PPE and economic concerns highlighted in global COVID-19 spine survey

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Over 900 spinal surgeons have contributed to research looking at the impact of the COVID-19 pandemic on their practice, with concerns over availability of personal protective equipment (PPE), and the long term economic and health impacts of curtailment of elective procedures among the emerging messages. The increasing prevalence of telehealth consulting and digitisation of research are other key themes to have been highlighted through the study.

The research, commissioned by AO Spine, canvassed views and insights from spine care specialists through more than 70 questions across six topics, covering: personal perspectives, attitudes and coping strategies; caring for patients; implications of government and leadership; financial impact; research; and, future challenges and impact. The research was developed by Dino Samartzis (Rush Medical College, Chicago, USA), chair of the AO Spine Research Commission, with contributions coming in from across the globe.

AO Spine has released early results from the research, and says it will continue to canvas views from the spinal surgery community to understand the financial impacts of the pandemic, as well as how governments and media have handled COVID-19, the transitions in patient care, and surgeons’ personal well-being.

The survey notes a 16% infection rate of COVID-19 among spine surgeons that had been tested, which AO Spine said, shows that surgeons are also vulnerable to this virus. “It underscores the fact that spine surgeons are not Teflon. Some surgeons said they were conflicted that if infected with the virus, whether they should disclose such information to their patients,” Samartzis commented.

As medical professionals that deal with delicate aspects of the body’s structure and function, spine surgeons have specific needs and concerns, AO Spine said in its release highlighting the results. Samartzis expressed alarm at the finding that personal protective equipment (PPE) are not standard and available to all worldwide. The study further highlighted that many spine surgeons may have multiple co-morbidities and report immense anxiety during this time, something that Samartzis further notes to be “a recipe for disaster if they ever do get infected with COVID-19, because they would fall into a high-risk group for complications.”

The survey also provides insights on what is going through the minds of spine surgeons; their greatest stressors, and what advice or encouragement they can give to their fellow colleagues and patients.

“Surgeons are not able to operate on patients they feel need surgery without considering the massive constraints on scarce resources and added risk of infection for their patients,” Dan Sciubba from Johns Hopkins University (Baltimore, USA), representing North America in the AO Spine Research Commission, said. “COVID-19 is not the only thing hurting patients. Those with cancer, heart disease, and other chronic illnesses still need our steadfast support. We cannot abandon these important and vulnerable patients.”

“The virus will have an unexpected long-term impact on our lives and work, economies, and international relationships,” the AO Spine release notes, adding that different reactions from governments, hospitals, health authorities, local culture, and economies will all have an impact on the survival of people and on healthcare systems.

“This will change the world,” Marko Neva, Research Commission member representing Europe and Southern Africa from Tampere, Finland, predicts. “That is why it is so important to do this study now and at various stages of the pandemic, to understand the impact to our spine surgeon community, treatment of patients, research, education of students and residents, and to compare outcomes of different reactions to it.”

While there are variations in societal restrictions imposed by governments, the initial results show similarities with the suspension of elective cases for an undefined time. The overall case volume has dramatically decreased for most spine surgeons and many are using more time for research and teaching. Lectures and seminars have been transferred online, and the appeal for online education is “astronomical”, the study’s findings suggest.

Additionally, as many as one in four surgeons are taking on medical roles outside of their standard practice of care to contribute to the response to COVID-19.

“Overall, our spine community has expressed sentiments of optimism, perseverance, determination, and unity,” Samartzis said. “They noted that this is a period of time-out to reconnect with family and for personal growth, as well as to reassess their priorities in life. It was evident that in many aspects, we as a community have more in common than differences. There is an underling thread of humanity that crosses all borders.”

“Most of us have never faced a pandemic like COVID-19,” states Philip Louie, one of the study developers from New York City, USA. “The outbreak has resulted in widespread work stoppages, hospital-wide reorganisations, drastic changes in societal norms, and raised amounts of anxiety and uncertainty for everyone.”

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