The COVID-19 pandemic shattered daily routines and disrupted businesses, schools, lifestyles, and economies around the globe. Social distancing and self-quarantine aim to slow the increase of new infections, mitigating a surge in demand for health care10. Some measures such as telemedicine, are now recommended to reduce hospital visits for some mild injuries11, 12. Nevertheless, even during a time of social distancing, patients with severe injuries require urgent treatment and the number of such injuries has not decreased as was supposed. The economic recovery is accelerating all over the world after a long period of social distancing and economic stagnation. Workers have successively begun to return to their workplaces. Our study is pioneering in that it describes unique patterns of injuries which occurred this non-typical time. We highlight spikes in hand injuries during the work resumption following the COVID-19 pandemic.
Trauma at home accounts for the majority of all hand injuries seen during the outbreak period, inevitable as people stayed at home. Non-local patients visits were also significantly reduced because of traffic restrictions. However, as industrial work resumed, we observed a distinct change in patterns of hand injuries. High social demand after a long shutdown has motivated workers to throw themselves into high-intensity work. Thus, workplace injuries, especially manufacturing traumas, increased rapidly during the work resumption period. The proportion of major injuries has also tended to increase; our research illustrates this via comparison with the same period in the previous year. As a result of pandemic and economic stagnation, members of the public have also experienced an increase in psychological problems13, 14. Research has suggested that anxiety, depression, and stress in workers may increase the risk of unintentional injuries during the resumption of work15. One type of hand injury was relatively typical in this non-standard year, those sustained in the medical supplies manufacturing industry, the first to return to work. Compared with a control group, the study group had a longer length of stay on average. This does not necessarily reflect worse injuries. It could be due to the situation in which these injuries occurred during an atypical time when the medical services are slowed down.
Educational campaigns aimed at factories as well as an increase in the availability of professional workers during this atypical time are needed to reduce the incidence of hand injuries. In particular, in companies that have newly transformed to provide medical supplies, a lack of experience was a common phenomenon. It is recommended that the resumption of work proceeds sequentially and in segments. Local workers without a history of exposure to areas affected by the epidemic were allowed to return to work first6.
Hospitals must re-orientate health care resources at this unique time to meet actual injury burden. Indeed, in order to reduce the risk of exposure in transit, patients were encouraged to seek treatment in nearby hospitals and preventive measures should be put in place to avoid the risk of COVID-19 spreading. These include the registration of personal information, regular disinfection, body temperature monitoring, and a cap on daily visitors, all strictly implemented across all departments in our hospital to lower the risks of infection. However, despite the necessity of ensuring effective inspection, the time required for emergency preoperative preparation was not significantly prolonged during the period of the epidemic.
The city of Hangzhou was the first in China to launch a health QR code system to curb the spread of infection as it tentatively restarted production16. This health QR code and body temperature were checked at first contact upon entry into the hospital. Thus, only patients with a green QR code and normal body temperature were allowed into the emergency department; those with temperatures higher than 37.3℃ are guided to the fever clinic first for infection screening. A nucleic acid test and a lung CT scan are then performed simultaneously. In our hospital, patients who are suspected of being infected are examined in a separated CT room, distinct than the one used for other patients. Statements with a consensus agreement from an international Delphi process supported a distinction of surgery between protocols involving patients with suspected COVID-19 and those perceived to be free from infection17. Patients are admitted to the ward only when pneumonia has been excluded by sputum culture and CT. Preoperative preparation includes blood work, a medical evaluation, a chest x-ray, and an EKG, all performed while waiting for COVID-19 test results. The initial clinician is responsible for the diagnosis and preliminary management of the injuries throughout the whole process. As direct contact poses a high risk for healthcare professionals performing wound care, surgery, and resuscitation10, 18, the appropriate use of personal protective equipment, as well as strict disinfection and hand hygiene are required of every clinician10, 19. A total of 105 patients with COVID-19 are either undergoing intensive therapy or have been cured in our center. We have also achieved substantial success with zero nosocomial infections and have a zero mortality rate. In addition, none of the staff in our center have been infected, even in the isolation wards, no SARS-Cov-2 RNA has been detected amongst objective samples20.
It is also the case that at this unique time, medical workers may become anxious and may be afraid to work. This is a time for solidarity, not fear; the COVID-19 outbreak is a test of solidarity in the political, financial, and scientific spheres, as stated by WHO Director-General Tedros Adhanom Ghebreyesus21. Thus, all doctors in our center have remained at their posts since the outbreak in a show of solidarity.