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      Pooling of neglected and delayed trauma patients – Consequences of ‘lockdown’ and ‘Unlock’ phases of COVID-19 pandemic- A retrospective cohort analysis from a tertiary centre

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          Abstract

          Background

          The COVID-19 pandemic resulted in nationwide lockdown and quarantine strategies to break the chain of transmission of the SARS-CoV-2 virus in India. Management of patients with trauma has been particularly challenging across the country.

          Aims

          To evaluate the effect of delay in surgery in patients with traumatic injuries along with the peri-operative outcomes during the ‘Lockdown’ and ‘Unlock’ phases of the COVID-19 pandemic at a Level I Trauma centre in the National Capital Region (NCR) of India.

          Methods

          This retrospective, observational cohort study included 488 patients. Comparative analysis to assess patient characteristics, mechanism of trauma, clinical outcomes in patients managed operatively during ‘Lockdown period’ (24 March 2020 to 31 May 2020) Group A with Group B, who presented during ‘Unlock phases’ (01 June 2020 to 31 December 2020).

          Results

          The average delay in surgery, surgical time and hospital stay was significantly increased in group B patients ( p-value <0.05). The average blood loss, stay in the Intensive Care Unit (ICU) and blood transfusion requirement were clinically higher in group B but these differences were not statistically significant ( p-value >0.05). Only in group B; 9.01% patients (42 out of 466) required bone grafting.

          Conclusion

          ‘Neglect’ and delay in receiving operative management of orthopaedic trauma has led to unprecedented rise in number of complications of fractures, such as mal-union, delayed union or non-union during COVID-19 Pandemic. Patients have had to undergo longer surgical procedures with increased risk of intra-operative blood loss, need of peri-operative blood transfusion and bone grafting supplementation to facilitate union. Diligent attention to achieve the most optimal configuration of fractures should be planned in conservatively managed injuries during the pandemic to minimize future intra-operative difficulties.

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          Effects of COVID 19 pandemic in daily life

          Abid Haleem, Mohd Javaid, Raju Vaishya (2020)
          Dear Editor, COVID-19 (Coronavirus) has affected day to day life and is slowing down the global economy. This pandemic has affected thousands of peoples, who are either sick or are being killed due to the spread of this disease. The most common symptoms of this viral infection are fever, cold, cough, bone pain and breathing problems, and ultimately leading to pneumonia. This, being a new viral disease affecting humans for the first time, vaccines are not yet available. Thus, the emphasis is on taking extensive precautions like extensive hygiene protocol (e.g., regularly washing of hands, avoidance of face to face interaction etc.), social distancing and wearing of masks etc. This virus is spreading exponentially region wise. Countries are banning gatherings of people to the spread and break the exponential curve 1 , 2 . Many countries are locking their population and enforcing strict quarantine to control the spread of the havoc of this highly communicable disease. COVID-19 has rapidly affected our day to day life, businesses, disrupted the world trade and movements. Identification of the disease at an early stage is vital to control the spread of the virus because it very rapidly spreads from person to person. Most of the countries have slowed down their manufacturing of the products 3 , 4 . The various industries and sectors are affected by the cause of this disease; these include the pharmaceuticals industry, solar power sector, tourism, Information and electronics industry. This virus creates significant knock-on effects on the daily life of citizens as well as about the global economy. Presently the impacts of COVID-19 in daily life are extensive and have far reaching consequences. These can be divided into various categories: A) Healthcare • Challenges in the diagnosis, quarantine and treatment of suspected or confirmed cases • High burden of the functioning of the existing medical system • Patients with other disease and health problems are getting neglected • Overload on doctors and other healthcare professionals, who are at a very high risk • Overloading of medical shops • Requirement for high protection • Disruption of medical supply chain B) Economic • Slowing of the manufacturing of essential goods • Disrupt the supply chain of products • Losses in national and international business • Poor cash flow in the market • Significant slowing down in the revenue growth C) Social • Service sector is not being able to provide their proper service • Cancellation or postponement of large-scale sports and tournaments • Avoiding the national and international travelling and cancellation of services • Disruption of celebration of cultural, religious and festive events • Undue stress among the population • Social distancing with our peers and family members • Closure of the hotels, restaurants and religious places • Closure of places for entertainment like movie and play theatres, sports clubs, gymnasiums, swimming pools etc. • Postponement of examinations This COVID-19 has affected the sources of supply and effects the global economy. There are restrictions of travelling from one country to another country. During travelling, numbers of cases are identified positive when tested, especially when they are taking international visits 5 . All governments, health organisations and other authorities are continuously focusing on identifying the cases affected by the COVID-19. Healthcare professional face lot of difficulties in maintaining the quality of healthcare in these days. Declaration of Competing Interest None
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            Impact on health and provision of healthcare services during the COVID-19 lockdown in India: a multicentre cross-sectional study

            Rajiv Raman, Ramachandran Rajalakshmi, Janani Surya … (2021)
            Introduction The COVID-19 pandemic resulted in a national lockdown in India from midnight on 25 March 2020, with conditional relaxation by phases and zones from 20 April. We evaluated the impact of the lockdown in terms of healthcare provisions, physical health, mental health and social well-being within a multicentre cross-sectional study in India. Methods The SMART India study is an ongoing house-to-house survey conducted across 20 regions including 11 states and 1 union territory in India to study diabetes and its complications in the community. During the lockdown, we developed an online questionnaire and delivered it in English and seven popular Indian languages (Hindi, Tamil, Marathi, Telegu, Kannada, Bengali, Malayalam) to random samples of SMART-India participants in two rounds from 5 May 2020 to 24 May 2020. We used multivariable logistic regression to evaluate the overall impact on health and healthcare provision in phases 3 and 4 of lockdown in red and non-red zones and their interactions. Results A total of 2003 participants completed this multicentre survey. The bivariate relationships between the outcomes and lockdown showed significant negative associations. In the multivariable analyses, the interactions between the red zones and lockdown showed that all five dimensions of healthcare provision were negatively affected (non-affordability: OR 1.917 (95% CI 1.126 to 3.264), non-accessibility: OR 2.458 (95% CI 1.549 to 3.902), inadequacy: OR 3.015 (95% CI 1.616 to 5.625), inappropriateness: OR 2.225 (95% CI 1.200 to 4.126) and discontinuity of care: OR 6.756 (95% CI 3.79 to 12.042)) and associated depression and social loneliness. Conclusion The impact of COVID-19 pandemic and lockdown on health and healthcare was negative. The exaggeration of income inequality during lockdown can be expected to extend the negative impacts beyond the lockdown.
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              Fracture management during COVID-19 pandemic: A systematic review

              Vijay Kumar Jain, Hitesh Lal, Mohit Kumar Patralekh … (2020)
              Purpose The COVID-19 pandemic has affected orthopedic practices worldwide. Few studies focusing on epidemiology and management of fractures in COVID-19 patients have been published. We conducted a systematic review to evaluate the fracture types, presentation, treatment, complications, and early outcomes of fractures occurring amidst COVID-19 pandemic. Methods A systematic review of the all published papers was conducted with a comprehensive search of PubMed, Google Scholar, Scopus, and Cochrane Library database using keywords ‘COVID-19’, ‘Coronavirus’, ‘trauma∗’and ‘fracture’ from January–April 2020. Results The searches yielded a total of ten studies with 112 Patients who were positive for COVID-19 associated with fractures was performed for six studies, reporting data separately for 44 patients with COVID 19 and an associated fracture. A diagnosis of COVID 19 was made on the basis of positive Computed Tomography scan in 39 patients and 30 patients had a positive Reverse Transcription-Polymerase Chain Reaction test. Overall, there were 29 proximal femoral fractures, 8 spine fractures, 7 fractures of the other bones. The fractures were treated surgically in 30 cases (68.18%) and the remaining 14 cases (31.82%) were managed conservatively. There were 16 patients (36.36%) who died, mostly due to respiratory failure with a median age of 82 years. Conclusion COVID-19 has led to a significant reduction in a load of fracture patients globally, though the incidence of fragility fractures continues to be unaffected. There is a significantly higher risk of mortality in elderly patients with fractures and hence they should only be operated in a facility with a robust intensive care. Conservative treatment should be adopted as far as possible in non-obligatory fractures and in lesser equipped centers. Surgery in patients with proximal femur fragility fractures when judiciously selected did result in improvement in respiratory status. Reorganizing medical services is vital to deliver effective fracture care and also mitigate disease transmission.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Orthop Trauma
                Journal ID (iso-abbrev): J Clin Orthop Trauma
                Title: Journal of Clinical Orthopaedics and Trauma
                Publisher: Delhi Orthopedic Association.
                ISSN (Print): 0976-5662
                ISSN (Electronic): 2213-3445
                Publication date PMC-release: 26 July 2021
                Publication date (Print): October 2021
                Publication date (Electronic): 26 July 2021
                Volume: 21
                Page: 101533
                Affiliations
                [1]Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
                Author notes
                [∗ ]Corresponding author.
                Article
                Publisher Item ID: S0976-5662(21)00417-3 Publisher ID: 101533
                DOI: 10.1016/j.jcot.2021.101533
                PMC ID: 8312047
                PubMed ID: 34334981
                SO-VID: 3f8ebf3c-9cea-4a5c-8fbe-d85661a4c4d3
                Copyright © © 2021 Delhi Orthopedic Association. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 8 July 2021
                Date revision received : 22 July 2021
                Date accepted : 25 July 2021
                Categories
                Subject: Article

                Keywords: covid-19,coronavirus,pandemics,trauma centres,orthopaedic trauma,india
                Data availability:
                Keywords: covid-19, coronavirus, pandemics, trauma centres, orthopaedic trauma, india

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