Pandemic Preparedness Among Spine Surgeons: Major Work in Progress
by Elizabeth Hofheinz, M.P.H., M.Ed.
“Learn from yesterday, live for today,” said Albert Einstein.
Alas, it’s pretty tough to follow in Einstein’s footsteps.
Ideally, we would all learn from Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), H1N1 Swine Flu, etc. Recently, a team of researchers from multiple institutions around the globe wanted to know specifically if spine surgeons had learned much from past disease epidemics that would help with our current pandemic. Their work, “Learning from the past: did experience with previous epidemics help mitigate the impact of COVID-19 among spine surgeons worldwide?” appears in the June 4, 2020 edition of the European Spine Journal.
Dino Samartzis, D.Sc. is Director of the International Spine Research and Innovation Initiative and an Associate Professor at Rush Medical College in Chicago. He told OSN, “We used the Global Health Security Index—a measure of 195 nations’ levels of health emergency preparedness—and compared it to a survey that we meticulously crafted and sent to spine surgeons worldwide.”
The 73-item survey—distributed via AO Spine—assessed demographics, COVID-19 preparedness, response, and impact. A total of 902 surgeons from 7 global regions completed the survey.
“Overall scope of the survey included surgeon demographics, country and region of practice, COVID-19 perceptions, institutional preparedness and response, personal and practice impact, and future perceptions,” wrote the authors. “Demographics obtained included country of practice, region of practice, population of city of practice, specialty, fellowship experience, year in practice, and practice type. Previous experience with SARS, MERS, H1N1, or Ebola was queried to ascertain experience with prior infectious disease outbreaks.”
“Of the 881 participants, the majority of the responses we received were from Europe (27.5%), Asia (24.2%), North America (17.3%),” said Dr. Samartzis. “Most spine surgeons had had no prior experience with an epidemic (75.8%). As for anxiety-producing nature of the epidemic, the three main stressors identified for those with previous epidemic experience were family health (74.5%), personal health (47.8%), and economic issues (46.7%). For those with no prior epidemic experience the concerns were as follows: family health (69.6%), community health (42.5%), and timeline to resume work (42%).”
Cue up the symphony?
The researchers found that coping strategies were fairly consistent between those with and without previous epidemic experience (exercise, music, meditation/mindfulness, tobacco, alcohol). But, said Dr. Samartzis, those who had been through an epidemic in the past reported using music more often than those who were new to an epidemic (43.9% vs. 33.7%).
“Formal hospital guidelines for epidemic/pandemic response were in place in 60.4% of respondents’ hospitals,” wrote the authors. “Prior epidemic experience did not impact on the presence of guidelines (64.2% vs. 59%). Surgeons reported having adequate PPE at a rate of 49.6%; prior epidemic experience did not impact PPE availability rates (51.9% vs. 48.7%). N95 masks were provided to 50% of respondents, surgical masks to 81.8%, face shields to 46%, gowns to 54.4%, and full-face respirators to 10.5%. There were no significant differences in the type of available PPE based on previous epidemic experience. Surgeons reported that 41% of their hospitals had adequate ventilators for the volume of patients they expected.”
The United States had a Global Health Security Index score of 83.5 and was ranked as the most prepared nation for a global pandemic. However, the team found poor correlation between this score and access to adequate PPE, N95 masks, and adequate ventilators. Dr. Samartzis commented to OSN, “We found no correlation between Global Health Security Index score and formal hospital guidelines.”
“This is an unprecedented survey of the spine surgeon community that has shed light on numerous aspects of preparedness,” stated Dr. Samartzis. “We are pleased that the World Health Organization will be using our work going forward.”
Asked how he hopes that the WHO might use this information, co-author Joe Weiner, M.D., an orthopedic resident at Northwestern University, told OSN, “Our study identified a few salient points that the WHO can use to guide their future pandemic guidelines. Shockingly, formal hospital guidelines for epidemic or pandemic response were only in place in 60% of respondents’ hospitals. Furthermore, prior epidemic experience did not impact the presence of guidelines. Our hope is that the WHO can utilize these statistics to make pandemic preparedness a requirement rather than a suggestion, similar to how they’ve made surgery safer through the Safe Surgery Checklist.”
“Hospital systems also need to take initiative in preparing for future pandemics. Our study identifies that COVID-19 was a wake-up call to many hospitals who were underprepared for an event of this magnitude. Leaders in our field need to promote a multidisciplinary approach for preparedness that keeps our patients safe and our practices up and running.”