Reduced presentations with fractures or orthopaedic infections to a major children's hospital during a national COVID‐19 elimination strategy

Abstract

Background From 26 March 2020, New Zealand implemented a COVID‐19 elimination strategy which initially involved substantive limitations on public movement and assembly, and closure of non‐essential businesses. We asked what effect this had on acute paediatric orthopaedic presentations to a tertiary children's hospital. Method The numbers, age and gender of patients with orthopaedic presentations, seen by either the Children's Emergency Department (CED) or the orthopaedic service during the study period, were compared with the equivalent 2019 period. Results During the first 64 days of lockdown, 708 patients were seen in CED with orthopaedic presentations compared with 1124 patients in the same period in 2019 (37% reduction). We found a 55% reduction in musculoskeletal infections (from 135 to 61), a 40% reduction in total fractures (from 446 to 268) and a 27% reduction in soft tissue injuries (from 520 to 380). In 2020, similar proportions of patients were admitted for operating room procedures (15%) or had fractures reduced under sedation in CED (17%), however, increased numbers of soft tissue injuries were managed through CED under procedural sedation. Conclusion A national COVID‐19 elimination strategy, closing all but essential businesses, limiting public movement, physical distancing and focusing on hand hygiene, led to reduced presentations not only with fractures and soft tissue injuries but also musculoskeletal infections. Increased numbers of patients had procedural sedation for soft tissue injuries, but there was no significant change in the proportion of patients admitted for surgery.

The Advantages of the Zero-COVID-19 Strategy

“…One of the most noticeable medium-term health benefits of the zero-COVID-19 strategy is the reduced presence of infectious diseases (e.g., [ 26 ]). In a study of Kawasaki disease, a communicable disease that can cause high fever and coronary vasculitis in children, researchers found that compared to 2018 and 2019, the incidence of the disease in Taiwan decreased by 30% and 31% in 2020, respectively [ 27 ].…”

“…However, in light of the unintended consequences that the zero-COVID-19 strategy could cause, such as a high demand for health care professionals for testing and tracing, more rigorous empirical evidence is needed to reach a more grounded conclusion in terms of whether the strategy also has a positive impact on the physical and psychological health of health professionals and other vulnerable populations, including COVID and non-COVID patients. Other than potentially reduced knock-on effects on the overall health and social infrastructure, medium-term advantages of the zero-COVID-19 strategy, such as a reduced presence of other infectious diseases and relatively undisturbed economic productivity, have also been discussed in the literature [ 26 , 27 ]. In addition to the reduced presence of health conditions, such as fractures and Kawasaki disease [ 26 , 27 ], it is possible that the relatively low presence of monkeypox in zero-COVID-19 countries such as China may also be contributed to the zero-COVID-19 strategy’s rigorous capability in curbing the transmission of viruses.…”

“…Other than potentially reduced knock-on effects on the overall health and social infrastructure, medium-term advantages of the zero-COVID-19 strategy, such as a reduced presence of other infectious diseases and relatively undisturbed economic productivity, have also been discussed in the literature [ 26 , 27 ]. In addition to the reduced presence of health conditions, such as fractures and Kawasaki disease [ 26 , 27 ], it is possible that the relatively low presence of monkeypox in zero-COVID-19 countries such as China may also be contributed to the zero-COVID-19 strategy’s rigorous capability in curbing the transmission of viruses.…”

Global Impact of the COVID-19 Pandemic on Orthopedics and the Implications of Telemedicine: A Systematic Review of the Literature

“…However, the New Zealand Government committed to an elimination strategy with a level four alert, declaring a state of national emergency on 25 March 2020. Level four was the most stringent and included the complete cessation of elective surgeries [ 79 ]. As a result, there was a 100% drop in elective surgeries.…”

Expert Update on Acute Bacterial Skin and Skin Structure Infection Treatment Options in the Community Setting

“…is may be because of increased hand hygiene and social distancing practiced to reduce COVID-19. 9,10 What organisms typically cause these infections? ABSSSIs in a generally healthy population are typically caused by Gram-positive pathogens, the most common being Staphylococcus aureus and beta-hemolytic streptococci.…”