The COVID-19 has shattered the 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, thereby avoiding a surge in demand for health care systems10. Some measures such as telemedicine, are now recommended to reduce hospital visits for some mild injuries11, 12. But even in 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 time 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 during this non-typical time. It highlights spikes in hand injuries during the work resumption following the COVID-19 pandemic.
Trauma at home, accounts for the majority of all hand injuries during the time of the outbreak. This was an inevitable result of people staying at home. Nonlocal patients visits were significantly reduced because of traffic restrictions. With the resumption of work in industries, we have 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. As a result, workplace injuries, especially manufacturing traumas, increased rapidly during the work resumption period. Thus, the proportion of major injuries has tended to increase. Our research illustrates this through comparison with the same period of the previous year. As a result of pandemic and economic stagnation, members of the public have been experiencing an increase in psychological problems13, 14. It is supposed 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, namely, injuries sustained in the medical supplies manufacturing industry which was 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.
When considering factories, educational campaigns 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 gear health care resources during this special time to meet the actual injury burden. In order to reduce the risk of exposure in transit, patients were encouraged to seek treatment in nearby hospitals. Furthermore, preventive efforts should be put in place to avoid the risk of COVID-19 spreading. Measures, such as the registration of personal information, regular disinfection, body temperature monitoring, and a cap on daily visitors are strictly implemented in all departments in our hospital to lower the risks of infection. Despite the necessity of ensuring effective inspection, the time of emergency preoperative preparation was not significantly prolonged during the period of the epidemic.
On February 11, Hangzhou was the first city in the nation to launch a health QR code system to curb the spread of infection as it tentatively restarted production16. The health QR code and body temperature is checked at first contact upon entry into the hospital. Only patients with a green QR code and normal body temperature are allowed into the emergency department. Those with temperatures higher than 37.3 degrees Celsius are guided to the fever clinic first for infection screening. A nucleic acid test and a CT lung screening are performed simultaneously. In our hospital, patients who are suspected of being infected are examined in a separated CT room, different 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 the sputum culture and CT. Preoperative preparation includes blood work, a medical evaluation, a chest x-ray, and an EKG – which are performed while waiting for the 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. There are 105 patients with COVID-19 who are either undergoing intensive therapy or have been cured in our center. We have achieved substantial success with zero nosocomial infections and a zero mortality rate in our center. None of the staff in our center has been infected. Even in the isolation wards, no SARS-Cov-2 RNA was detected among the objective samples20.
In this very particular time, medical workers may become anxious and may fear continuing their work. However, this is a time for solidarity, not fear. This outbreak is a test of solidarity in the political, financial, and scientific spheres – as stated by WHO Director-General Tedros Adhanom Ghebreyesus21. In a show of solidarity, all doctors in our center have remained at their posts since the outbreak.