Coronavirus in Scotland: Surgeon warns fifth of hip fracture patients 'caught virus in hospital'

Mr Murray, a consultant paediatric orthopaedic surgeon in Lanarkshire, said: "Early evidence from the Scottish IMPACT data suggests that up to 20 per cent of our hip fracture patients may have contracted Covid-19 after admission in March and April this year."

It comes after the Herald revealed that 908 patients in Scotland had become infected on non-Covid wards, with 218 dying.

READ MORE: More than 200 patients die after developing Covid while in hospital 

Although elective surgery, such as hip and knee replacements, was put on hold to free up beds during the pandemic, emergency admissions for patients with broken bones continued.

In Edinburgh alone, there were 169 admissions for 'fragility fractures' in the elderly between March 5 and April 13 - including hip fractures - but there are no published figures for Scotland as a whole.

The letter, shared with the Herald and dated June 3, goes on to discuss how to reduce the infection risk from Covid as routine operations resume.

It states: "Clearly our elective 'green' pathways will be designed to minimise this and should see nowhere near this [20%] level of risk for screened and tested elective patients but the consequences of contracting Covid-19 [around the time of operation] emphasise the importance of getting this right."

The 'green' pathways refer to segregating hospitals into Covid and non-Covid zones, which will require regular virus testing of staff and patients prior to admission.

READ MORE: Edinburgh study reveals huge drop in people suffering broken bones from assault and road collisions since Covid began

Mr Murray added that there was "a consensus" that patients should be asked to self-isolate for 14 days prior to surgery, with limited visits to hospital beforehand, but added that testing could be harder to implement.

"Most suggest testing patients at around 48 hours pre-surgery but the logistics of this can be challenging.

"When, and if, to test staff is more contentious and how we separate staff teams from acute, unscreened, activity needs to be considered.

"It seems sensible though to make every effort to minimise movement of staff between green and red/blue pathways."

Thousands of orthopaedic appointments and planned surgeries have been cancelled since mid-March, with waiting lists closed to new referrals, leading to fears that it could take years to clear the backlog.

Mr Murray warned that the "scale of the challenge is already huge and will only become worse the longer it takes for us to resume some degree of normal activity".

Theatre capacity has been cut by around a third, he said, as a result of requirements for more stringent infection control measures and for surgeons to wear enhanced protective gear which slows down their operating speed.

Mr Murray said this could be partly alleviated after new guidance issued by Health Protection Scotland stated there is no evidence that coronavirus is transmitted in the spray from orthopaedic surgical tools, such as high-speed saws.

"On the basis of this our biggest health board [Greater Glasgow and Clyde] recently permitted the use of standard PPE (droplet protection) and precautions for orthopaedic surgery regardless of a patient’s Covid-19 status," said Mr Murray.

"The same policy is in use in Lothian and now in Fife."

READ MORE: No coronavirus deaths recorded in Scotland for a second day

However, one retired surgeon said he fears some patients waiting for hip and knee replacements will never get their operations.

Gavin Tait, an orthopaedic surgeon and former clinical director at NHS Ayrshire and Arran, until his retirement in 2016, said some elective treatments "will be severely rationed, if not unavailable".

He said the current backlog of patients, combined with reduced turnaround times in theatre, and the possibility of planned operations being axed again in winter to free up beds - as some health boards have done in previous years due to flu - would exacerbate the crisis.

"I can see some people basically never getting their operations at all," said Mr Tait.

"Or being told 'I'm terribly sorry but it'll be three or four years'.

"They might try going private, but I don't see how the private hospitals are going to be financially viable if their surgical throughout drops by 30%.

"If they've been doing 15 hip and knee operations a day before, and it drops to five in a day, they won't be able to make money."

Mr Tait added that orthopaedic colleagues were "bored out their skulls" due to the lack of elective work.

"Tumbleweed in the corridors is a phrase I hear quite a lot from colleagues," he said. "And intensive care being basically empty because the Covid patients aren't going in anymore."

He added that he believed Covid and non-Covid patients should be treated in separate hospitals going forward.

"With the best will in the world green areas and red areas in the hospital, just don't work," said Mr Tait.

"Covid will transmit, people will lose the discipline of wearing masks, or washing their hands.

"You just have to have a hospital that is completely separate and you just test people before they come in. You don't mix Covid and non-Covid people."

Jacqui McMillan, an orthopaedics surgeon and deputy chair of the BMA's Scottish Consultants' Committee, said: "There will need to be enhanced cleaning between procedures to reduce the risk of the virus being spread, and plenty of time will need to be given for PPE to be taken off and put on.

"On that basis, it is absolutely clear that capacity for patients will inevitably be substantially reduced – I have no doubt that the NHS will simply not be able to see people or operate anywhere near the same capacity as pre-Covid-19 for a considerable period of time."

Last week, Health Secretary Jeane Freeman said elective services would resume on a “cautious, phased” basis, including “some elective surgery that is urgent and has been postponed”.

She said the NHS would prioritise treatments whose unavailability was “clearly having a detrimental impact on people’s lives”, while maintaining “sufficient capacity to deal with any surge in Covid-19 cases”.

A Scottish Government spokeswoman said: “The response to Covid-19 has seen necessary changes to the way that health services are delivered and we recognise additional service changes will be required to address the full impact of the pandemic going forward.

“We are working with health boards and partnerships to ensure robust Orthopaedic plans are in place to strengthen capacity and minimise the impact of Covid-19. Our Elective Centres will be central to this.

“As we move into future phases of our response we will continue to work with professional bodies, health boards, local authorities, unions and other key stakeholders to ensure the NHS operates as effectively as possible.”