The COVID-19 has shattered the daily routine, business, schools, lifestyle and economy of the globe. Social distancing and self-quarantine aim to slow down the increase of new infections, thereby avoiding a surge in demand on health care systems10. Some measures such as telemedicine are recommended to reduce hospital visits for some mild injuries11, 12. But even at the time of social distancing, patients with severe injuries require urgent treatments. And the number of that had not decreased as supposed. Economic recovery has been accelerated all over the world after a long time of social distancing and economic stagnation. Workers have started to return to their work in succession. Our study is pioneering in describing the unique pattern of injuries during this special time. It highlights the “outbreaks” of injuries during the work resumption following the COVID-19 pandemic.
Trauma at home makes accounts for the majority of all hand injuries in the outbreak time. That was the inevitable result of people staying at home. Nonlocal patients visits were significantly reduced because of the traffic restriction. With the work resumption of industries, we’ve observed a distinct change in the pattern of hand injuries. High social demand after a long shutdown had driven the staff to throw themselves into high-intensity work. As a result, severe manufacturing traumas increased rapidly. As the result of pandemic and economic stagnation, the public have been experiencing psychological problems13, 14. It is supposed that anxiety, depression, and stress of workers may increase the risk of unintentional injuries during the resumption of work15. One type of hand injury was quite typical in this special year, that is, the medical supplies manufacturing industry which returned to work in the first place. Compared with the 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 that these injuries occur during this special season when the medical services slow down.
As for the factories, educational campaigns as well as increasing the availability of professional workers during this special time are needed to reduce the incidence of hand injuries. Especially for those companies that have newly transformed to provide medical supplies, lacking of experience was a common phenomenon. Work resumption is encouraged to proceed in batches and in order. Local workers without a history of exposure to epidemic areas were allowed to return work first6.
Hospitals have to gear health care resources during this special time to meet the actual injury burden. As to reduce the risk of exposure in transit, patients were encouraged to treat in the hospital nearby. Furthermore, preventive efforts should be set in place to avoid the risk of COVID-19 spreading. Measures such as registration of personal information, regular disinfection, body temperature monitoring and cap on daily visitors are strictly implemented at all departments in our hospital to lower the risks of infection. Hangzhou was the first in the nation to launch a health QR code system on Feb 11, to curb the spread of infection as it tentatively restarted production16. The health QR code and body temperature is checked at the first stand of the hospital. Only patients with green QR code and normal body temperature are allowed into the emergency department. Those with temperatures higher than 37.3 are guided to the fever clinic first for the detection of infection. Nucleic acid test and CT lung screening are performed simultaneously. In our hospital, suspected patients are examined in a separated CT room different from the other patients. Statements with 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 of infection17. Patients are admitted to the ward only when the pneumonia has been excluded by the sputum culture and CT. Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG are performed while waiting for the COVID-19 test result. The initial clinician is responsible for the diagnosis and preliminary management of the injuries throughout the whole process. As direct contact is a high risk for healthcare professionals performing wound care, surgery and resuscitation10, 18. Appropriate use of personal protective equipment, as well as strict disinfection and hand hygiene are requested to every clinician10, 19. Under the premise of ensuring inspection, the time of emergency preoperative preparation was not significantly prolonged during the epidemic period. There are 105 patients of COVID-19 undergoing intense therapy and cured in our center. We have achieved amazing success with zero nosocomial infection and zero mortality rate in our center. None of the staffs in our center has been infected. Even in the solation wards, none of SARS-Cov-2 RNA was detected among the samples of objects20.
In this special season, medical workers may become anxious and fear to continue their work. However, it’s a time for solidarity, not fear. This outbreak is a test of solidarity political, financial and scientific, just as WHO Director-General Tedros Adhanom Ghebreyesus said21. Thus all doctors in our center have remained at their posts since the outbreak.