May 18, 2020
It's been 6 months since the first COVID-19 outbreak was reported in December 2019 in this world. These 6 months have changed the world totally a different place. The impact of the outbreak was such that it forced the cancellation of the 2020 Tokyo Olympic games and has taken a greater toll on Japanese employment than the Lehman financial shock. The outbreak in Tokyo surged at the beginning of this March, when my hospital was forced to adopt a serious stance toward the COVID-19 pandemic. The situation grew worse day by day. Our ICU was filled with COVID-19 patients with severe pneumonia treated with ventilators, and some wards were transformed and dedicated to patients with moderate COVID-19 symptoms.
All foot and ankle elective surgeries were cancelled after the Japanese government declared a state of emergency on April 7. At our hospital, we have postponed all outpatient clinic appointments unless the patient has urgent symptoms. The medical staff wear masks and rubber gloves during practice, and colored tapes have been placed on the floor for social distancing between physicians and patients. Because the infectious disease control, emergency and critical care unit staffs were exhausted and faced a severe lack of manpower, they called for help from other fields. Our hospital management team decided to schedule shifts for most of the doctors to treat COVID-19 patients.
Next week, I will start a 2-week shift treating COVID-19 inpatients. I will be in charge of treating patients who are admitted for moderate COVID-19 pneumonia treated without ventilators. Instead of learning cutting edge foot and ankle surgical skills, I am now forced to learn updated COVID-19 treatments.
During this period, I strongly felt how government policy can influence our life, especially during such an unexperienced disaster. The Japanese government has set very strict standards for COVID-19 polymerase chain reaction tests: only people who had a fever over 37.5°C for more than 4 days or those who had lethargy and difficulty breathing worse than with normal influenza, in addition to having had close contact with a COVID-19 patient, could consult with one of the coronavirus-related Return and Contact Consultation Centers around the country to determine if they should get tested for COVID-19. This strict standard frustrated both patients and medical staffs. During this period, I have encountered some patients who suffered from orthopedic disease with fever or respiratory symptoms. Most of them could not even get a polymerase chain reaction test because they did not meet the strict criteria the government has set, even though it is well known that a large population of COVID-19 patients do not have fevers lasting more than 4 days and/or display severe respiratory symptoms. I believe the restrictive standards for testing delayed societal and public health responses, leading to the spread of the disease, which could potentially result in the collapse of the health care system and the medically protected regional community. Thus far, not very many Japanese citizens are interested in politics, but the COVID-19 pandemic has made us realize the importance of actively participating in politics as a member of our society.
Among the gloomy news of recent days, some news has encouraged me. The cancellation of all academic conferences and social distancing has, paradoxically, made the foot and ankle surgeon community much stronger. In order to refresh our knowledge and maintain the advancement of technology in our field, the Japanese Society for Surgery of the Foot is posting various news items on its Facebook page, including the introduction of cutting edge knowledge in our field, updates from foot and ankle surgeons from all over Japan, and a training menu to keep fit during the stay at home period.
The international foot and ankle surgeon community has also strengthened its ties with free web conferences such as the Step 2 Walk 2020 Foot & Ankle World Congress Online held this May involving foot and ankle surgeons from all over the world. It became a great platform to not only share cutting edge knowledge and techniques but also to give us the opportunity to think about what we can do during this worldwide pandemic as foot and ankle surgeons.
I sincerely hope we can learn something beneficial from our experience through this worldwide crisis and innovate to move our community toward a post-COVID-19 era.