Timeline and Procedures on Restarting Non-Emergent Arthroplasty Care in the US Epicenter of the COVID-19 Pandemic
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RESPONSE TO COVID-19/COMMENTARY
Timeline and Procedures on Restarting Non-Emergent Arthroplasty Care in the US Epicenter of the COVID-19 Pandemic Friedrich Boettner, MD & Mathias P. Bostrom, MD & Mark Figgie, MD & Alejandro Gonzalez Della Valle, MD & Steven Haas, MD & David Mayman, MD & Douglas Padgett, MD
Received: 18 June 2020/Accepted: 7 September 2020/ * Hospital for Special Surgery 2020
Keywords
COVID-19 . elective surgery . arthroplasty
Introduction A novel coronavirus disease (COVID-19) was identified in several patients living in Wuhan, China, and first reported in December 2019 [35]. By early June 2020, the disease had been diagnosed in 6.6 million people and 388,000 deaths had been reported in 215 countries. Mortality rates were high in some European countries; in Italy, the rapid growth of COVID-19 cases led to shortages of hospital beds, ventilators, and personal protective equipment (PPE) [2]. The USA has had the highest number of confirmed cases–nearly 6 million by late August 2020 [15]. The first US case was reported in January 2020 [12], and the first case in New York State on March 1, 2020 [32]. As of May 24, 2020, New York State had the highest number of confirmed cases in the nation (374,085) and deaths (24,079) [15]. The state had more confirmed cases than many countries, and within New York State, New York City and its nearby counties of Westchester, Suffolk, and Nassau had 80% of all confirmed COVID-19 cases in the state [15]. The experience in other countries, coupled with predictions that COVID-19 could overwhelm local healthcare resources, led to a halt in all elective surgery. On
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-020-09801-4) contains supplementary material, which is available to authorized users. F. Boettner, MD : M. P. Bostrom, MD : M. Figgie, MD : A. Gonzalez Della Valle, MD (*) : S. Haas, MD : D. Mayman, MD : D. Padgett, MD Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA e-mail: [email protected]
March 7, 2020, the Governor of New York State, Andrew Cuomo, declared a state of emergency after 89 cases were confirmed in the state and after predictions indicated that the hospital capacity for beds, ICU beds, and ventilators would be insufficient to cope with the demand of people affected by COVID-19. Hospital for Special Surgery (HSS) suspended all elective outpatient visits and surgeries in mid-March 2020, a decision that had last been taken after the terrorist attack on September 11, 2001. Our hospital’s decision was soon followed by an executive order by the governor stopping all nonessential medical and surgical care in hospitals, clinics, surgical centers, and outpatient offices statewide. During March, April, and May, HSS, which had been primarily devoted to elective treatment of orthopedic and rheumatologic conditions, underwent a substantial transformation and admitted COVID-19 patients and others affected by non-orthopedic condi
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