PART I: What’s going on?
COVID-19 has brought many sudden changes to the hospital system, and subsequently in the way we interact with, prepare and treat patients. While some of these changes are temporary, some will likely continue well into future as our “New Normal”.
Humber Hospital is currently the second busiest in the province in terms of COVID-19 inpatient volume. The vast majority of patients are over 80, and a significant portion are from Long-term care facilities. The good news is that the ICU still has capacity, and the numbers of patients seems to be manageable.
Firstly, because of pandemic planning and resource allocation, all elective surgery in Ontario is currently on hold. While the curve seems to be flattening, there is no timeline to resume surgery yet. Once the government allows the health regions to resume surgery, each individual hospital will prioritize and slowly resume elective surgery.
However, the return to “normal” once started, will be different. The province and hospitals are working together to determine the safest way to resume surgical volumes. As a priority, this will involve all patients being tested for COVID-19 prior to surgery. The process, timing and administration of these tests has yet to be determined. There are logistical issues, in terms of where to administer these tests and self-isolation requirements after – as they depend on the turnaround time of testing as well as availability of the tests.
Once we get to surgery, there are anaesthetic concerns. Because the process of intubation (placing a breathing tube into a patient to allow for assisted ventilation while the person is completely anaesthetized during surgery) presents the highest risk to those doing the procedure (anaesthesiologists), spinals anaesthetics will likely be administered whenever possible. This will allow people to be frozen from the waist down, and comfortably sedated, while their hip/knee surgery takes place.
In addition to this, when elective surgery resumes, a preference for day surgery procedures will be given. This is to minimize the need for inpatient resources in case of a “surge” or second wave of COVID-19 patients. In terms of orthopaedics, this likely means same-day total hip replacements will take precedence over total knee replacements, or bilateral (both sides) surgery.
There is discussion that in an effort to minimize potential infection exposure and spread, “at risk” patients, may have their surgery delayed once elective cases start to resume. This means patients over 80, those with respiratory issues, or that immunocompromised may have wait longer until they can have their hip and knee surgery done safely.
All of these plans and regulations are in flux. The province, hospital and our office are trying their best to keep abreast of the changes and inform patients in a timely way. For now, it is unfortunately a bit of a waiting game until the curve is clearly flattening (and trending down), and direction is received from the Ministry of Health.
Until then, wash your hands, stay safe, minimize social interaction and stay tuned. The next part of this blog will give advice on how to deal with your hip and knee pain while at home and awaiting an in-person assessment or surgery.