Page 36 - ISAKOS 2021 Newsletter Volume 1

CURRENT CONCEPTS
COVID-19: A Worldwide Human Perspective
Eiji Itoi
The first case of COVID-19 in Japan was confirmed on January 15, 2020, and the first case in my prefecture, Miyagi, was reported on February 28. As of September 1, 2020, we have 67,865 cases of COVID-19 nationwide and 207 cases in Miyagi prefecture. I work at a university hospital, a designated infection-control center. Many coronavirus patients have been admitted to our hospital. As a result, we needed to maintain the number of staff members in the infection unit. To that end, the Hospital Director issued a couple of orders: (1) procedures requiring postoperative care in ICU or HCU should be postponed because we need to keep the number of personnel in the infection unit (most of whom are from ICU and HCU), and (2) elective procedures should be postponed because of the lack of surgical gowns and masks. Between mid-April and mid-June, we performed no arthroplasties, no rotator cuff repairs, and no Bankart repairs; we only performed procedures for malignant tumors and paralytic / paretic cases. We are gradually resuming elective procedures. All patients must undergo mandatory PCR testing for COVID-19 before surgery in our hospital. In terms of the number of new cases (as of September 1, 2020), we are in the middle of the second wave. The death rate caused by this virus is 1.9% in Japan. The problem is that the more patients we accept, the worse the financial status of our hospital becomes. We are requesting the government to support the institutes in which coronavirus patients are being treated.
My professional life has changed dramatically. I used to travel abroad to attend international meetings and invited lectures almost every month. In addition, I used to travel extensively for domestic meetings and lectures. All of these activities have been cancelled, postponed, or changed to virtual. In January of 2020, everything was normal; I attended the Board-Certified Examinations of Japanese Orthopaedic Association in Kobe (a 1.5-hour flight from Sendai) as well as two local meetings in Sendai. However, the first coronavirus case in Japan was found in January and the cruise ship “Diamond Princess” was anchored in Yokohama harbor in early February after a passenger tested positive for the virus. The virus was confirmed in one passenger after another, ultimately affecting >700 passengers from this cruise ship. A great fear of the virus rapidly spread throughout the country. In early February, I had a plan to attend the Nepal / Japan Combined Orthopaedic Symposium in Kathmandu, Nepal, but, because of the fear of coronavirus, I cancelled the trip. I also was invited to the International Biennial Congress of Iranian Society of Knee Surgery, Arthroscopy, and Sports Traumatology in Kish Island, Iran, in mid-February, but that meeting was postponed because many invited speakers started to cancel their trips. From February 2020 until now (September 2020), I have not traveled anywhere in the world, not even to Tokyo; I have just stayed at home and continue to go to my university on a regular basis.
Our problems are by no means unique and, in comparison with many parts of the world, they almost pale into insignificance, although it is sometimes hard for individuals to see that. We are a lucky country, but we have not escaped the effects of this virus or the effects of our response to it.
Margaret Fok
Because of the proximity of Hong Kong with Mainland China, measures to control the spread of COVID-19 were started in late January 2020. With many locals still having the experience of SARS (2003) fresh in their memories, members of the public diligently started their preparation and precaution by stocking up food, cleaning their homes with bleaches, and wearing face masks, without being commanded by the government. Despite it being the start of the celebration of Chinese New Year, social gatherings were kept low.
In hospitals, many elective procedures were cancelled at the start of February 2020, with the priorities being given to emergency, trauma, and oncology procedures. Hospital staff were reminded by infection-control teams to be vigilant in terms of hand hygiene. Protective gear was given with specific instructions on how it should be put on and taken off in order to minimize the chances of contamination and infection. Some of the surgical wards were emptied and were converted to negative-pressure wards in preparation for potential patients with COVID-19. Measures were established for the management of patients with COVID-19 who needed emergency operations.
Although the number of confirmed cases each day was kept low (mostly <50) in this city as compared with the rest of the world, the public has remained vigilant in terms of mask-wearing and hand hygiene. Because of the population density, the public understand that any spread in the public may be disastrous. As a result, we have succeeded in not having any lockdown and only a minimal number of health- care workers have been infected with COVID-19 by working in the public hospitals.
We have gradually resumed elective procedures, although there was a period during which we kept the number of turnovers in the hospitals low (i.e., by performing one long procedure instead of a few shorter procedures). Zoom meetings and webinars have become the norm, and medical students have had to adjust to virtual learning.
With the borders being closed since March 2020, the general public has missed travelling. Yet, this enables people to slow down, spend time with their family, enjoy nature, and enjoy what the city has to offer.
34 ISAKOS NEWSLETTER 2021: VOLUME I