COVID-19 fundamentally changed society. More than 18 months into the pandemic, schools have implemented a range of remote, hybrid, and in-person models to educate students, employees in many business sectors have worked remotely, and various lockdowns and mask mandates have been instituted over time. Notably, the health care systems nationwide have been stretched beyond capacity during peak waves. As a semblance of normalcy appears to be within reach, at least in places with high vaccination rates, one Orthopaedics faculty member at Yale School of Medicine paused to reflect.
Lee E. Rubin, MD, is an associate professor and division chief of Adult Reconstruction with the Department of Orthopaedics & Rehabilitation as well as chief of the Total Joint Replacement Program at Yale New Haven Hospital. He offers an inside look, not only to what physicians and surgeons have experienced, but what he has done personally to keep focused and prioritize mental health.
“The onset of COVID in March 2020 had an enormous impact on our clinical activities,” Rubin said. “Based on the public health crisis and the governor’s orders, we had to immediately wind down and stop all elective surgeries, and simultaneously determine how to care for patients needing urgent or emergent surgical care.”
One of the most critical shortages in the early stages of the pandemic was personal protective equipment (PPE). Suddenly, there was an immediate lack of PPE and sterile supplies for the operating room, as existing materials had to be diverted to COVID care in the emergency department, medical wards, and intensive care units. During the initial months of COVID, additional supplies were difficult or nearly impossible to obtain.
Lisa Lattanza, MD, chair of orthopaedics & rehabilitation, spearheaded efforts to organize collections and donations to increase PPE supplies. Lattanza worked with suppliers across the Northeast to secure more gowns and procure masks for physicians at sites across Yale New Haven Health. Through friends of Yale in China, Frontline Heroes, manufacturing companies in Connecticut, and thanks to local and national innovation and community support, more than 30,000 masks and over 100 hazmat suits were delivered within the first few weeks of the pandemic.
The highly contagious nature of COVID-19 presented barriers beyond PPE, which required health care providers to quarantine given their frequent and direct contact with patients. “Our attending surgeons took turns staffing the total joint service each week, so that we could care for patients with urgent needs while also sequestering the other surgeons and staff from COVID exposure to protect them if anyone was to become sick or incapacitated,” Rubin said.
Academically, many clinical research projects in the Department of Orthopaedics & Rehabilitation were also impacted. Rubin added, “For example, Dr. Jinlei Li, Dr. Michael Leslie, and I were working on a prospective randomized controlled trial evaluating the effectiveness of different peripheral nerve blocks for hip replacement, but we could not continue this for months as no elective hip replacements could be performed during that time, forcing a major delay in completion of this project.”
He continued, “At that same time, I also was working with Dr. Jodi Sherman, Dr. David Gibson, and Dr. Dan Wiznia on a semester-long seminar and research project in partnership with the Yale School of Public Health and Yale School of the Environment to understand and evaluate the environmental impact of joint replacement surgery, and that work also had to be completely suspended.”
Additional collaborative endeavors were adversely impacted. The adult reconstruction division is fortunate to have a unique program that enables the department to host international surgeon visitors and scholars during the academic year, funded by Dr. Kristaps Keggi via the Keggi-Kimball International Surgeon Education Endowment Fund at Yale University. Prior to COVID, plans were in place to host orthopaedic surgeons from Latvia, Egypt, Singapore, Brazil, and Costa Rica. All were postponed indefinitely.
While lockdowns affected much of the nation, the likelihood of contracting COVID felt imminent for many health care providers. Mental health quickly came into focus as physicians and hospital staff navigated an overwhelming number of patients, the stressors of a highly contagious virus, quarantine protocols, and PPE shortages.
“The threat of illness or death has been real for everyone during the pandemic, and anxiety about this impacted physicians to a very significant degree, as health care workers were at the highest risk of exposure during the initial waves of COVID prior to the vaccine,” Rubin said. “I wanted to keep my patients, residents, faculty, and staff safe, but I also spent a great deal of time and energy working to keep my family safe. My wife and kids were quarantined at home, but I continued working in the hospital and our office to a limited degree. I felt an obligation to do everything possible to embrace and advocate for the best possible public health practices and protect my patients, my community, and my family from exposure.”