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Visit our Evidence-Based Covid-19 Website and Stay Up to Date with the latest Research.

OE COVID-19 EXCLUSIVE Resource Centre A Message from the Editor-in-Chief

COVID-19 BEST PRACTICES

The COVID-19 Pandemic requires the rapid identification and implementation of large-scale action. OE Best Practices will help guide MSK care in the weeks and months to come.

Best Practices

OE Best Practices for Surgeons V3.0

COVID-19 Evidence-Based Scoping Review A Unifying Report of Global Recommendations

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Best Practices

OE Best Practice for Virtual Meetings

Recommendations for transitioning to Virtual Meetings amid the COVID-19 Pandemic

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Endorsed by International Associations Worldwide

Full Report of ICM “Protocols for Resuming Elective Surgery” Available Exclusively on OrthoEvidence.

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Summary of ICM “Protocols for Resuming Elective Surgery” Published on JBJS.

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AIOT Releases Recommendations for 150K + Surgeons Worldwide Listing OE Best Practices as Key Resource.

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Italian Orthopaedics and Traumatology Society Translates OE Best Practices Document for Members.

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Canadian Orthopaedic Association Released Position Statement Referencing OE Best Practices Document.

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COVID-19 INSIGHTS

08/01/2020

A Vexing Virus and The Valuation of Vaccines

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07/25/2020

Health Care Heroes: Are We Asking Too Much?

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07/16/2020

Harnessing the Power of a Crisis: Will We Repeat History or Learn From It

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07/02/2020

Reaching Zero: New Zealand's Strategy in the Fight Against COVID-19

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06/13/2020

The Trouble with Testing: Navigating Uncertainty on the Road to Resuming Elective Surgeries

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06/07/2020

ALONE: Solitude As Strategy

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06/01/2020

A Surgical Deep Freeze: Backlogs, Burden and New Beginnings!

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05/23/2020

Welcome To The Jungle! Surviving Misinformation

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05/14/2020

The Case For, and Against "Corticosteroid Distancing" in the Management of Knee Osteoarthritis

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05/06/2020

Has the Pandemic Worsened the Epidemic? Opioid Use Disorder in Orthopaedic Patients

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04/27/2020

The Productivity Paradox Keeping Busy During Shutdown May Be The Wrong Strategy

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04/17/2020

Rise of a New Virtual "Reality" for Orthopaedic Surgeons: Boom or Bubble?

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04/07/2020

Masks in the Fight Against COVID-19: An 'Inconvenient' Truth

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COVID-19 PODCASTS
“This Study is highest level of evidence”: Dr DeSa urges community to reconsider Hip Injections

8/4/2020

“This Study is highest level of evidence”: Dr DeSa urges community to reconsider Hip Injections

Colombia’s Rapid Rise in COVID: Young are Major Source of New Infections

7/29/2020

Colombia’s Rapid Rise in COVID: Young are Major Source of New Infections

“We almost eliminated it -We were Wrong!” -Australias New Rise of COVID cases

7/29/2020

“We almost eliminated it -We were Wrong!” -Australias New Rise of COVID cases

“It’s A Very Difficult Time” : Entering the Second 14 day lockdown in India

7/23/2020

“It’s A Very Difficult Time” : Entering the Second 14 day lockdown in India

“It’s been a tumultuous year!” Professor McKee -President, Orthopaedic Trauma Association

7/21/2020

“It’s been a tumultuous year!” Professor McKee -President, Orthopaedic Trauma Association

“We Let Our Guard Down”: Florida COVID Cases Surge

7/17/2020

“We Let Our Guard Down”: Florida COVID Cases Surge

Estimates Suggest 1 in 200 (6 Million) Are Likely Infected: India Surging As Testing Increases

7/17/2020

Estimates Suggest 1 in 200 (6 Million) Are Likely Infected: India Surging As Testing Increases

“We’ve Had to Take Step Back After Re-opening: Cases Surge in San Antonio, Texas”

7/16/2020

“We’ve Had to Take Step Back After Re-opening: Cases Surge in San Antonio, Texas”

“Too much, Too fast” Re-Opening and COVID Surge In California

7/9/2020

“Too much, Too fast” Re-Opening and COVID Surge In California

Uganda Rising: Locusts, Floods, and COVID infections

7/2/2020

Uganda Rising: Locusts, Floods, and COVID infections

“The COVID Back”: Rise Backpain in the Young

6/24/2020

“The COVID Back”: Rise Backpain in the Young

Argentina: 9 of 10 Patients Say No To Elective Surgery

6/16/2020

Argentina: 9 of 10 Patients Say No To Elective Surgery

The 3 C’s: Japan’s strategy for crushing COVID-19

6/11/2020

The 3 C’s: Japan’s strategy for crushing COVID-19

India’s COVID-19 Lockdown Creates Mass Migration

6/9/2020

India’s COVID-19 Lockdown Creates Mass Migration

Hong Kong: We assume all patients coming for surgery are COVID positive

6/9/2020

Hong Kong: We assume all patients coming for surgery are COVID positive

We are in a War, And Much Will Be Learned in its Aftermath

6/5/2020

We are in a War, And Much Will Be Learned in its Aftermath

In Time of Crisis We Collaborate Extremely Well

6/2/2020

In Time of Crisis We Collaborate Extremely Well

We were just recovering from Ebola, when COVID-19 struck

5/28/2020

We were just recovering from Ebola, when COVID-19 struck

Brazil is the New Epicenter: “The poor cannot physical distance-they have to work to survive!”

5/26/2020

Brazil is the New Epicenter: “The poor cannot physical distance-they have to work to survive!”

Pakistan’s so called ‘Smart Lockdown’ Strategy: The ‘Poor’ under lockdown would starve to death.

5/26/2020

Pakistan’s so called ‘Smart Lockdown’ Strategy: The ‘Poor’ under lockdown would starve to death.

Radial Head Fractures: Not Letting COVID-19 Negatively Impact Quality of Care

5/22/2020

Radial Head Fractures: Not Letting COVID-19 Negatively Impact Quality of Care

Trauma Surgeons say “We’ve remained busy throughout COVID—and It’s only going to get worse”

5/20/2020

Trauma Surgeons say “We’ve remained busy throughout COVID—and It’s only going to get worse”

An Infodemic of Journal Publications Associated with Covid-19

5/19/2020

An Infodemic of Journal Publications Associated with Covid-19

Buckle Up: New AI Data Suggests Cases Will Continue to Rise in the Coming Months

5/14/2020

Buckle Up: New AI Data Suggests Cases Will Continue to Rise in the Coming Months

Added Strain on An Already Backlogged System: Orthopaedic Surgeons Urging for New Models of Care

5/13/2020

Added Strain on An Already Backlogged System: Orthopaedic Surgeons Urging for New Models of Care

Advocating for Patients: An Evolving Crisis of Unmet Needs for Orthopaedic Patients

5/8/2020

Advocating for Patients: An Evolving Crisis of Unmet Needs for Orthopaedic Patients

3 Critical Considerations in Resuming Elective Surgery

5/5/2020

3 Critical Considerations in Resuming Elective Surgery

Three Critical Things Australia Did to “Squash COVID-19”

4/30/2020

Three Critical Things Australia Did to “Squash COVID-19”

Unifying Through Alliances: 5 Major International Associations and 150,000 Surgeons Worldwide

4/29/2020

Unifying Through Alliances: 5 Major International Associations and 150,000 Surgeons Worldwide

Sweden’s Less Radical Approach to Physical Distancing

4/23/2020

Sweden’s Less Radical Approach to Physical Distancing

We were not ready: It came so fast” Real Talk from Paris, France

4/23/2020

We were not ready: It came so fast” Real Talk from Paris, France

Germany’s Largest Arthroplasty Center Triaging Only the Most Urgent Patients

4/20/2020

Germany’s Largest Arthroplasty Center Triaging Only the Most Urgent Patients

No Elective Orthopaedic Surgery Until September 2020: Singapore’s  "Circuit Breaker" Approach

4/20/2020

No Elective Orthopaedic Surgery Until September 2020: Singapore’s "Circuit Breaker" Approach

Oman’s Elderly Have been Cocooned At Home: Dramatic Decrease in Hip Factures

4/15/2020

Oman’s Elderly Have been Cocooned At Home: Dramatic Decrease in Hip Factures

India’s Starting Another 3 Week Countrywide Lockdown: 95% Reduction in Orthopaedic Surgical Care

4/14/2020

India’s Starting Another 3 Week Countrywide Lockdown: 95% Reduction in Orthopaedic Surgical Care

“Our Mentors Are Smiling”: Re-learning the Principles of Non-operative Trauma Care

4/14/2020

“Our Mentors Are Smiling”: Re-learning the Principles of Non-operative Trauma Care

Beware of NSAIDs and Corticosteroids”: Rethinking Pain Management During COVID-19

4/14/2020

Beware of NSAIDs and Corticosteroids”: Rethinking Pain Management During COVID-19

New Modeling Reveals that North America Is Grossly Underestimating COVID-19 Infection Rates

4/12/2020

New Modeling Reveals that North America Is Grossly Underestimating COVID-19 Infection Rates

Supporting the Frontlines in NYC: The Redeployment of Orthopaedic Residents and Faculty To Medicine and Intensive Care Units

4/8/2020

Supporting the Frontlines in NYC: The Redeployment of Orthopaedic Residents and Faculty To Medicine and Intensive Care Units

Almost All Trauma Patients in Pavia, Italy are Positive Now: Tough Decisions in Fracture Care in Patients With COVID Pulmonary Disease

4/8/2020

Almost All Trauma Patients in Pavia, Italy are Positive Now: Tough Decisions in Fracture Care in Patients With COVID Pulmonary Disease

Rethinking Hospital Spaces in one of Spain’s Largest University Hospitals As They Manage 700 Inpatients with COVID Disease

4/8/2020

Rethinking Hospital Spaces in one of Spain’s Largest University Hospitals As They Manage 700 Inpatients with COVID Disease

Evolving Partnerships Between Physiotherapists & Surgeons Amid the COVID-19 Pandemic

4/6/2020

Evolving Partnerships Between Physiotherapists & Surgeons Amid the COVID-19 Pandemic

How Universities Can Work With Hospitals to Manage The Looming COVID-19 Bed Shortage

4/5/2020

How Universities Can Work With Hospitals to Manage The Looming COVID-19 Bed Shortage

Sash Vaid, PhD - Flattening the Curve: A Glimmer of Hope

4/3/2020

Sash Vaid, PhD - Flattening the Curve: A Glimmer of Hope

Dr. Zain Chagla Provides Update on COVID-19 Pandemic in Canada

4/2/2020

Dr. Zain Chagla Provides Update on COVID-19 Pandemic in Canada

OrthoEvidence Launches Evidence Based COVID-19 Resource Centre

3/27/2020

OrthoEvidence Launches Evidence Based COVID-19 Resource Centre

View All Covid-19 Podcasts
Listen on Apple & Spotify

OrthoEvidence Partners with JBJS for a Rapid Evidence-Based Review:

Novel Coronavirus COVID-19: Current Evidence and Evolving Strategies

ACCESS THE REVIEW LETTER FROM THE EDITOR
COVID-19 Related OE Originals

Our Covid-19 OE Originals' leverage the expertise of our in house data scientists who provide new data analyses and results to inform critical questions.

8/6/2020

The Sobering Story of SARS-CoV-2 Seroprevalence: What You May Have Heard About Herd Immunity

7/29/2020

Why Bill Gates is “Most Excited” About The Promise of Monoclonal antibodies for COVID-19: Evidence Deep Dive

7/27/2020

Don't Believe the Hype; Remdesivir in the Treatment of COVID-19

7/17/2020

Delivering Bad News: The Emergence of “Protector” As a New Health Care Provider Role

7/7/2020

UPDATE 2.0: Emerging Treatments in Fight Against COVID-19

7/2/2020

COVID-19 Delays: Patient Perspectives on Orthopaedic Surgery Postponements and Post-operative Care Limitations

6/24/2020

Dexamethasone: New Study Shows Promising Results for COVID-19 Patients

6/16/2020

Facts Don’t Have Feelings: Prophylaxis, treatment, and safety of hydroxychloroquine / chloroquine against COVID-19

6/12/2020

Tele-Rehabilitation: Will it Move Us, or Just Move Away?

6/2/2020

Vitamin D and COVID-19: Taking It Won’t Hurt, But Probably Doesn’t Help!

5/26/2020

Caught in the COVID-19 Crossfire: Supporting Patients Facing Surgical Uncertainty

5/20/2020

Tips for Navigating the Information Epidemic During a Crisis

5/20/2020

UPDATE: Emerging Treatments in Fight Against COVID-19

5/13/2020

The (R)evolution of Virtual Communication You may not love it, But Some of Your Patients Do!

5/11/2020

Life-threatening Clots in COVID-19 Patients: Digging Deeper

5/11/2020

Anxiety and Depression in the COVID-19 Pandemic: Are We Doing Enough?

5/8/2020

Improving Fracture Care Begins by Ensuring Timely Treatment: Critical Barriers in Emergency Care Systems in Low-Resource Settings

4/30/2020

Tumor Surgery and Research Goes On Amid O.R. Shutdowns: A Double-Edged Sword for Patients in the COVID-19 Era

4/23/2020

Trapped at Home: The Rise in Domestic Violence During COVID-19

4/20/2020

Emerging Treatments in Fight Against COVID-19

4/12/2020

OE BEST PRACTICES

4/3/2020

Cloth Masks for protection against COVID-19: MythBuster

4/2/2020

COVID-19 Pandemic: A Global Perspective

3/27/2020

COVID-19: Guiding surgeons through this pandemic

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If we have ever needed quality and timely data to help us make critical decisions---decisions that will ultimately save lives and restore health—we need it now. The COVID-19 pandemic has generated millions of data points. We have the answers, we simply need the tools to extract the signal

Mohit Bhandari MD, PhD, FRCSC

Professor and University Scholar, McMaster University

Hamilton, Ontario, Canada

All elective surgeries (such as total knee replacement) have been postponed indefinitely, while surgeons using full protective gear will perform high-risk aerosol-generating procedures (such as extensive burring/drilling). A geriatric hip fracture case was actually confirmed to be COVID positive after her hemiarthroplasty, fortunately, none of the medical staff was infected.

Samuel Ling, MD

Assistant Professor of Orthopaedics & Traumatology

The Chinese University of Hong Kong

Hong Kong, China

Currently, as on 17/03/2020, there have been 4 deaths reported in India, and the number of infected cases in India have reached 149. Pune has reported 16 cases already. In my opinion, we are in the 2nd phase of this pandemic and there is a possibility that further spread may occur and the scenario may worsen if we enter the 3rd phase wherein communities may get infected.

Parag Sancheti, MD, FRCS (Ed), MS, DNB, MCh ,Ph.D

Professor & Chairman Sancheti Institute

For Orthopaedics & Rehabilitation

Pune, India

It is crucial to enhance international communication and collaboration to fight the disease. The key message is to alert the mass of common people, globally, to do their best to prevent infection. I estimate that the pandemic of COVID-19 might end in June this year. However, if not all the countries take this seriously and put in action interventions, the anticipated turning point of its pandemic will postpone.

Nanshan Zhong, MD

Professor, Chinese epidemiologist and

pulmonologist who discovered

the SARS coronavirus in 2003

The steady declination of cases in recent two weeks in China has been credited to the effective national interventions. We need to keep the data open and transparent, enhance sensitivity of early nucleic acid testing is important. Any intervention strategies should be evidence-based. Policy-makers should take actions based on the local public health experts’ opinion. Community isolation is probably inevitable. Every area should try efforts to find the best model fitting to local condition. Lastly, it is valuable to enhance international communication of researches and experiences on the pandemic control.

Guang Zeng, MD

Professor, Chinese Epidemiologist

Chief Scientist from the Chinese Center for Disease

Control and Prevention (Chinese CDC)

In Mexico, COVID -19 cases are just starting to climb, with around 120 cases reported so far. Streets are empty and misinformation is climbing. Our politicians are not doing their part- only thinking about re-election maneuvers. The healthcare system is preparing for the worst-case scenarios and are trying to learn from other countries experience. Young doctors are ready to fight, while older doctors try to dig into there experience to fight against this virus. We as a society have to be brave and strong to be able to get a victory around this scary situation

Edmundo Berumen, MD, FRCSC

Orthopaedic Surgeon

University of Mexico

...the Division of Trauma at R Adams Cowley Shock Trauma Center are into our second week of significant changes to mitigate the impact of COVID-19...we conduct our daily Morning Report virtually—each member of the team in a different office. Clinically, we have split our service into three teams working 3 days at a time. We are making all these changes to prevent the spread of the novel coronavirus within the team, and most importantly, to ensure we have sufficient personnel once members get infected. Will this work? The uncertainty is quite unnerving.

Gerard Slobogean, MD, MPH, FRCSC

Associate Professor, Department of Orthopaedics

University of Maryland

With time and implementation of a lot of drastic policies & stringent measures, Hong Kong has been able to prevent major outbreak in the community....gradual resumption of elective surgeries, increasing outpatient attendance, more interactive educational activities, and progressive normalisation of all the research works have been coming back gradually since early March 2020. Having said that, because of the outbreak in America & Europe in the recent few weeks, Hong Kong is again at threat of another wave because of infected cases from overseas...

Professor YUNG Shu Hang Patrick JP

Chairman, Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong

President, Asian Federation of Sports Medicine

In consequence of COVID-19, the orthopaedic community has come to a standstill in Canada, with most centres acting responsibly by cancelling all elective surgery and nonessential clinical visits to limit interactions…. Throughout Canada, responsible orthopaedic surgeons are exclusively treating urgent cases and adopting strict safety protocols to avoid further spread of COVID-19 while delivering emergency care… we commend your efforts and are grateful for your contributions.

Mark Glazebrook, MD, FRCSC, PhD

President

Canadian Orthopaedics Association

The COVID-19 is also increasing in Germany with a current number of infected cases around 58.000. Fortunately, the mortality rate in Germany is with 0.77% signifcantly lower compared to other countries. One reason for the lower mortality might be the fact, that the German government started early with preventive policies to avoid the corona virus spread. In Germany, the vast majority of hospitals have postponed elective surgeries, interventions and admissions in order to have free capacity for COVID-19 patients. In our arthroplasty center, we only perform cases such as periprosthetic fractures, dislocations of the hip prosthesis, periprosthetic joint infections or acute spinal disorders.

Mustafa Citak MD, PhD, CPT

Hamburg, Germany

As of March 28, there are 1909 COVID cases in Chile with 6 deceased people. The highest percentage of cases (56.8%) is concentrated in the Metropolitan Region… In conversation with some orthopedic colleagues, only emergency surgeries are being performed at various healthcare centers. All elective surgeries have been postponed until further notice.... Also, in the centers where I work, the teams have been divided so that one group is active and the other group is in preventive quarantine for 2 weeks. At the end of this period we will make the respective change.

Fernando Vargas, MD

Foot and Ankle Surgeon

Clinica Santa Maria

Hospital Mutual de Seguridad

In Amsterdam the COVID19 situation is still under control. The hospitals are preparing for a worst case scenario. All elective cases are postponed. OR staff is trained to use ventilators in ICU setting. The OLVG hospital launched a smartphone app to monitor inhabitants of Amsterdam who have minor symptoms. In this way the hospital is able to gauge the situation and is prepared to scale up. All residents - including ortho - are taking shifts to answers questions from app users and give advise. Never waste a good crisis. This gives us opportunities to speed up digital consultations with patients. We hope to find smart solutions working towards a digital hospital.

Rudolf W. Poolman MD PhD

Orthopedic Surgeon-Scientist

Leiden University Medical Centre

Leiden, Netherlands

SARS-CoV-2 coronavirus has crossed all borders. In Spain, the coronavirus is growing exponentially. Radical measures that the situation demanded have been taken late. Data from 7 April report more than 140,511 confirmed Covid-19 cases and more than 13,897 deaths. Tests are not done on all symptomatic patients, so it is considered that only 20% of cases are being diagnosed. Around 12% of Health personnel has been infected. Since March 14 the radical measures were taken and confinement is rigorously controlled, probably this is the reason why new infected cases and new deaths are decreasing. Data that should be taken with caution.

Ernesto Guerra

Vall d´Hebron University Hospital

Barcelona, Spain

KEY TAKEAWAYS
  • Coronavirus originating from Wuhan, China in December, 2019
  • Can be transmitted directly or indirectly by asymptomatic and presymptomatic persons
  • As of March 26, 2020: 462,684 infected; 20,834 deaths
  • Most common symptoms are fever and cough. Presenting on avg 5.1 days after infection, with 97.5% presenting by 11.5 days
  • Hygiene, social distancing, and isolation are most recommended mitigation measures. Public and private closures are recommended in specific cases
  • 88.2% have abnormalities on chest x-ray
  • Mortality rate estimates are approximately 3.9% in confirmed cases. Comorbidities most likely linked to mortality are cardiovascular disease and diabetes
  • 20% of cases are severe or critical
  • Social distancing seems effective in flattening the curve from evidence of the 1918 influenza pandemic
  • A second wave was seen in both SARS and the 1918 influenza epidemics following relaxation of containment methods