Supermarkets and Surgical Centers

To become infected with corona virus, you need to be exposed to a set number of virus particles, but doctors do not yet know exactly what that number is for the virus that causes COVID-19. We do know exposure occurs by breathing the virus in, or by touching something with viral particles on it, and transferring it to your mouth, nose, or eyes.

When an infected – symptomatic or not -- person coughs, they produce a lot of droplets ranging in size. Bigger droplets settle onto surfaces more quickly because of their higher mass; they also carry more virus particles. Smaller droplets can be transported further away from an infected person, since their lower mass allows them to be carried more easily.

What it boils down to is, the more virus particles you are exposed to, the more likely you are to become infected. Therefore, it stands to reason that the more people we encounter, the higher our risk of virus transmission. Shopping for groceries is when people will likely encounter the highest number of people during the pandemic. So, are you safe when shopping? What about if you need to have surgery in a surgical center?

Let’s think about surface contamination. Those bigger droplets that are transported can settle onto surfaces. Likewise, people infected with COVID-19 can contaminate surfaces just by touching them. We have also been told the coronavirus can survive on different materials for varying lengths of time --one day on cardboard and three days on plastic or stainless steel.

The surfaces most likely to have the virus living on them are those that are touched frequently by people. In a market, areas such as the trolley and basket handles, the chip reader and pin machine and self-checkout, are likely to have the largest number of virus particles. Ideally, we avoid locations with probable higher virus concentrations/contamination. We also take precautions such as face masks, gloves and avoid touching the face.

Likewise, the virus can be killed. Detergents, alcohol, bleach, and some disinfectants have all been shown effective at inactivating the virus. Stores are charged with constantly cleaning common contact surfaces.

There are many ways to try to keep yourself safe during the pandemic.  The cleaning processes and precautions now a part of each shift at supermarkets and big box stores have long been the standard for surgery centers. However, elective, necessary surgeries remain on hold.

During COVID we have experienced shutdowns, layoffs and shelter in place orders to avoid the spread of the virus. Now, as we begin to assess the reopening our economy, safety processes will need to be put in place to manage our “healthy” patient population.

Recently I published a paper for the International Society for the Advancement of Spinal Surgery on the “Road Back to Elective Surgery.” It highlights the importance of a structured system to ensure patient, staff and physician safety. Some of the key drivers should be 1) the adoption of telehealth and 2) utilization of stand-alone surgery centers.

Telehealth provides a convenient and efficient system for interaction between physicians and patients. It also enables physicians to maintain close contact with patients while avoiding one-on-one in-person interactions, avoiding long drives and crowded waiting rooms. There will always be a role for in-person doctor visits, but a hybrid model seems to be the best solution in navigating the new COVID world.

Surgery Centers have always been a safe and efficient model for healthcare delivery. Operating rooms have implemented special precautions above and beyond the standard surface cleaning guidelines by the CDC and AORN. Typically run with a smaller staff the centers allow for social distancing precautions as well as eliminate the proximity of an emergency room or ICU with COVID-sick patients. Clinical results demonstrate extremely low complication rates for outpatient surgeries -- lumbar fusion, cervical disc replacements, SI joint fusion*. Additionally, the surgery center allows for near complete control of the clinical pathway from check-in to discharge.

I have been able to reach out to colleagues in Italy to gain insights into PPE best practices as well as colleagues from Johns Hopkins and Northwestern that are on the front-line ICUs of this pandemic. Obviously, we are still in the early stages of rethinking technology and how it might assist in creating the safest possible medical care environment. I believe a thoughtful approach will come to define best practice.

So, which is better, a supermarket or a surgery center?