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      Orthopaedic Systems Response to and Return from the COVID-19 Pandemic : Lessons for Future Crisis Management

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          Abstract:

          The coronavirus disease 2019 (COVID-19) pandemic has become the dominant health-care issue of this generation and has reached every corner of the health-care delivery spectrum. Our 3 orthopaedic departments enacted a response to the COVID-19 pandemic within our organizations. We discuss our health-care systems’ response to the outbreak and offer discussion for the recovery of the orthopaedic service line within large health-care systems.

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          Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic

          Megan Ranney, Valerie Griffeth, Ashish Jha (2020)
          New England Journal of Medicine
          Article 0 comments Cited 893 times – based on 0 reviews     Review now
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            Profiling Early Humoral Response to Diagnose Novel Coronavirus Disease (COVID-19)

            Li Li Guo, Lili Ren, Siyuan Yang … (2020)
            Abstract Background The emergence of coronavirus disease 2019 (COVID-19) is a major healthcare threat. The current method of detection involves a quantitative polymerase chain reaction (qPCR)–based technique, which identifies the viral nucleic acids when present in sufficient quantity. False-negative results can be achieved and failure to quarantine the infected patient would be a major setback in containing the viral transmission. We aim to describe the time kinetics of various antibodies produced against the 2019 novel coronavirus (SARS-CoV-2) and evaluate the potential of antibody testing to diagnose COVID-19. Methods The host humoral response against SARS-CoV-2, including IgA, IgM, and IgG response, was examined by using an ELISA-based assay on the recombinant viral nucleocapsid protein. 208 plasma samples were collected from 82 confirmed and 58 probable cases (qPCR negative but with typical manifestation). The diagnostic value of IgM was evaluated in this cohort. Results The median duration of IgM and IgA antibody detection was 5 (IQR, 3–6) days, while IgG was detected 14 (IQR, 10–18) days after symptom onset, with a positive rate of 85.4%, 92.7%, and 77.9%, respectively. In confirmed and probable cases, the positive rates of IgM antibodies were 75.6% and 93.1%, respectively. The detection efficiency by IgM ELISA is higher than that of qPCR after 5.5 days of symptom onset. The positive detection rate is significantly increased (98.6%) when combining IgM ELISA assay with PCR for each patient compared with a single qPCR test (51.9%). Conclusions The humoral response to SARS-CoV-2 can aid in the diagnosis of COVID-19, including subclinical cases.
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              Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection

              Shaoqing Lei, Fang Zheng Jiang, Wating Su … (2020)
              Background The outbreak of 2019 novel coronavirus disease (COVID-19) in Wuhan, China, has spread rapidly worldwide. In the early stage, we encountered a small but meaningful number of patients who were unintentionally scheduled for elective surgeries during the incubation period of COVID-19. We intended to describe their clinical characteristics and outcomes. Methods We retrospectively analyzed the clinical data of 34 patients underwent elective surgeries during the incubation period of COVID-19 at Renmin Hospital, Zhongnan Hospital, Tongji Hospital and Central Hospital in Wuhan, from January 1 to February 5, 2020. Findings Of the 34 operative patients, the median age was 55 years (IQR, 43–63), and 20 (58·8%) patients were women. All patients developed COVID-19 pneumonia shortly after surgery with abnormal findings on chest computed tomographic scans. Common symptoms included fever (31 [91·2%]), fatigue (25 [73·5%]) and dry cough (18 [52·9%]). 15 (44·1%) patients required admission to intensive care unit (ICU) during disease progression, and 7 patients (20·5%) died after admission to ICU. Compared with non-ICU patients, ICU patients were older, were more likely to have underlying comorbidities, underwent more difficult surgeries, as well as more severe laboratory abnormalities (eg, hyperleukocytemia, lymphopenia). The most common complications in non-survivors included ARDS, shock, arrhythmia and acute cardiac injury. Interpretation In this retrospective cohort study of 34 operative patients with confirmed COVID-19, 15 (44·1%) patients needed ICU care, and the mortality rate was 20·5%. Funding National Natural Science Foundation of China.
              Article 0 comments Cited 629 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Bone Joint Surg Am
                Journal ID (iso-abbrev): J Bone Joint Surg Am
                Journal ID (publisher-id): jbjsam
                Title: The Journal of Bone and Joint Surgery. American Volume
                Publisher: Journal of Bone and Joint Surgery, Inc.
                ISSN (Print): 0021-9355
                ISSN (Electronic): 1535-1386
                Publication date (Electronic): 11 May 2020
                Electronic Location Identifier: 10.2106/JBJS.20.00709
                Affiliations
                [1 ]Kaiser Permanente Southern California, Harbor City, California
                [2 ]Kaiser Permanente Southern California, San Diego, California
                [3 ]Kaiser Permanente Southern California, Los Angeles, California
                [4 ]University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
                [5 ]University of Arizona College of Medicine–Phoenix, Phoenix, Arizona
                [6 ]Banner Health, Phoenix Arizona
                Author notes
                [a ]Email address for R.A. Navarro: ronald.a.navarro@ 123456kp.org
                Author information
                http://orcid.org/0000-0003-1869-6440
                http://orcid.org/0000-0001-6966-5068
                http://orcid.org/0000-0002-2908-6659
                http://orcid.org/0000-0002-2091-7743
                http://orcid.org/0000-0001-7821-4269
                http://orcid.org/0000-0003-4306-4090
                http://orcid.org/0000-0002-1035-6751
                Article
                Publisher ID: JBJS-D-20-00709
                DOI: 10.2106/JBJS.20.00709
                PMC ID: 7396222
                PubMed ID: 32675663
                SO-VID: 1f984ce6-e205-48f9-a182-a21c492189a9
                Copyright © Copyright © 2020 by The Journal of Bone and Joint Surgery, Incorporated
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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                Page count
                Pages: 8
                Categories
                Subject: 0180
                Subject: The Orthopaedic Forum
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