As a serious global public health emergency, the impact of the COVID-19 on people's lives all over the world has greatly exceeded that of Ebola virus in 2014, Middle East respiratory syndrome (MERS) in 2015 and SARS in 2003. COVID-19 has a long duration and a wide range of spread, which is far beyond the previous global public health events in recent years. Under the strong control by the Chinese government, the pandemic of COVID-19 did not break out in Shanghai. On January 24, 2020, the Shanghai government announced to launch the first-level response of prevention and control. Subsequently, residents in Shanghai have experienced the whole process from first-level response to third-level response (Shanghai still hasn't stopped third-level response of prevention and control). In the process of fighting the pandemic, the economy, life and politics will change with the changes of the pandemic situation. The hospital's treatment process has also been optimized7. In this study, we found that children's orthopedic emergency also changed with the pandemic situation.
Before the response, the data about pediatric orthopedic trauma in Shanghai kept at the same level as the previous two years in terms of emergency number, emergency diseases, number of operations, severity of surgery or injury mechanism. The disease spectrum did not change significantly in different years. With the change of climate and semester, the number of orthopedic trauma in children in Shanghai increased with the rise of temperature and the beginning of school.
Under first-level of prevention and control response, schools and classes were suspended and all public places were closed. Without outdoor activities and campus life, the injury probability of children living at home is significantly reduced, so the number of emergency and surgery are significantly reduced. Moreover, the severity of the disease in children undergoing surgery was lighter than that in the previous two years. With family care, especially with the care of parents (most people stop work under first-level response), orthopedic trauma in children can be effectively avoided, and even if injured, the severity of the injury is less than that after school beginning. Interestingly, starting with the response, this decrease in the number and severity of injuries is not only reflected in trauma, but also in the number of subluxations of the radial head. The incidence rate of radial head subluxation in girls is higher than that in boys because girls are more likely to be pulled by their parents8. Similarly, we can speculate that outdoor activities and campus life will increase the probability of guardians pulling children's arms. Therefore, parents and preschool teachers should pay more attention to the correct posture when protecting their children in outdoor activities, and avoid direct arm pulling.
After the response level of prevention and control was adjusted to second-level, Shanghai began to recover gradually. But, most of the children are still staying at home. In the late stage of second-level response, older students from the graduating class returned to the campus (on April 27, 2020, the ninth grade and senior three in Shanghai was resumed). At this time, we found that the number of orthopedic emergency and surgery increased slightly, and the severity of surgical children has begun to be the same as that in previous years. The increase of trauma is directly related to the return of guardians to work and the reduction of family care for young children, which reflects the importance of parents for children's family care.
Under third-level response, public places and stadiums have been reopened in Shanghai, and non-graduating students are recommended to the campus. At this stage, the number of orthopedic emergency and surgical operations this year are the same as those in previous years. The severity of the damage has also returned to the level of previous years. We can infer from the data of pediatric orthopedic trauma that most of the children's study and life have recovered under third-evel response in Shanghai. It should be noted that the number of cases undergoing surgical treatment due to falling from height has increased compared with previous years. We compared the opening date of school and the date of falling building in recent three years and found that the visiting time of children with high falling injury was concentrated in the middle of the semester. For example: Although the age and school start date of the 10 high falling patients in 2020 are different, they are all injured in the middle of the semester after the beginning of school in their grade (Table 7). We can infer that the pressure on students caused by academic pressure will gradually increase with the progress of the semester. This provides guidance for the future school targeted psychological counseling.
Table 7
Information about patients with high falling injure in 2020
Patient No. | Gender | Age(y) | Opening Date (mm/dd) | Injury Date (mm/dd) | diagnose |
1 | male | 10 | last term | 01/07 | fracture of femur |
2 | male | 14 | last term | 01/13 | multiple injuries |
3 | male | 3 | - | 02/06 | Fracture of upper arm |
4 | female | 10 | 06/02 | 03/07 | fracture of tibia and fibula |
5 | male | 16 | 04/02 | 05/07 | fracture of spine |
6 | female | 16 | 04/27 | 05/10 | fracture of pelvis |
7 | male | 17 | 05/06 | 05/16 | multiple injuries |
8 | male | 15 | 04/27 | 05/18 | fracture of femur (bilateral) |
9 | male | 14 | 05/06 | 05/20 | multiple injuries |
10 | female | 13 | 05/18 | 06/07 | fracture of femur |