Listen to Mr Andrew Duckworth interview Associate Professor Andrew Shimmin about the effects COVID-19 has had in Australia.
Click here to view our COVID-19 content
Listen to Mr Andrew Duckworth interview Associate Professor Andrew Shimmin about the effects COVID-19 has had in Australia.
Click here to view our COVID-19 content
[00:00:00] Welcome everyone. I am Andrew Duckworth and I would like to thank you for joining us for our special series of BJJ podcasts on the COVID 19 pandemic. As we all know the impact of the pandemic is being felt throughout the world, and without doubt will have affected every aspect of our professional and personal lives.
Through these series of podcasts, we hope to reflect on the main issues that have arisen as a consequence of the COVID-19 pandemic, for us in trauma & orthopaedic surgery, as well as the medical profession as a whole. We hope to give you insights from colleagues throughout the UK, as well as from across the globe, including hearing from colleagues working in some of the worst affected areas.
We also feel it's an opportunity to discuss the future in terms of both the recovery phase, following the pandemic and what we can hope to anticipate when the worst of it is hopefully over.
So today I have the pleasure of being joined by Associate Professor Andrew Schumann, who is an orthopaedic surgeon and director of the Research Foundation for the Melbourne Orthopaedic Group in Victoria, Australia.
Many thanks Andrew, for taking the time to join us today.
Pleasure, thank you for having me.
So Andrew, if we look at first of all in [00:01:00] Australia, the general overall impacts, if you start by giving us a general overview of the impact of the COVID crisis so far on your healthcare system, both in terms of your service provision and the potential consequences you are, I suppose, seeing or anticipating moving forward.
Well, Andrew look, I think Australia is very, in terms of orthopaedic surgery, Australia's very similar to the UK at the moment. You know, orthopaedic surgeons certainly involved in elective surgery have been, you know, fairly bluntly told, just get out of the way. You know, we can't be using any equipments, PPE, et cetera that might be used.
There's no doubt that we've been asked to prepare for a significant impact on both our private and our public health system. That said, you know, we'll no doubt get to talk about some numbers. We have, you know, very small numbers of infected cases in Australia fortunately, and these numbers seem to be dropping.
In [00:02:00] terms of orthopaedics, no elective surgery happening at the moment aside from what's called category one type surgery. You know, that obviously includes trauma surgery. Interestingly, the amount of trauma has changed, but we'll get to that I'm sure Andrew.
But, very similar, the public has been asked to behave like the English public in terms of stay at home, dont go out, unless you need to go to the shops, go to your essential work or go to see a doctor. It's pretty much stay at home. And in general, the community is being very, very, in general that is, very cooperative with regards to that.
Yeah. Yeah. You sort of allude to the figures there. What are the current figures in Australia at the moment Andrew?
Well, the total number of positives tests in Australia is 6,015. And that was this morning's data. So, you know, compared to the UK, tiny numbers of cases, and numbers of death in the whole of Australia has been 50 through this whole [00:03:00] pandemic. And you know, when you compare that to what we hear from the UK, it's staggeringly small.
You know, no one really knows the reasons by that. Obviously we're a big Island and that kind of helps with control of their borders fairly comprehensively two or three weeks ago. And the other thing is we've managed to keep it out of nursing homes and, you know, places where the elderly exist. And there's some very strict visiting rules that have been put in terms of visiting homes for the elderly. So I think, you know that, and in addition to the fact that, you know, we don't live in crowded high rise cities, that much we're pretty open plan living. You know, all of those things I think could be contributed and smoking is pretty uncommon in Australia. That would be the, you know, I think the summary of why we're different to other parts of the world.
Yeah, that's really interesting. Isn't it? I think it's, like you said, there's a variety of factors there about why those numbers are [00:04:00] just maybe not quite where, like you said, the UK and the rest of the world is. Do you ever feel Andrew, did you feel that you, because maybe the rest of the world was ahead in terms of the timeline, that maybe the lockdown measures per se were sort of brought a bit earlier do you think there?
I dont think so. I mean, my recollection of the past month, I think that we certainly didn't have that, you know, theoretical wish to go down the herd immunity concept, which I think we heard from the UK. We never had any of that. So we were probably maybe if I recollect correctly a little ahead in terms of lockdown, and I think both Australia and New Zealand have been reasonably definitive and have the huge advantage that we are an Island and everyone that comes in has to usually go through an airport where we can screen them and control what they do. And we have very effective [00:05:00] contact tracing. I think that's a key, in that you know it is incredibly difficult to do in the UK, incredibly difficult to do with big, big US cities, but we've had, you know, I'd say very effective contact tracing.
Yeah. Yeah, absolutely.
So you've sort of alluded to this, moving on, Andrew, so you talked about sort of all orthopaedic and trauma care. What do you feel has changed in terms of that care? Both I suppose because obviously you have the private and public systems sort of working side by side there. What has changed in terms of service delivery particularly you mentioned about how trauma care has changed.
Just a couple of issues. You are right, we do have a very separate private and public system, but as of last week, they are now considered one - private healthcare sector and our NHS equivalent and the government and the providers have all agreed that it's now one system for the duration of this pandemic. So that has a whole range and that means a whole lot of the facilities now can open up. And, you [00:06:00] know, I don't know anyone would describe it as such, but we have an NHS, I suppose now, no differentiation. Now that's only for the duration of the pandemic we're led to believe.
In terms of trauma look, no elective surgery. My job is the knee arthroplasty really, and, you know, and I'm one of those people who've been told, you know, get out of the way. And so we're not doing any of that.
The major trauma centres in Melbourne, for instance, one of the major trauma centres is the Alfred hospital, which is also the COVID hospital. And there's been a lot less that the ambulance drivers obviously take people there and the Royal Melbourne, which is another big trauma institution, they've noticed a decrease in road trauma as you'd expect. Rather sadly, over the last two weeks, they have noticed that most major trauma has come from people attempting suicide due to the consequences of the positions.
Yep.
And [00:07:00] also of interest is the other major increasing trauma at the Royal Melbourne Hospital is, tongue in cheek, somewhat, but middle aged men falling off the roof of their house while they're doing renovations while they're in lockdown.
Yeah, no, absolutely. I think that's certainly something we are slowly seeing here and certainly from our colleagues in Europe and in Italy, have noticed that unfortunately, people attempt to take their own life and DIY injuries as we call them, of the things that have just persisted. And obviously our neck of femur fractures have just continued to come no matter what.
But in terms of, you know, in terms of how about your clinic appointments? Has that changed? Are you still seeing people in clinic at all? Or how have you worked that?
Well, we've been encouraged to do lots of phone consults or video consults, and it certainly led to the rapid uptake [00:08:00] of these remote, if you like, methods of consulting.
Yeah.
So I think, you know, when we look by this or past this in a year, when we're thinking about what do we learn from this? Well, I think it's really hastened tele medicine or whatever you want to call it. And I think that's going to be a really good thing.
You know Australia is a big country, and we have people often travel a long way to see us just for, you know, sometimes it's a social call, you know, to see how they're going or, you know, and even people have to travel four or five hours, you know. We can now maybe review their wounds with some sort of telemedicine consult.
So we're doing a lot more of that, but we're a little weird bit, you know, our facilities need to improve there. And there's a lot of activity along those lines right as we speak.
It's interesting, isn't it? Yeah. I think we're very much the same way. You do wonder whether even when the pandemic is over, whether there will be some adaptation of those systems because they are developing quite, quite quickly in terms of remote reviewing.
Curiously enough, curiously enough on that subject though, you know, [00:09:00] many patients, you know, we now have only, we have a large clinic. We have 15 surgeons in the clinic. And we have, you know, strict social distancing rules. So we have the patients who will stay in their cars and they'll get a text when it's their turn to come in. We have a large waiting room which would normally accommodate, you know, 50 people. And now there's only four people in it at one time sitting far apart. We take their temperatures when they enter. So, you know, with all those things, you know, people, I think they do like the face-to-face contact, they still feel comfortable with that. So it'll always be an element of that, I think.
No no, I totally agree. I agree.
If we sort of move on then Andrew to sort of, I suppose, to the community, your trauma & orthopaedic community, your fellow professionals, how do you feel it's impacted on them? And I suppose not just on their work plans, but in terms of, you know, there is a, I suppose, a fear element with this as well, and, you know, and for their themselves and their family members, how do you feel it's impacted [00:10:00] on things like that?
Well, you know, different people are affected differently. You know, some people, you know, many, most I would say orthopaedic surgeons, you know, they're type A, often male, egotistical type people and they're defined by their work often. And then it's taken away from them and they're not used to being home a lot. And so a lot of my colleagues, you know, admitting to finding it very difficult, and kind of know what to do. Busy people are doing not much. They're struggling.
In terms of the younger people who are just starting practice both publicly and privately, you know, it's stressful. It's the young businessmen effectively, and, like everyone else, they have mortgages and stresses. And so they're feeling it like the rest of the community.
So, yeah, that would be the summary. There's a great variety.
Yeah.
You know.
We've got a [00:11:00] partner in our practice who is over 70 and he's pretending nothing's happening. He's just kind of rolling on and ignoring what's going on. You know what I mean? So everyone manages it slightly differently.
No, absolutely. I think that's certainly what we've seen here as well. And in terms of, I suppose, sort of protection for the professionals, I suppose in many ways, you know, one theme through our podcast has been the availability of the protective equipment that is required when interacting with patients and the concern that obviously in patients who are COVID positive, what's the situation in Australia currently with regards to protective equipment and I suppose with the ability of testing as well for healthcare professionals.
Okay. Taking the testing first, where we've come and we are a very high testing country per capita. I think there's two elements to the testing as far as I can understand, is one is the test itself and the technology associated with it and another is the equipment swabs, et cetera, to do that. And [00:12:00] the PPEs for the staff to do these swabs safely.
We are like the rest of the world. You know, you can't anticipate this and so Australia is like the rest of the world. We are rationing and being very careful in how we use PPE. It's been directed and it's been stockpiled ready for uses and intensive cares, and A&E departments like it should be. And so that's why elective surgery is essentially not happening because we are saving it for the scenarios.
There's still a concern that, you know, we're going to get this tsunami effect. And, you know, everyone's very interested in that sort of nightly news about how the numbers are trending and but we are still expecting a bigger volume. We're coming into winter. You guys are coming into summer. So again, there's some concern about, you know, the relevance of that.
So volume of testing, high. I think that's been really [00:13:00] important. PPEs struggling like the rest of the world. I think supplies of it are now becoming a little easier to get as manufacturing's been able to ramp up. And there's been small manufacturers in Australia who have normally manufactured small amounts have had great assistance from governments and from even the military to help increase their manufacturing of these things. So summary though, same as the rest of the world really.
Yeah. And in terms of just, if we go back to testing in terms of your patients, do you have a policy if a patient's admitted to the hospital, do they all get tested or do you selectively test?
No. So it's still selective testing. And I think the, you know, the prerequisites for who gets a test is changing all the time, and I think it's becoming a little more liberal. It used to be, you know, had to have symptoms, you had to be *inaudible*, but I think it's becoming a little [00:14:00] more liberal now. But to try treating, you know, availability of the test and the importance of the test.
Yeah. Yeah, no, I agree. In terms of, finally just talking about our colleagues, has there been any movements so far, obviously in the UK, some of our colleagues have been redeployed to other areas and has that happened yet in Australia, and where do you think, you know, if it did happen, where would we add most value?
No there's been no redeployment. There are strategies and plans for this to happen but nothing's happened. As I said our volume of sick people is not there yet, but there's certainly strategizing and, you know, I think consultant orthopaedic surgeons and the registrars are going to have to be prepared to take on the workload that what they would be doing and probably the interns and then the more junior [00:15:00] doctors are going to be deployed somewhere else. So people are prepared for the fact that their work may change if we do get this sort of tsunami of cases.
Yeah. No, absolutely. Absolutely.
So if we just move on then, Andrew if we talk about, I mean it's difficult to talk about research at times like this, obviously there's a lot more pressing clinical issues, but it is important in terms of how have your research practices changed since the start of this. And it's certainly a lot of research has been very significantly either stopped or trimmed down here in the UK and obviously a lot of efforts and money has been put into COVID research, which obviously is the right and sensible thing to do, but has anything changed so far in Australia with regard to that?
Oh, I think the relevance of it has taken its place. You know, certainly clinical research with calling patients back for examinations, imaging, et cetera, that's quite appropriately gone to zero. I think, you know, it is a good opportunity, if you like, for fellows and registrars to you know, [00:16:00] put pen to paper but I think in terms of the actual activity of research, that's taking its appropriate place, which is in the background.
Yeah. No, absolutely. And in terms of have there been any sort of thoughts about any COVID-related orthopaedic research that you guys do. Obviously like you say your numbers are still small at the moment, but is there anything in particular you feel would be quite an important thing to look at, I suppose for the future as well?
Look, I'm not aware of that. No, I'm not aware of that. I had a conversation today with a colleague and, you know, there are some radiology practices here saying that, you know, there's some connection between corticosteroid injections, you know, the joint and risk of COVID infections and managing it. Now again, I'm not sure of the science behind that, but you know, that's something of interest to orthopaedic surgeons at this time, especially, you know, when you've got people who are, you know, waiting for elective hip and knee replacements who are really struggling and you want to come and help them out to get them over the line for as long as possible.
You know, so I think, you know, that's the [00:17:00] only sort of area that we'd like to know more about immediately.
It's interesting because obviously the current protocol certainly where I work is that all those steroid injections are currently stopped for that very reason. But like you say, it's difficult to know and it's like, well, if it's based on sort of, I suppose theory rather than actual data.
But I suppose just moving on finally Andrew, to the future, I mean, it's very difficult to predict and if anybody could predict it, it would be a crystal ball sort of moment, isn't it really? But how do you, how do you see us moving forward? How do you see you moving forward in Australia in terms of, how you think this will progress, especially in the immediate future. And then in particular for your sort of specialty getting back on our feet, really more than anything.
Well, you know, no one has the answer and you know, this is a very unusual situation where, you know, we can't go, well, you know, last time this happened, this is what we did. We can't do that. [00:18:00] And we're all struggling with that. That said, I think, you know, if we can get through this Easter period with the population, you know, could I say awfully behaving and following the strict instruction, I would really hope that, you know, we could get this to a manageable level. We could lose our fear that our hospital system is going to be overrun. And then I think the next challenge will be both in a social way, i.e. how do we let people out? How do we let the community out? Can we have people over to our house for dinner? Or can we just restart sporting events? Or when should we start elective surgery? That's going to be the challenge for these people who have unfortunately been elected by us now find themselves doing something that they were not prepared for and in some ways not qualified for, to make these decisions. And that's what we don't [00:19:00] know other than it's going to be a slow return. It won't be, you know, first of May, all goes back to normal, I think that's pretty sure.
And I think getting back to orthopaedics and elective orthopaedics, I would imagine the elective orthopaedics will be one of the last things that comes back on going back online.
Yeah, no, I think, yeah, I think you're very, very right with that. And I think, like you say, I think the fear certainly is here is that if you, you know, obviously this break has been put on with lockdown and social distancing and if you take that off too soon, you'll just get the spike of cases that you've been trying to avoid. So I think that's right.
Well, I think that's all we have time for Andrew, but thank you so much for your super comments and insights. And it's been really interesting to hear how you're all doing in Australia and I really do appreciate your taking the time to join us. We send our best wishes to you and your colleagues and their families through these difficult times.
Thank you, Andrew. Thank you.
Finally, as always, we'd also like to acknowledge and thank our many colleagues around the UK and across the globe for their ongoing, untiring contributions in the delivery of care to our [00:20:00] patients during this pandemic. We at the journal will continue to try and support you all in any way we can. Stay safe and thanks for listening.