Listen to Mr Andrew Duckworth interview Mr Donald McBride about the clinical and professional challenges COVID-19 is presenting on both a national and regional level, and how the BOA is helping with these issues.
Click here to view our COVID-19 content
Listen to Mr Andrew Duckworth interview Mr Donald McBride about the clinical and professional challenges COVID-19 is presenting on both a national and regional level, and how the BOA is helping with these issues.
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. The pandemic is the most significant healthcare crisis of our generation and has led to severe worldwide disruption like which we have not seen in many decades.
Through these podcasts we hope to consider the main issues that have arisen as a consequence of the COVID-19 pandemic for us in orthopedic and trauma surgery, as well as on our healthcare profession as a whole. We hope to give you insights from our colleagues throughout the UK, as well as from across the globe.
We also take the opportunity to hopefully look forward to the future in terms of both the recovery phase and what we can anticipate when the worst of this pandemic is hopefully over. So today I have the privilege of being joined by the president of The BOA, Mr. Donald McBride, who I know will be able to give us an exceptional overview and insight into the clinical and professional challenges we are facing each day at both the national and regional level, how this is affecting training and education, how the BOA is working very hard to help with these issues. And finally, what is installed for us moving forward.
Many thanks Don, for taking the time to join us today.
Not at all, Andrew, [00:01:00] nice to speak to you.
So if we could just, first of all, talk about, obviously we get onto the bits of our specialty that's affected, but if you could give us an overview of what you feel the impact of the pandemic has been on the NHS as a whole, both in our healthcare system, our ability to provide service and the potential consequences we are seeing, and potentially we'll see moving forward.
Well, I think that this is something that probably not many people envisaged was going to happen, even when matters started in Wuhan just a few months ago. In the UK, it's almost like a wartime deployment. We have effectively wartime politicians present. And I think that because of that, the NHS and the economy is going to be very severely affected for some, some months to come basically.
The problem we have in kind of like generally is not just an orthopedics, but staff are being redeployed across the whole scale of things. We [00:02:00] are seeing retraining of such things to do things that they probably never expected to ever have to consider. And that's also the case, I think, with our specialist nurses.
Yeah.
I think a number of specialists nurses are also retraining to do things that they probably weren't expecting to do as well. I think we should remember that it depends a little bit of where you are in the curve as well of the pandemic. Having spoken to a number of people across Europe and across the world in the past week or so, we are all at various different parts of that curve. And in fact politically, we're all using very different methods of managing the problem. Some, for example in Sweden, are kind of effectively doing very little expecting things to come quickly and pass quickly, which they probably will. And others of course are suppressing things by self-isolation, and a number of other techniques, more or less to protect certain parts of the public.
Yeah, they say the over seventies, but it might even be the over [00:03:00] fifties from what's been going on recently. And of course, those who have previous health conditions are more likely to be more severely affected. I think in the longer term we have to bear in mind, it's not often an orthopedic surgeon will talk about this, but the mental health issues of people, including the staff is going to be quite significant.
I think it's very difficult and we've seen videos online quite regularly, recently of nurses from intensive care and other parts are clearly very drained by the whole process. So I think that now currently and in the future, there are going to be quite a number of mental health issues we'll have to deal with, even in including in our own staff effectively. This is quite a difficult time for everyone.
I agree Don. I think what's been interesting about doing this series is how that theme of mental health, both for the healthcare provision and on our patients has been a thing that's come up every time. And I think it's something we have to be very wary of because it's something we can in times like this, when we're [00:04:00] just concentrating on clinical care, but we can sometimes forget about those things, can't we, and I think it's something we must keep very much in the forefront of our minds.
I think we forget about it personally. The other that is important is actually our own hygiene. Going to and from work, it should be quite a religious process effectively, i.e. we should be making sure that we protect our family, friends and those around us as well. That's particularly the case coming back from work, but actually going to work is also quite important how we deal with things. We should not be seeing staff in uniforms, in supermarkets, et cetera, and that sort of thing. And again, I'm a bit concerned when occasionally I do see people like that. It is something we have to bear in mind.
Absolutely. So if we move on from that Don and talk about, you know, you are very much our specialty, the trauma & orthopedic specialty, what do you feel have been the main sort of impacts that you've seen in our specialty so far?
Well, this has been quite interesting [00:05:00] actually. From the trauma point of view, things have decreased quite significantly across the board - major trauma, other aspects of trauma care seems to have dropped quite a lot. I think that we have to also bear in mind that quite a number of other specialties seem to be having the same issue. We have been told that things like acute abdomens all seem to also have dropped. Nobody seems to understand quite why appendicitis, et cetera. So it's not just in trauma & orthopedics, that there is an issue regarding that side of things, but it certainly across the board has been affected.
Other things have happened. So elective care has been suspended. And that will have quite significant short to long-term effects. We went into this on the back of quite significant in-patient waiting lists and our a prime minister actually said that was, that was going to be one of his major things he was going to try and address, and of course this will really [00:06:00] have affected that quite significantly.
The elective side is going to be interesting, shall we say, over the next few months as well. Training is obviously important and education. If you speak to, again, people across Europe, as we have done, I think they are looking at things in a different way. A number have actually said that this is educational - it is something we should be learning from.
Of course, when you look back at wartime, et cetera, that is when trauma and orthopedics actually learnt a lot. Maybe the wrong sort of type of thing to learn from but in fact, that's what you do. So across Europe, they're actually turning this to training and education experience as much as possible, given the concerns, obviously regarding the virus itself from that point of view.
I think that the other side of things that's important of course, is that we don't have as many face-to-face [00:07:00] calls or interviews anymore. We don't see patients very often, you can, but you really should make, keep that to the bare minimum. We were talking about virtual fracture clinics and they were talking more or less about virtual everything effectively. And it has to be said that technology out there is really quite significant now for doing this. So video conferences with your patients are quite important. These will probably be mainly in those of trauma care, effectively, elective patients that you might want to catch up with just in case there's an issue or they catch up on you from that, that side of things.
Patients are really important. We need to try and remember that they are going through a delayed treatment for a lot of things, such as total joint replacement. So we need to contact and involve ourselves with patients and patient groups and actually try and get a handle on how much that has [00:08:00] affected them. Because I think that will be quite significant.
Yeah, no, absolutely. Do you think, picking up on that, do you think, obviously we have changed the way we are seeing the patients at the moment, like you say, with technology and things like that. Do you think any of that, you know, when this is finished, do you think that could persist in some ways there's been some benefits, like you say, learning from our experiences and taking it forward and advancing things potentially in some ways?
There are some very good articles on this. I think that it's undoubtedly that we will be doing more. I think we were kind of going down that line anyway, it's just that this has become more evidence and it probably for a lot of conditions, particularly for follow-up appointments have video conference with your patients is just as effective. Surgeons in general terms like to examine their patients, not necessarily once, but more than once. So it will probably be a little bit of an issue, but I think that, yes, I think that that's going to becoming much more frequent.
Absolutely.
[00:09:00] I'd say as you say that would be positive.
Absolutely. I agree. I think it's interesting what you say about the training. I think again, having spoken to some people from Europe and elsewhere, spoke to Ken Egol in America as well, you know, and I think it's interesting how they have said the same thing. It's almost, you know, rather than thinking of this as trauma & orthopedic training, this is training to be a doctor and actually there's a lot to be, to be gained from that. And I think that that is definitely true. That's definitely your feeling you've got as well, from that?
Indeed and of course, actually in lots of ways, it's gone back to the original surgical training because people do not go through emergency departments anymore, but they certainly are probably doing that.
Absolutely.
And that basic training, which I had and which a number of my contemporaries will also have included this kind of care.
Absolutely.
Therefore, perhaps a revisit is not such a bad thing.
Absolutely. No I agree.
So if we look at your role at the BOA, what has been the main [00:10:00] issues that you at the BOA have taken to tackle during this crisis, both on a national and regional level.
Well, I think what I have to do here is say that the office have been closed, but the BOA staff have been absolutely wonderful in the support that they have given to us, particularly in policy and programs, but also in other areas. We have been signposting and delivering on our website updates for our members for our patients and for those who wish to access them from here and abroad. In fact in my conversations with those from abroad, a number of them have been using these posted documents. We have BOAST, which we have been using in the past, we have specific BOA member information on the website. We also now have a transient jungle of trauma and orthopedics with the [00:11:00] coronavirus, which has been very well looked at. Yeah, plenty of hits on the website for that one. It has very good articles looking at various issues, including legal issues about what may be the situation in the future. Of course we have links to NHS England, public health England. That's about the sort of thing we were talking about. PPE equipment laminate flow - there's a little bit of contention about that. I think our guidance is much clearer than some. It has been used very well from that point of view.
So these are the main things that we have done. And I think that we will continue to do that. We update it quite regularly sometimes at the beginning, every couple of days, but now it's probably down to a few days, perhaps a week. As we are heading into the more difficult parts of what's happening in the UK. London has been badly affected initially. In America that's been shown in New York. So when you have the big [00:12:00] conurbations, that is where they will be effected. And it's going to spread out to the provincial areas now.
Okay. Yeah, absolutely. No, I totally agree. And in terms of, I suppose that leads on nicely. I mean, nobody can predict the future and I think this is probably one of the hardest things to predict moving forward. And as we've mentioned before, maybe a sense of positivity, if we can find one. But how do you see us progressing, I suppose, over the next weeks to months in our specialty and how do you eventually see us sort of coming out of this, not only as a healthcare system, as a country, but also as our specialty as well.
Well, it is a little bit difficult to be positive of the situation. Having spoken to colleagues from Spain and Italy in particular, who have been having a terrible time with this condition. I have to say that that there is some uncertainty, I think the immediate future really we're going to be staying in lockdown for longer than people think. I think that's going to go on for a little longer than we think. I've heard various [00:13:00] timescales on this, so 12 months, some people even this morning on BBC news two years. So I think that that return to what we might call normality might be quite a bit in the future yet.
I think from a trauma and orthopedic point of view, we're hoping that the suspension of meetings, for example, courses, education and so on, hopefully it will start to kick in towards the beginning of 2021. But I can't see it being before then. And one of the biggest conferences EFORT has just canceled, but I think there are other reasons why that's happened.
Though effectively I think it is going to be longer than people think. I think we will never go back to normality as you call it. We mentioned earlier on about things like video conferencing, that sort of thing. We have to be a little bit wary about some of the conditions that we treat, perhaps politicians will revisit, some of the things that we treat. I think that it's [00:14:00] important that we make sure that our patients remain central to all of this, because it is their orthopedic and trauma conditions that we are really, really so focused on trying to manage now and there will be, I hate to use the term, but there will be a tsunami of orthopedic problems when this all comes to an end.
Yeah, no, absolutely. That's interesting. I think that's right. As you say, I think as a profession and the public find harder, it's the unpredictable nature of it, isn't it? But I think the feeling is, we have started on this path and if we release things too early with regards to the lockdown, we could end up with just being where we were having had having had this time off already. Would you agree with that?
Yeah, but what we have at the present time is I think, well, I think the politicians are actually being relatively sensible in the UK. It is always terrible to see absolutely sensible, but relatively sensible. And I think that the only [00:15:00] potential risk they have, and they've already highlighted themselves, is that they may have a second bounce.
Yeah.
So they have actually created a situation where they've quieted it down regarding the surge, which may affect intensive care, et cetera, in hospitals. But by doing that, you don't have the herd immunity that people are talking about, which means that that second surge is less likely to occur.
Yeah.
So you're protecting groups if you have a second surge, maybe even more at risk. But I think at the present, we will just have to see how far the lockdown goes and hopefully people will manage it themselves because I think that people do need to realize that it's what they do that's important.
Absolutely.
I heard a thing yesterday about allowing younger people to go out because they're much less at risk. And I was thinking, unfortunately, [00:16:00] they're the ones who are going to spread it to the ones who are at risk. So not the best idea.
No, absolutely. Well Don, thank you for that. Unfortunately that's all we've got time for, but that was a really excellent overview and insight today, I do appreciate you taking time to join us with how busy you are at the moment. I really, really do appreciate it. Thank you.
Thank you very much, Andrew, thank you.
And finally, as always, we'd also like to acknowledge and thank our many colleagues around the UK and across the world for their ongoing enormous efforts and contributions in the delivery of care to our patients during this difficult time and during this pandemic. We at the journal thank you. And we'll continue to support you in any way we can.
Stay safe and well, and thanks for listening.