Effect of COVID-19 Lockdown on the “Deliverymen Injuries”

Stamatios Papadakis, A.^*, Georgios Gourtzelidis, Dimitrios Pallis, Konstantinos Tsivelekas, Evangelos Triantafyllou & Charikleia Komari

B’ Department of Orthopaedics, KAT General Hospital of Attica, Greece

*Correspondence to: Dr. Stamatios Papadakis, A., B’ Department of Orthopaedics, KAT General Hospital of Attica, Greece.

Copyright © 2021 Dr. Stamatios Papadakis, A., et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction
Humanity has been stricken by epidemics many times in the past. The most recent epidemic is COVID-19, which was eventually documented as a pandemic [1]. In the early months of 2020, the first COVID-19 case outside the borders of China was recorded [1]. WHO published a series of recommendations and instructions to avoid spreading the virus [2]. The rapid increase of people testing positive for the virus forced many countries, including Greece, to take measures that would prevent overcrowding. The first strict national lockdown was announced on 23^rd March 2020 which was gradually lifted from 4^th May 2020. The total period of lockdown revealed a clear change in the distribution of orthopaedic trauma treated by the healthcare professionals [3]. A notable exception was the deliverymen. The term “Deliverymen disease” includes the variety of injuries sustained by motorcyclists who are working in delivery services. The term was firstly presented in the European Congress of Trauma and Emergency Medicine, Oslo Norway 2020 [4].

Materials and Methods
This is a retrospective study comparing data from two periods of the same duration in a Level-1 Trauma centre, namely Period A (between March 25^th and May 5^th 2019) and Period B - the lockdown period- (March 25^th to May 5^th 2020). The study included 17 males with a mean age of 30.8 years (18 - 45 years), who were working as delivery distributors and suffered injuries during their service time. Cases treated either surgically or conservatively, were included in this study. The indications for surgical treatment were not affected by the pandemic in our centre. We also recorded and evaluated the use of adequate personal protective equipment of delivery men.

Results
During Period A deliverymen disease - associated admissions were 9, while in Period B there were 8. The admissions remained by and large the same during the lockdown. All of the examined patients were males. The mean age was 27,2 years old for Period A and 31,1 years old for Period B. The surgical treatment involved 2 tibial plateau fractures treated with external fixation, and four cases of open reduction-internal fixation of a femoral, forearm, tibial plateau and ankle fracture respectively.

There were 2 cases involving a shoulder injury during the Period A and one during Period B. There seems to be a decrease in the overall rate of the upper extremities injuries during the lockdown period (four cases in 2019, two in 2020). On the contrary, the lower extremities injuries had the same rate between the two periods. A total of 3 tibial plateau fractures were treated in both periods (Table 1 and 2). Only one fracture involving the malleoli was treated during the second period of the study. There was a cervical spine injury during the lockdown injury without neurological or bony compromise that was treated conservatively (Table 2). Protective gear of any sort, such as helmet, gloves etc. was not used in its entirety and not always, as shown in Table 3.

Discussion
The spread of the COVID-19 pandemic resulted in the need to enforce measures to prevent transmission. These measures had an impact on orthopaedic cases that required admission to hospital and surgical treatment, as shown by previous studies [3,5]. This did not apply for delivery workers who continued delivering food and goods, in growing numbers, and most of the times without the proper protective gear as this study revealed. Moreover, in an under-review study by our department we found a decrease rate of 41% in orthopaedic trauma cases. (Pandemic effect on orthopaedic trauma at a Level 1 trauma hospital, Papadakis et al. - Hippokratia 2021, under review). The number of trauma cases that required surgical treatment remained the same. Banning the majority of athletic activities and constricting peoples’ transportations lowered the number of orthopaedic trauma cases, whether motor vehicle collision or sports related injuries [3,5] However, delivery of food and goods saw a dramatic rise [6]. That meant a raise in the number of motorcyclists delivering food and goods in their area at any given time during the lockdown. The great plethora of orders that needed to be delivered within a reasonable timeframe meant that these workers were urged to accelerate in the empty roads, with devastating sometimes results. In our opinion, this was the main reason why there was no apparent decrease in this particular type of occupational accidents during the quarantine period, in combination with the fact that the much-needed protective gear was not used - as shown in Table 3.

Deliverymen disease, as described in a previous study [4], is a separate clinical entity - namely the entirety of injuries sustained by delivery workers during their working hours as a result of activities associated with their duties.

The lack of an adequate personal protective equipment due to their low income and financial status in combination with the absence of driving professional education among workers in this category of delivery employees results in lower extremity injuries with the majority requiring hospitalization and surgery. Further investigation is needed, as well as constant training and setting right criteria for the pursuit of such employment [7].

Conclusions
COVID-19 pandemic resulted in the enforcement of national lockdowns. Delivering food and goods rose dramatically, leading more motorcyclists to speed on the empty roads. This, in combination with the lack of awareness among delivery workers about the much needed- though expensive-protective gear, contributes in the continuation of the deliverymen injuries.

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