key: cord-0909475-imbuy8gc
authors: Khanuja, Harpal S.; Chaudhry, Yash P.; Sheth, Neil P.; Oni, Julius K.; Parsley, Brian S.; Morrison, J. Craig
title: Humanitarian Needs: The Arthroplasty Community and the COVID-19 Pandemic
date: 2020-04-24
journal: J Arthroplasty
DOI: 10.1016/j.arth.2020.04.054
sha: d5d686b11a92f9866279c37bafa4fe8db4aaddd1
doc_id: 909475
cord_uid: imbuy8gc

Abstract As the world struggles with the COVID-19 pandemic, healthcare providers are on the front lines. Although hip and knee arthroplasty surgeons are not at the center of the epidemic and it may seem our role is limited, there are and will be many opportunities to contribute. During international crises such as these, the less fortunate are the most significantly affected. We highlight the value of humanitarian medical work, contributions of the hip and knee arthroplasty community to date, and future needs following the resolution of the COVID-19 pandemic. We polled members of medical mission group lead by arthroplasty surgeons to understand their efforts and benefits they have received doing humanitarian work. Google Search and PubMed were used to find articles relevant to the current environment of the COVID-19 pandemic. We sought to understand how the arthroplasty community can contribute, based on historical lessons from prior pandemics and recessions, current needs and projections of the COVID-19 impact. We conclude that there will be a great need for humanitarian work, and as in the current time, the immediate need globally may not be in our subspecialty.

As the world struggles with the COVID-19 pandemic, healthcare providers are on the front lines. 4

Although hip and knee arthroplasty surgeons are not at the center of the epidemic and it may 5 seem our role is limited, there are and will be many opportunities to contribute. During 6 international crises such as these, the less fortunate are the most significantly affected. We 7 highlight the value of humanitarian medical work, contributions of the hip and knee arthroplasty 8 community to date, and future needs following the resolution of the COVID-19 pandemic. We 9 polled members of medical mission group lead by arthroplasty surgeons to understand their 10 efforts and benefits they have received doing humanitarian work. Google Search and PubMed 11 were used to find articles relevant to the current environment of the COVID-19 pandemic. We 12 sought to understand how the arthroplasty community can contribute, based on historical lessons 13 from prior pandemics and recessions, current needs and projections of the COVID-19 impact. 14 We conclude that there will be a great need for humanitarian work, and as in the current time, the 15 immediate need globally may not be in our subspecialty. The current COVID-19 pandemic has changed our understanding of the world and healthcare 27 delivery and highlighted many global deficiencies. As orthopaedic surgeons, it is in our nature to 28 fix what is broken. These situations that are beyond are control can be frustrating, particularly for 29 subspecialists with completely elective practices. Our clinical skills are best used in 30 orthopaedics, and many have continued to treat fractures and trauma in the current crisis. 31

Although it may seem that there is little else we can do, there are many opportunities to make 32 difference. In a worldwide crisis of this magnitude, there will be many opportunities for 33 humanitarian work, both home and abroad, within arthroplasty and outside of medicine. Many physicians enter the field of medicine to develop the skill to care for those afflicted by 38 illness and disability and to serve those who cannot help themselves. Although physician burnout 39 and increased cynicism in medicine have made it difficult at times for some to clearly envision 40 this purpose, humanitarian medical work offers benefit both to the practitioner and the patient in 41 many ways [1] . This has led many physicians to participate in medical or surgical mission trips. There may be little we can do with our clinical skills as hip and knee surgeons at the moment, 53 but we can use our knowledge and compassion to make a difference for many around the world. 54

In this time of pandemic, we are reminded that we are in this together. Regardless of income, 55 education, or nationalities, we are all connected as humans and subject to the ravages of a disease 56 that does not discern, discriminate, nor favor. Once this pandemic subsides, the impacts and the 57 effects on those in greatest need will increase. As the global economy recovers, the poor will 58 continue to suffer the most from longer term impacts of this crisis. 59 60 While the focus of humanitarianism is outward, the benefits are felt inward. In an era of 61 medicine defined by concerns of burnout, humanitarian work can help us rediscover our purpose. 62

Additionally, global mission work is transforming the way surgical care is delivered at home. It 63 can teach surgeons how to conserve costs, work with less, and better listen to patients in 64 considering their economic, social, and logistic needs when determining care. 65

In humanitarian work, we are in a unique position to tap into our empathic side and come to the 67 aid of those less fortunate to give help and hope. This pandemic offers us that opportunity now, 68 and its aftermath will require the aid of the international humanitarian community for years. 69

These times are difficult for all. We have our own concerns for our families, friends, co-workers, 70 and finances. However, there is also an opportunity to remember how much we have by helping 71 those with less. Requests have been made for surgeons and staff (including orthopaedic trainees) to be 152 redeployed throughout health systems in an effort to support our colleagues and to prepare for a 153 potential surge of COVID patients. It has been heartwarming to see orthopaedic surgeons and 154 residents stepping out of their comfort zone to care for patients in any way necessary. However, 155 a rise in the daily COVID burden does not obviate the need for orthopaedic services, and it is 156 equally important to shield a portion of our surgeons so they can maintain essential orthopaedic 157 functions. . As it applies to arthroplasty, we needed to be available to treat patients with peri-158 prosthetic fractures, acute peri-prosthetic infections, and revision patients with severe osteolysis 159 that are at risk of fracture without prompt treatment. Forging successful partnerships with the ED 160 has been critical. Patients that have screened out for COVID-19 should be evaluated primarily in 161 the orthopaedic clinic so that beds could be available for COVID-19 patients; this collaboration 162 has been very helpful for our ER colleagues. 163

The orthopaedic community has come together like never before to adapt to the COVID-19 165 crisis. We are in hope that the marketplace will soon return to some semblance of normalcy, so 166 that we could once again employ elective procedures to treat our patients with lower extremity 167 degenerative joint disease. Although a contraction in the market is likely due to patient 168 unemployment, loss of healthcare benefits, and inability to take time off, our sub-specialty will 169 continue to provide tremendous service to our patients when the time comes -and we will be demonstrated 2 nd waves as precautions were lifted early [7] . While the world is eager to move 185 on, until we are certain of control, we will continue to have outbreaks. Here we will need to be 186 vigilant as we resume elective cases. We will also have to be aware of the at-risk populations 187 domestically and internationally. From a humanitarian perspective those with fewer resources 188 and access are hit hardest. Not only is this a historical worldwide perspective, but it is evident in 189 today's crisis here in the U.S., where a disproportionate number of infections and deaths are 190 occurring in Black Americans [8, 9] . Immigrants and refugees within our own country have been 191 known to be a vulnerable population; the native American population had a 4 to 5 times 192 mortality rate from H1N1 [8, 10] . The impact will be greater in developing countries. The drain 193 on resources of already poor health care systems with weak infrastructures will be unsustainable. The global economic impact is certain to be devastating, but without understanding where we are 204 in the course of this pandemic, it is too early to forecast. In addition to the health care burdens 205 and circumstances outlined above, the interdependence of our global economy will remain 206 disrupted as we recover from this initial outbreak. Disruptions to supply chains and borders 207 closed to travel will continue to suppress economies as countries emerge from the crisis. A 208 global recession is likely [14] . 209

The economic effects in our country, on our patients, and on our practices will be evident and is 211 infected across the world increase, financial and medical resources will become sparse. Limits on 225 travel and lack of supplies from developed countries will add to this burden, and their recoveries 226 will be slow. 227

We have seen the difficulties here in the United States at a very early stage in this pandemic. 229

New York City's healthcare system has been overwhelmed. We can only guess the ultimate 230 financial impact. It is clear that the COVID pandemic is and will continue to be a humanitarian 231 crisis with far-reaching consequences [9] . Rapid spread of this virus is attributable to the 232 interconnected nature of today's world. Just as the collaborative nature of our societies led us to 233 this point, our best response would be a unified one, involving governments and private 234 organizations all over the world to build an infrastructure for managing the current issues and to 235 detect and avoid future pandemics. Developed countries will need to support less developed ones 236 and share best practices and knowledge [9]. While we see telemedicine and newer technologies 237 as a means to care for our patients while social distancing, it can revolutionize the care for those 238 without any access in underserved parts of the world both with direct care and education. Newer 239 technologies such as artificial intelligence, are currently being used to screen and identify 240 patients [22] . 241

As arthroplasty surgeons, we are not leading the fight in the front lines, but we can do our part 243 now and in the future. The humanitarian needs during and after COVID-19 will be great and 244 varied across the world. Given the compassion that brought us into medicine and the drive to fix 245 things that took us into arthroplasty, as long as we remain aware of the need, our contribution 246 will be a given. 247

The humanitarian efforts of our members, either as individuals or as part of organizations such as 251 the multiple Operation Walk chapters, need to be recognized and appreciated by us all. In light of 252 this, the AAHKS Humanitarian Committee will aim to identify and highlight the work of our 253 "AAHKS Heroes" quarterly on the AAHKS Humanitarian Endeavors website. We will also 254 continue to recognize the recipient of the AAHKS Humanitarian Award at the annual meeting. 255

There are multiple ways to make an impact, and we ask our membership to tell us of those who In an increasingly globalized world, AAHKS remains committed to efficiently developing 267 resources for humanitarian work as needed to address challenges in our local and international 268 communities. 269 their own PPE to aid in the fight against the COVID-19 pandemic. They credited Walk Strong in 324 helping them develop a "can do" attitude that has helped them so far. 325

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