Response To CoVid Pandemic

The initial response in Australia failed to take into account that the COVID virus is an airborne disease. Even without coughing or sneezing, people with the virus breath it out with every breath. Perhaps the initial response didn’t include masks as supplies were not available for the whole community, but now masks can easily be made or bought, and will probably be required for some months.

Masks for pandemics started with “The Great Manchurian Plague” of 1910-11. A Cambridge trained Chinese doctor Wu Lien-Teh introduced the idea. It was dismissed by some doctors – a French Professor Gerald Mesney was vocal in his opposition to masks, but then contracted and died from the airborne disease after visiting affected patients. The argument soon passed. Masks were again used in the Spanish Flu pandemic of 1918, but for generations, we have not had a serious airborne disease for which there is no vaccine.

Dr Wu Lien-Teh. Instigator of mask wearing.

There are a huge variety of masks available. In the Manchurian plague and Spanish flu, simple cloth masks achieved the result. Current studies suggest a cloth mask will reduce spread of infection by 75%. Each improvement beyond this is a small increment. Masks protect you from other people, and other people from you. 50% of people with infections will have very few symptoms, so it is critical everyone wears a mask at this stage.

Between telemedicine & internet radiology, we can sort out many patients without face to face meetings. We are sending text messages to individual patients with as clear instructions as possible. Some patients require plasters to be removed or stitches to be removed, but MOST of our patients have dissolving stitches. If you are required to attend – don’t bring books, drinks or handbags into our building. Wash you hands as soon as you arrive.

We require our patients and staff to wear masks. If you don’t have your own, a disposable mask is available. If you have a medical or psychological or some other issue making mask wearing impossible, please telephone our receptionist before attending here. Patients without masks will be asked to return to their cars until the issue is agreeably sorted out. A maximum of one support person per patient should also be adhered to.

Telephone calls and video phone calls are the new reality. We will telephone at the appointment time. We will either need credit card details or bulk bill you depending on your circumstances. We can look at XR’s over the internet. If you don’t have a referral, you will need to speak with our registrar first, who will arrange any details before you speak to the specialist orthopaedic surgeon. We cannot provide surgical care for people outside of the Ballarat & Western District region. Many computers have video cameras built in. If we have your email address, we can use “Zoom” or other programs to do video consultations over the internet.

Emergency Surgery
• Fractures unable to be managed with closed reduction & casting /bracing / strapping
• Infections not reasonably treated with antibiotics alone
• Tendon lacerations not reasonably managed non operatively (finger flexor tendons, pec major, triceps, achilles avulsion from bone)

Urgent (category 1) orthopaedic surgery
• Some emergency surgery is done as planned urgent surgery (see above)
• Malignant & potentially malignant tumours
• Imminent fractures (related to tumours, loose implants, extreme pain with weight bearing)
• Tendon ruptures not reasonably managed non operatively (finger flexor tendons, pec major, triceps, biceps at elbow, achilles avulsion from bone)
• Severe nerve compression where no other treatment available
• Locked knees (osteochondritis dissecans, meniscal tear with or without ACL)
• Locked fingers (as opposed to trigger fingers that sometimes lock)
• Primary or revision joint replacements are rarely indicated for falls or extreme intractable pain causing imminent admission to hospital

Essential surgery (category 2) is being undertaken for:
• Severe pain preventing sleep, work, or ability to function around the house
• Some high yield operations where limited resources are required
• Day surgery cases are also being limited to 75% capacity currently.
• Since we are working with very restricted capacity, we are avoiding surgery if situation is manageable with tablets, walking aids or splints

Elective surgery (category 3) is resuming but is not at full pace because:
• Limited anaesthetic resources.
• Limited Personal Protective Equipment availability.
• Safety of staff and patients. (Prevent Coronavirus spread).

Some orthopaedic conditions can be reasonably managed, or temporised with the best non operative treatment. Our orthopaedic surgeons and sports medicine team are expert in this. For patients where surgery is inevitable, we are making arrangements for their surgery and prioritising the patients so we can get you sorted out as soon as the Department of Health eases restrictions.

You will be required to wear a mask.  Phone prior if you can’t because of medical or psychological reasons.
Do not come if you are sick, phone instead.
If you have a cough, or sneeze, you will be asked to leave unless you are wearing a mask.
Do not bring extraneous items into the building.
Go directly to washing your hands.
Keep your distance from other people.
Be kind to other people – everyone is stressed.

Lake Imaging
Sovereign Radiology
Ballarat Base Hospital (try to leave this to the virus sufferers)
Bendigo Radiology (including Stawell & Ararat)
Healthcare (eg Wimmera)