe fatigue of orthopaedic surgeons during the 2 months before the outbreak was found to be a risk factor for COVID-19 infection. (Fatigue from overwork, less sleep, and mental stress are issues for orthopaedic surgeons under many “normal” circumstances.)

Real-time training in infection-prevention measures was found to have a protective effect against COVID-19, as was wearing respirators or masks all the time. More specifically, not wearing an N95 respirator was found to be a risk factor.

Generally, Guo et al. conclude that orthopaedic surgeons must be highly vigilant to avoid infection with COVID-19. They recommend the following approaches:

• Work with medical and orthopaedic associations to provide real-time infection-control training and to address any shortages of personal protective equipment.
• Minimize, postpone, or cancel elective operations. Test patients for COVID-19 before any operation if resources allow. Place face masks on all patients.
• Wear N95 respirators all the time while in a hospital during the pandemic.
• If you are exposed to the virus by patients with confirmed or suspected COVID-19, avoid close contact with family members at home and maintain physical distance in other situations.
• If possible, avoid long-term overwork and fatigue, which could compromise immunity against COVID-19.