Listen to Mr Andrew Duckworth interview Professor Ken Egol about the impact COVID-19 has had in the US.
Click here to view our COVID-19 content
Listen to Mr Andrew Duckworth interview Professor Ken Egol about the impact COVID-19 has had in the US.
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 many aspects of our professional and personal lives.
Through these podcasts, we hope to cover the key issues that have arisen as a consequence of the pandemic, for orthopedic and trauma surgery, as well as our healthcare profession as a whole.
We will be talking to colleagues from throughout the UK, as well as from across the globe, including hearing from colleagues working in some of the worst affected areas in the world as we will today. We also feel it's an opportunity to discuss the future in terms of both the recovery phase and what we can anticipate when the worst of the pandemic is hopefully over.
So today I have the pleasure of being joined by Professor Ken Egol, who is the professor of orthopedic surgery and vice chair of the department of orthopedic surgery at the NYU school of medicine and NYU Langone health group in New York city, which as we all know has been today, one of the worst effected regions in the US and the world. Many thanks Ken for taking the time to join us today.
How you doing Andrew?
Yep. [00:01:00] Good thanks Ken.
So Ken, if we could start off just looking at the general overall impact of COVID in the US. Obviously we've had a lot through the press here and seeing what's happening over there, but how would you describe the impact on the healthcare system over there and what changes you've seen so far?
Well, , I can only speak to the change of scene in the field of orthopedic surgery in our area of New York, but certainly the effects have been fairly devastating - devastating for patients and families, devastating for healthcare providers who are thrust into various situations, that they have varying levels of comfort with, and not just the providers, but our support staff, the nurses, and the patient care associates, and even the people who clean up the hospital and move the linen and you know, every aspect of people who help make the hospitals and the healthcare system go. Everybody's been fairly affected.
No, I can understand. I mean, it's [00:02:00] certainly been the same case here. In terms of your ability to provide the service to your patients, I mean, in terms of trauma and elective work, where are you at at this stage?
Well, all elective orthopedic surgery has been eliminated and we stopped elective cases about a month ago now. Yeah, we don't foresee any start-up of that for at least another four to six weeks at all. The trauma system is up and working - we have capacity, the city trauma centers have capacity. Fortunately there has been a significant decrease in the number of trauma cases we're seeing and obviously that's because people aren't going out. They're not going to bars. They're not drinking. They're not walking inebriated in the streets and getting hit by cars. They're not falling down the steps. You know, we are still seeing geriatric trauma, the older people falling in the homes, minor traumas, which has been fortunate. So the [00:03:00] volume has diminished yet our capacity maintains a fairly strong.
That's that's interesting. And that would very much mirror what we've seen here. That sort of, sort of downturn, but we're still getting the fragility fractures and the elderly fractures through the system. And you're still managing to maintain a service for them at present?
Yes. We treat all the trauma and fracture patients as we would have absent of COVID. Obviously we're treating the majority of people as they are COVID-positive but fractures that need surgery or getting surgery, traumas that need attention are being treated appropriately. And no one is being turned away.
Yeah. We have relaxed some, you know, some of our indications, you know. I've attempted to treat a couple of non-displaced hip fractures without surgery, with varying degrees of success. But other than that, you know, it's pretty much in the trauma world business as usual.
And in terms of sort of your outpatient work or your [00:04:00] office work, as you would call it, has that changed at all?
Yes. I would say we're doing probably about 80, 90% telehealth visits now. We have a pretty robust EMR and we have a very good tele-health program built into it and that's been working out very well. In fact, I'm sure it'll change the way we practice medicine after this whole thing is over, because we could see that we can do a lot of things fairly efficiently using this technology. So, that's been an unintended consequence, but maybe a bright spot.
I think in trauma, I'm still seeing people in the office, the post-ops that need their sutures removed, anybody with a potential wound issue or people who need x-rays for follow-up obviously need to come in. So we in trauma, you know, probably are seeing more people than our sports and arthoplasty and spine colleagues are.
Sure. No, [00:05:00] I would exactly mirror that for us as well. And, I think it, like you say, it's one of the unintended, maybe positives out of this is it's maybe going to change even for the future when things get back to normal. We maybe still be using this technology because it does work very well. I'd agree.
In terms of your staffing and sort of the community, have you lost your junior staff? Are they being seconded elsewhere to other parts to help out?
It's an all hands on deck situation here. Everybody has been redeployed. Our resident staff, our orthopedic residents who are the best and the brightest in this country are working floors and ICU and taking care of medical patients. They're part of proning teams. They are working in the ED. So they are working their butts off.
Our faculty has also answered the call. The faculty, people who are spine surgeons and arthroplasty surgeons and sports medicine docs are dawning protective equipment and going on and helping hospitals [00:06:00] manage patients on the floors and where they can't, they're going to ICU and helping manage patients in the ICU. Everybody is doing everything they can, and they're really putting out an incredible effort here. I'm sure in every hard hit area as well.
No, I agree Ken, like we've spoken to a few people and I think that's been the overwhelming thing is that almost everybody to none is contributing, you know, and keen to help. And I think no matter what specialty you are, somebody said on one of our previous podcasts is we're just all doctors at the moment and just helping out, you know, as best we can.
Correct. Correct. A lot of our residents and junior faculty have relearned how to operate the ventilators and relearned the physics and the physiology involved.
It's crazy. Isn't it? I know.
In terms of your, so that moves on to the community itself, how do you feel it has affected your teams and your colleagues? With this pandemic, there is obviously a fear for our [00:07:00] own safety and our families as well. How have you all dealt with that?
I think everybody deals with it a little differently. I think the number I heard about 20% of our workforce has been affected and in some way or another, you know, being positive at some point and missing time from work. We've had five or six of our residents turn positive. And two of whom were fairly sick. Couple of my faculty colleagues have had to be hospitalized. Others who have not have been treated at home. The question I think you're asking is, you know, how do we come to work and then go home and potentially expose our families. Different people are doing different things. Some people are staying away. The city and the hotels in the city have offered free housing in their empty hotel rooms for healthcare workers. Our hospitals are putting people up in empty dorm rooms. The food and service industry in New York is donating tons [00:08:00] and tons of food to healthcare workers. Some people are going home and social distancing themselves from other members of their families within their own homes. Everyone is, you know, doing things in their own way, but I think everybody has in mind to keep their loved ones, their family, their friends safe.
Absolutely.
That's obviously the first thing in our mind. We want to do everything we can for our patients and keep those who are important to us to safe as we can.
I couldnt have said it better. I totally agree. In terms of that, in terms of keeping safe. I mean, one of the issues that has come up a fair bit and is often in the press a lot, is about the protective equipment. How have you found that in terms of, I suppose the supplies of that more than anything?Has that been good where you are?
Well, so again, speaking for NYU and what I've seen, we have not had a problem with PPE. Now that doesn't mean if you go to the floor and you're going from patient to patient, that you might [00:09:00] not find a yellow cover gown to put over, you might have to walk around to find one. But certainly everyone is provided with masks and face shields, and it's all there. Obviously they're being a little bit conservative with the N95 masks because they're in short supplies. So we use them for about a week or so before we replace them. I wear mine when I go to the OR I cover it with another mask, just so it doesn't get blood splattered and I can maintain it.
Yeah.
But for the most part, you know, I have not seen that. I know there are some outlying hospitals around New York where it has been a bit of a problem. And I think that was early on in the whole, you know, pandemic, when people didn't know where things were going. I think maybe supplies were being courted and yeah, I don't know. I think it's easier to find the mask now than it is to find a roll of toilet paper though.
I know it is crazy.
That was the first thing to go in New York.
Yeah, no, same here. Same here. Still not figured out why completely, but yeah. [00:10:00] And in terms of the testing, just out of interest because we've had a variety of opinions on this. If somebody comes to your hospital and is admitted, does everybody get tested or how are you working at the moment?
Well, if they're admitted for a pulmonary problem or PUI presumed infection, then they're getting tested. If someone comes in with a broken leg and otherwise healthy, I don't believe they're getting tested fine. And I don't believe we are testing every single patient that needs surgery.
Right. Yeah.
Obviously the majority of people who are presenting at hospitals nowadays are people who are, you know, suspicious of having, you know, the virus.
That's interesting. And so moving on to we are going to talk about a bit of research, but obviously research is I'm sure in your institutions the same as around the world and with ours is that [00:11:00] everything's sort of on hold at the moment while we deal with the major clinical problem. But I know you're a very active department. Have you sort of, have you managed to maintain anything or try and keep anything going with all your projects?
Well, we're certainly trying to keep, you know, our databases going. So as patients with various conditions come in we're trying to keep track of them without enrolling them so that we can go back and try to contact them when time allows. You know, we have people who are working on gathering, you know, no patient contact gathering data and radiographic parameters and things like that to fill in, you know, while this is all going on. It's a good time to gather what you have and write papers and abstracts. And we're certainly looking at, we're allowed to work on projects that don't involve patients like surveys and things that we can do amongst each other. We're trying to do that. And of course, we're going to try and keep track of [00:12:00] everything we're doing in this pandemic, orthopedic trauma wise so that we can be prepared a little bit better for the next time this comes around.
Absolutely. Is there anything you've looked at in particular, I mean, one thing we started looking at here is obviously COVID-positive patients and hip fractures. Is there anything in particular that you guys have started with in terms of that?
Yeah, we're looking at the same thing. You know, obviously there are people who have to be treated and the majority of them, these elderly people they're coming in and many of them are COVID-positive, asymptomatic or symptomatic. And you know, we're seeing a lot of post-surgical, pulmonary decompensation and we're seeing it even with regional anesthesia. So, you know, obviously it changes the game a little bit, but you know, we're gonna take a look at everything in detail, obviously when we get a moment to do so.
Absolutely. And sort of that, that leads into sort of my final sort of question Ken, in terms of the future. I mean, I [00:13:00] said to people before we can't predict the future, who knows how long this will last for, and how we will come out the other side of it. But have you got any feel from your institution, how things are gonna progress over the next couple of weeks to months in terms of, and what sort of challenges, I suppose you think as trauma orthopedic surgery, we're going to face moving forward.
Well, I mean, I think obviously I think the biggest challenge that we're going to have in trauma is if, you know, God forbid there was some type of mass casualty event on top of all of this, with all of our resources diverted towards this pandemic. And I think in the future, we're going to have to look at how we'll be able to manage multiple disasters, medical, and mass casualty that would potentially occur simultaneously.
Well, from the standpoint of getting back to normal, who, you know, who can predict, I mean, this is no one's ever seen anything like this. I was here during 9-11 and, you know, we didn't think [00:14:00] anything would ever get back to normal, but that was something that really only affected, you know, our city and in our area. The rest of the country and the rest of society and the rest of the world and the rest of the economy went on but this is completely different. So I don't really have an answer for that, but I'm pretty certain that things will return to fairly normal lifestyle eventually. They always do. Will things be different? Yes. How there'll be different I can't tell you, but they certainly will be different. Hopefully, you know, we'll learn when we go back and do a deep dive into everything and figure out how we can approach this better in the future and something will happen next time that we're not prepared for. And that's what happens. You always learn from each experience. That's what medicine is. That's what this situation is going to be. But I fully expect that this city, this country, the world is gonna bounce back and we will, you know, return to life [00:15:00] as it was. And we'll be.
Yeah, I agree. And that's a nice way to finish on that note. So thank you so much for your excellent comments and insights. It's been really good to hear how things are across the pond. And we do appreciate you taking the time to join us at this busy time. And we send our best wishes to you and your colleagues and their families through these difficult times. So thanks for joining us, Ken.
Thanks for having me. Be safe and healthy and everybody over there as well.
And finally, as always, we also like to acknowledge and thank our many colleagues around the UK and across the globe for their ongoing timeless contributions and the care of our patients during this pandemic and here at the journal will continue to support you all in any way we can. Stay safe and well, everyone, and thanks for listening.