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AAOS Now

Published 4/30/2020
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Julie Balch Samora, MD, PhD, MPH, FAAOS

Two Orthopaedic Leaders Discuss Their First-hand Battles with COVID-19

The COVID-19 pandemic has turned personal for various AAOS members: AAOS leaders Elizabeth Matzkin, MD, FAAOS, associate professor at Harvard Medical School and chair of the newly created AAOS Membership Council, and Douglas W. Lundy, MD, MBA, FAAOS, an orthopaedic traumatologist at Resurgens Orthopaedics in Atlanta and AAOS Now Editorial Board member, were both diagnosed with COVID-19. They shared their personal stories and advice with Julie Balch Samora, MD, PhD, MPH, FAAOS, during a roundtable discussion.

Dr. Samora: Prior to your COVID-19 diagnosis, what were your work responsibilities (e.g., were you still participating in orthopaedic endeavors, including elective procedures; had you been converted to frontline providers; etc.)?

Dr. Matzkin: I had worked a pretty busy schedule the week of March 9 to 13, with the anticipation that we would be “shut down” for COVID-19 starting on March 16. On March 13, I saw clinic patients in the morning and did a few elective cases in the operating room (OR) in the afternoon. I was asymptomatic at the time.

Dr. Lundy: I am an orthopaedic trauma surgeon, so I still had a fairly full workload of patients with fractures and severe injuries who needed to be seen. As a result, little changed from my perspective. Our hospital system is staffed with the full array of specialists, so the only way we would be converted to frontline physicians would be if massive numbers of them went out on quarantine or had a positive diagnosis.

Dr. Samora: What was your organizational response to this pandemic (e.g., early cancellation of elective cases or clinic visits, personal protective equipment [PPE] policies)?

Dr. Matzkin: Our organizational response was early and aggressive. We quickly shut down unnecessary patient clinic visits and all elective cases on March 16. Being a part of a large academic medical center in a metropolitan location, we did all we could to be as prepared as possible for the pandemic. We went from our normal practices to virtual visits in about three days. There was constant communication regarding the rapidly changing guidelines for COVID-19 testing and PPE.

Dr. Lundy: Our hospital was one of the last in Atlanta to stay “status quo” until we felt that it was irresponsible to proceed that way any longer. After that, we were only doing “urgent” and “emergent” cases, which is the vast majority of what I do anyway. My more elective partners saw their volume evaporate overnight, especially total joint arthroplasty. We had cut the clinic down to the patients who were absolutely necessary (postoperative or patients with acute problems) until we were able to get telemedicine up and going. PPE was and remains a challenge. Trying to get masks for everyone is a dilemma.

Dr. Samora: What were your initial symptoms?

Dr. Matzkin: I woke up on March 14 and felt a bit tired and sore. I assumed it was secondary to my busy work week, but by March 15, the body aches and low-grade fever started to make me think twice. This persisted for a few days, and then the body aches and fevers resolved. As I felt a bit better, I noticed I had lost my sense of taste and smell. At that point, I was certain I had COVID-19. Because I was not acutely ill, our occupational health did not recommend immediate COVID-19 testing but to continue to self-quarantine. After one week of symptoms, I thought I was feeling better, but things changed overnight. It started with a cough that proceeded to get worse over the next three days. It was hard to complete a sentence without coughing. My chest felt tight and heavy. There was a “sense of doom” in my chest and breathing the evening of March 23.

Dr. Lundy: My initial symptoms were fatigue and malaise. I had been so incredibly careful to avoid getting this that it was inconceivable when I realized I might have it. I got through clinic and went home. Fortunately, my wife and I are “empty-nesters,” and she was at our son’s place in Auburn, Ala. When I awoke the next day, I knew something was badly wrong. I called my friends in our health system, and they directed me to the nearest urgent care, where they had a test waiting on me. At that point, I was feeling exhaustion, malaise, and body aches.

Douglas W. Lundy, MD, MBA, FAAOS
Elizabeth Matzkin, MD, FAAOS

Dr. Samora: Can you describe the testing process?

Dr. Matzkin: On the evening of March 23, I went to the emergency department with some difficulty breathing. I had bloodwork and a chest X-ray. My chest X-ray demonstrated “bilateral lower lobe opacities, likely representing COVID-19.” I was also tested, which required a swab through the nose to the back of the throat. It was fairly uncomfortable and makes you cough, which is also what I was trying not to do. At that time, test results took four to six days. Now, we can get results in 24 hours. I was already feeling better by the time I received my results: “POSITIVE COVID-19.”

Dr. Lundy: The process was incredibly professional and compassionate. I put my N95 mask on when I arrived, and they rushed me back to a room with two nurses covered in PPE. They did a stat flu test, which was negative. I had a long discussion with the urgent care doctor, and we discussed that my case was atypical. He ordered a chest X-ray, which had classic findings. We then decided to do the test, which consisted of a nasal swab that goes all the way to your pharynx. That was a miserable experience, and I coughed and gagged all over the poor urgent care physician, who handled it in stride. Four days later, he called me with the positive results.
In one vein, I was relieved to know that I had “the virus.” To be that sick and not have COVID-19 would have depressed me severely. What would happen if I did contract COVID-19 being this sick with something else? On the other hand, knowing that I had the diagnosis itself was terrifying. The dyspnea started on day three, and it has been the worst thing overall.

Dr. Samora: Who was your primary provider managing your disease process?

Dr. Lundy: My “primary” provider was all from friends. I’m actually not even sure if my primary care provider knows that I was sick. Part of the problem that we have as “connected” physicians is that we know everyone. The good part of that is that we gain instant access. The downside is that we are the victims of “shortcuts” that our friends take for us.

Dr. Samora: Did he or she discuss the possible use of hydroxychloroquine?

Dr. Lundy: I discussed hydroxychloroquine with my friend who is the service line chair for pulmonary medicine. He was very negative about me trying it. As surgeons, we either believe science, or we don’t. As a result, I did not take this, although I know they would have found some for me if I wanted it (see “shortcuts” above).

Dr. Samora: Did you require hospitalization?

Dr. Matzkin: I did not require hospitalization. My O2 saturation was in the low 90s, my other vitals were stable, and my bloodwork was normal. I returned home and started to slowly feel better over the ensuing days.

Dr. Lundy: No, thankfully I did not. My dyspnea always settled down when I would rest. I had no less than eight or 10 physicians (not just orthopaedic surgeons) checking in on me daily, and I know they didn’t trust me. They were ready to drag me up to the hospital on a second’s notice. They carefully evaluated me over the phone, and I never became that sick.

Dr. Samora: What have you responded to best?

Dr. Matzkin: I managed my symptoms mostly with rest and staying hydrated. I was not recommended to start any other medications such as hydroxychloroquine and/or azithromycin. Vitamin C was recommended.

Dr. Lundy: Just acetaminophen. When I first became sick, there was all of that information that ibuprofen made things worse. I became incredibly tired of bedrest. I couldn’t stand anything on TV. Reading was a chore. It was absolutely horrible. Your mind starts to play all sorts of games during this time. On top of all of that, food becomes completely detestable. I lost 16 pounds in the first 10 days. I had to force down food, which had no taste at all. My wife pleaded to come home, but there was no way I was getting her and my sons sick. When I went through cancer surgery last year, she was by my side. I had to do this one alone.

Dr. Samora: Do you have an idea how you contracted the virus, especially given your great precautions?

Dr. Lundy: There is no chance that I contracted this any other way than through the hospital or clinic. I haven’t been anywhere else. I can’t say who passed it to me, and that doesn’t matter. Interestingly, our workers compensation carrier is denying coverage for this. Needless to say, we will fight that poor decision on their part.

Dr. Matzkin: I have no idea where I came in to contact with the virus. Besides working at the hospital, including the clinic and OR, there wasn’t a specific exposure. I also had covered the Northeast 10 Men’s College Ice Hockey tournament, where there were some positive cases, but again no specific exposure. No one else I was in close contact with at work or home came down with significant symptoms. I have to assume that my family had been exposed, but my husband and three daughters likely had very mild symptoms or were asymptomatic. The patients I had seen in clinic and had surgery the few days prior to my symptoms have luckily all not had any COVID-19 symptoms.

Dr. Samora: What’s your individual process for return to work? Do your institutions have protocols?

Dr. Lundy: My institution and my practice both adopted the “nontest-based strategy” per Centers for Disease Control and Prevention (CDC) guidance, available at https://bit.ly/34rQv3l.

Dr. Matzkin: Our return-to-work policy has been evolving and changing. Currently, we are following the CDC’s “test-based strategy.” Once we are asymptomatic for 72 hours, we can get retested. We are required to have two negative tests at least 24 hours apart prior to returning to work.

Dr. Samora: What advice would you give to other orthopaedic providers during this pandemic?

Dr. Matzkin: Stay healthy. COVID-19 knocked me down for two weeks, and I would not wish it upon anyone. I am grateful to be on the other side of it now. I plan to be tested again, and once I have two negative tests, I will look forward to being deployed where I can be helpful in the hospital.
Perhaps I have some immunity or protection, but I would never be cavalier with the coronavirus. We will get through this pandemic and emerge stronger and more resilient than before.

Dr. Lundy: Change your mindset from mine and all of my friends; you do not want to “just get it and get over it.” It is as bad as the experts say that it is. Be careful and seek medical attention if your dyspnea becomes severe. Understand that this is a marathon. You’re not going to just blast through this and move along. Lastly, you have to actively maintain your sanity. We are all tough, driven people who are not accustomed to being down. Rely heavily on your faith. Establish some type of routine so you have something to look forward to. Remember that this will eventually pass, and we will move on.

Dr. Samora: Do you worry about any long-term effects?

Dr. Lundy: Yes, but as there is nothing to do about it, I am relying heavily on my faith and the sovereignty of God.

Dr. Matzkin: Yes, especially as a runner. I expect my recovery to be like training for a marathon. I am slowly back to pounding the pavement; it will take time, but I will get there.

Julie Balch Samora, MD, PhD, MPH, FAAOS, is a pediatric hand surgeon at Nationwide Children’s Hospital in Columbus, Ohio, and the newly appointed deputy editor of AAOS Now. She can be reached at julie.samora@nationwidechildrens.org.