Lessons From The Pandemic

A Sports Surgeon’s Perspective

“Those who fail to learn from history are condemned to repeat it.” – Winston Churchill, after Santayana.

As Director of the International Orthopaedic Clinic (IOC) at Mount Elizabeth Novena Hospital the past year and a half have been a roller-coaster ride. The medical profession and the way we live have changed drastically. Each medical speciality in the private and restructured systems in Singapore has had to deal with the situation in its own way. Here are my experiences and what I have learned from them.

As an orthopedic surgeon, I perform both emergency work (e.g., treating broken bones) and non-emergency or ‘elective’ work (e.g., torn knee and shoulder ligaments from sports, replacing worn out hips and knees using robotic surgery). During the circuit breaker, I had to stop performing all non-emergency cases to reduce human traffic and risk of transmission, and to save hospital beds for potential COVID-19 cases. I still kept my clinic open to see emergency cases, and kept in touch with my patients (local and overseas) through telemedicine.

Like my most doctors, I am trained to build a rapport with patients, carefully examine them for signs of disease, and explain their diagnosis. None of this is easy via telemedicine, which I feel is useful for limited consultations (e.g., renewing a drug prescription) or when a diagnosis has already been established. However, it is not good in situations which may require a lot of tact and compassion (e.g., breaking bad news or a diagnosis). In Singapore, as medical practitioners, we were fortunate not to have to undergo the terrible scenario of sharing the dying moments of COVID-19 patients in ICU with loved ones via Facetime or videocall, as was so often the case in Europe and the USA.

I was also extremely fortunate to be able to keep my clinic open, and extremely grateful that the Singapore government offered me financial assistance to help pay my staff during the circuit breaker period. Even allied health professions, such as physiotherapy, were forced to close during the circuit breaker, although I would argue that they are essential to the work that I do – helping a patient regain strength and mobility following a surgery).

The use of masks at all times and personal protective equipment (PPE) in certain parts of the hospital became the norm. Despite a worldwide shortage of PPE, thanks to the Singapore government, we were always well equipped. I felt pity and embarrassment for my former colleagues in the NHS (National Health Service), who were forced to wear bin bags and totally inadequate protective equipment as COVID19 struck the UK.

Most of my patients before the circuit breaker had injuries from contact and semi-contact sports such as football, rugby, basketball and martial arts. All sports activities stopped last April and have yet to resume. Instead, sports like running, cycling and HIIT (high-intensity interval training) soared in popularity and have brought a different spectrum of injury – usually due to overtraining and repetitive overuse.

Interestingly, athletes who had been nursing injuries for months were keen to get them fixed through surgery, as working from home and being unable to travel or compete, they now had the time to recover and rehab after their operation. Many expats have also left Singapore; many decided to have surgery prior to their departure, as the health system to where they were headed was less predictable or reliable due to COVID-19.

I was fortunate to take part as a ringside doctor in the first large sporting event in Singapore post-COVID-19, the One Championship MMA (mixed martial arts) event at the Singapore Indoor Stadium on October 9, 2020. Dealing with athletes from countries with high rates of COVID-19, and spending an entire week in PPE was a challenge, but thanks to the excellent management team at One Championship, the event was a success and many more have followed, with a (limited) live audience. I have now shifted my focus to covering cycling events, in my role as official Events Team Doctor of the Singapore Cycling Federation.

Having a vaccine produced within a year and readily available worldwide, for a completely new disease and using a ‘new’ technology is a real milestone

for humankind. Messenger RNA (mRNA) technology could be a game-changer in the future for a wide variety of conditions including malaria, cancer and influenza (the ‘flu’). This could be the real silver lining of the COVID-19 pandemic.

Singapore has probably been the best place in the world to live during the start of the COVID-19 pandemic. Strong governance and social responsibility have made it so. I sincerely hope that once a large enough percentage of the population has had the vaccine, that the focus can be on opening up Singapore for business and travel.

Is nature trying to tell us something? This is definitely not going to be the last pandemic. As record temperatures occur across the globe, floods ravage Germany, and the icecaps melt, COVID-19 should be a lesson that teaches humans that the right kind of interaction with nature and environment is vital for our survival. Whether we can learn from this lesson and act collectively as a species is a different matter.

Dr Alan Cheung, Consultant Orthopedic Surgeon, International Orthopaedic Clinic From An Interventional Cardiologist

I learn to take nothing for granted. Absolutely nothing. Necessities. Working in healthcare, gloves and masks which we use day-in and day-out now become lifesaving. Prior to this pandemic, I would discard gloves and never consider how scarce face masks would be and how crucial they would be to preserve my life. Now, PPE has become an essential way of life.

Physical and mental toll. This affects everyone and being in healthcare this hits us hard. From functioning in split teams with strict safe management measures while continuing treatment for patients, to caring for infected patients and the fear of bringing back the virus to our loved ones makes it extremely tough. We learn to cherish every little victory.

Social and human interaction. As human beings, we draw strength from our daily interactions. Now with severely limited interactions make us feel isolated even in the workplace. Interactions have gone digital, and as physicians, we adapt to this readily among care teams to provide the best care to our patients.

Work as a community – a much bigger community. I realize that a physician’s skill is not enough in treating a sick patient during a pandemic. We need a broader health system, community, government, and even international effort to contain the spread of the virus to make it safe, and all of us as individuals must play our part.

Remain open to changes and innovation. As physicians, this pandemic caused severe disruption on how we can treat patients safely and not delay their treatment. We are forced to learn on the fly, prioritise treatment needs and embrace technology like teleconsultation to work around the limitations caused by the pandemic.

As an Interventional Cardiologist, the biggest challenge I faced was to continue the acute heart attack emergency service while having all the necessary precautions in place. Treating patients with heart diseases are time-sensitive, and any delays in treatment can be catastrophic. Our minds have to be open and our hearts strong to continue life-saving treatment during a pandemic.

Dr Joshua Loh, Senior Consultant Interventional Cardiologist & Medical Director, Capital Heart Centre A Vascular Surgeon’s Takeaways

Some of those who are fortunate enough to steer clear of the destructive wake of this disease continue to struggle in how to deal with COVID-19. Believe only factual data and reject fake news. Certainly, spreading falsehoods doesn’t help anybody.

The 1918, the H1N1 Influenza A pandemic infected 500 million people, or a third of the world’s population. Businesses and schools were closed, social gatherings prohibited, and facemasks were mandated, before the virus ended its deadly march that killed 50 million people. We have been here before. It takes three generations to forget. Keep your social distance and wear your masks. It will save lives.

SARS-CoV-2 is dependent on humans to keep it alive, replicate, and spread. Curb your social activities and don’t let the virus win this assault on humankind.

Vaccines are never 100 per cent effective as they depend on our immune system to mount a protective response. In life, there are risks to everything, even the most mundane.

Get vaccinated to protect yourself, your family, and your loved ones who are closest to you. Any vaccine is better than no vaccine.

Human inequalities are pervasive and the pandemic exacerbates them. Be kind to your fellow man.

Dr John Wang, Visiting Consultant Surgeon, PanAsia Surgery Group