**8. Psychological impact**

Psychological factors also have a certain percentage of influence. Stress or fear may come from drastic changes in oneself or the external environment. Psychological stress can be individuals or the public.

As for the surgeon's personal psychological pressure, a questionnaire survey in India was completed by 611 orthopedic surgeons from 140 cities in India. 22.5% of orthopedic surgeons said they must be under pressure, and 40.5% said they have mild pressure. With declining age, the percentage of orthopedic surgeons feeling "a lot of stress" had increased. The interruption of life-work balance and the uncertainty of returning to work were other factors closely related to the "absolutely stressed" group [24]. A questionnaire survey in Singapore showed 32 participants (51.6%) had 7 or more positive reactions. "Work adjustments" (74.2%), "changes in personal plans" (72.6%), and "restrictions" (72.6%) received the most positive responses in the questionnaire. On the other hand, "financial issues" received the least positive responses (21.0%) [31].

As for the public panic, it seems more obvious in some countries. As mentioned earlier, even there were few COVID-19 cases and no lockdowns or restrictions initially in Hong Kong and Taiwan, they still experienced an obvious impact on the number of surgeries. This may be attributable to the public's panic because of its proximity to China. At the beginning of the pandemic, exaggeration of the mass media, rumors or false news, and lack of medical resources may also cause widespread public panic. In Taiwan, the COVID-19-related fear seemed to reduce elderly individuals' willingness to undergo elective surgery. Elderly patients carry a higher mortality risk after being infected and they may have postponed their surgeries [55].

#### **9. Impact on orthopedic research**

A questionnaire survey of orthopedic surgeons received responses from 45 countries. Of the 192 respondents who conducted research, 149 (82.8%) reported continuing research activities during the pandemic, and most of them reported that participant recruitment stopped (n = 75, 64.15%) or decreased (n = 25, 29.9%) [36].

#### **10. Conclusions**

This chapter provides a comprehensive understanding of the impact of the pandemic on the field of orthopedics globally and aims to review the lessons learned from the impact of the pandemic to prepare for the next possible reimpacts. Although orthopedic surgeons may not be in the front line to fight against COVID-19pandemic, all the fields of orthopedics are still inevitably impacted. Most studies in current literature have reported that the number of cases in all aspects decreased significantly. Education and training, psychological factors, and orthopedic research, which have been less noted, have also been significantly impacted. All the fields of orthopedics were clearly affected by the COVID-19 pandemic. In the future, despite the pandemic, it is important to maintain treatment, especially the surgical care of the patients, to avoid negative effects on the prognosis. Strategies should be developed to enable orthopedic patients to receive timely treatment, even if the pandemic continues. Employees must be properly protected at the same time. This can be achieved by formulating a proper surgical scheduling algorithm for orthopedic patients. Several infection control measures and administrative

*Perspective Chapter: Impact of the COVID-19 Pandemic on the Field of Orthopedics DOI: http://dx.doi.org/10.5772/intechopen.102847*

management strategies may help maintain the normal operation. The implementation of appropriate preventive strategies may aid the scheduling of surgeries during the pandemic, which may, in turn, reassure the patients and prevent the suspension of normal orthopedic surgery practice. It is also important for orthopedic surgeons to prepare emergency response measures under normal circumstances, to deal with the emergency shortage of personnel caused by the redistribution or redeployment of personnel. The overall impact could be attributable to the staff redeployment in response to the pandemic. Therefore, it is important to maintain a flexible allocation of manpower and more sufficient and reservable staffing measures in case of emergency staff shortages. Orthopedic surgeons are suggested to prepare proper preventive strategies and set up special equipment and places for regular telemedicine for virtual consultations or virtual teaching.
