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How will the epidemic effect the US orthopedic industry?

Short Answer:  There will be a temporary economic downturn followed by a boom. Meanwhile there will be a big disruption to how we all work, with some permanent changes.

The Math

People don’t understand exponential math or log scales. Based on contagion algorithms, the coronavirus will reach half of the people in the US this year. It is doubling every 2.5 days in the US. It is very contagious and it has a long incubation period so people who feel great can spread it unknowingly. Models predict a peak in the US around April 15th.

Roughly half of Americans will be exposed to the new virus March through June, most people will be fine, but tens of thousands of Americans will die this year (~0.6%). Here is a quick video lesson on viruses and exponential math.

So, COVID-19 coming to your neighborhood, coming to your office and coming to your hospital customers.

Business Impact

MEETINGS – The biggest effect on the orthopedics industry, will be the way we conduct business. We will all learn social distancing. We will work remotely for some period. There will be few face-to-face meetings. Ortho conferences and most large gatherings will be postponed or cancelled starting in March through Fall.

SERVICE – OK, here is the big one… Sales reps will be banned from attending surgeries in many hospitals/ASCs. “We will let you delivery product through the back door, but you cannot attend surgery.” Some hospitals are screening EVERYONE who walks in. Some larger ortho companies are working on financial packages for their 1099 reps to tide them over during the slow down in elective procedures.

Personal story: During the SARS epidemic (another coronavirus strain), I remember traveling to London Ontario in early 2003. I received permission to enter a single door at Victoria Hospital since I was the technical support for a surgery with a brand new device. There was only one way in or out. I had to complete a questionnaire about my travels upon entering, but I passed. The surgery was performed in an empty hospital. Victoria Hospital only allowed critical doctors and nurse inside. No family allowed in. It was an eerie experience.

SURGICAL TRAINING – Training in large groups will disappear for a while, but there will continue to be some small surgical training by some device companies.

SUPPLY – Not really an issue. Fortunately most orthopedic manufacturers do not rely heavily on Chinese supply companies.  Even if they do, this is temporary blip in supply chain. Chinese manufacturing will come back on line in late spring/summer.

WORK – Tens of thousands of orthopedic industry professionals will work from home for the first time and we will discover that there is no real loss of productivity. Tools and advice are here.

HIRING – Growing orthopedics companies still need talent, so hiring will continue, but there will be a trend towards more video interviews.

Surgical Procedure Impact

Regarding surgical procedures, people still need to have some elective musculoskeletal surgeries and and, of course, emergency trauma surgeries. We will see a postponement of most elective musculoskeletal surgeries. The Surgeon General advised hospitals to postpone elective surgeries. Many states like Oregon have proactively banned “elective” surgeries for 2-3 months. There should be a Q3 boom in elective surgeries after the ICU usage peaks.

The ortho companies that are best positioned the weather the economic dip are those whose customers are ASCs and trauma centers, and those companies who make single-use sterile packed kits that can be shipped directly to the hospital OR.

Financial Impact

For the Big Orthos, this is a double whammy – lower sales + lower stock prices. Financially, company revenues will be hit in Q2 and Q3 as procedure volumes will dip. Analysts are predicting sales will be down 4%-18%. Any postponement in elective procedures will be an uptick at a later date. Stock in public orthopedic companies will dive with the economic forecast.

Positive Impacts

In some ways, this epidemic will make ortho device companies healthier. Orthopedic companies will finally get serious about how to conduct day-to-day business remotely. More meetings will be conducted over video or audio calls. Employees will learn to work effectively from anywhere. Ortho sales and service will learn to better service hospitals/ASCs in a more streamlined way. VR surgical training will get a boost. Virtual Home PT will get a boost. Hospitals will become extra protective of not passing infections from one patient to another during this time period. We will all learn better hygiene. Hospitals/ASCs will learn to support cases without the sales rep attendance and many will permanently ban the reps.

Takeaway message

This is temporary. Let’s all suck it up, learn social distancing, wash our hands and work remotely when we can. Get ready for the future boom!

How is the virus effecting your business?

***Actionable Advice ***

written by: Dr. James Robb, a former pathologist at UC San Diego.

1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.

2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove.

3) Open doors with your closed fist or hip – do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.

4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.

5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.

6) Keep a bottle of sanitizer available at each of your home’s entrances. AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands.

7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

What has Dr. Robb has stocked in preparation for the pandemic spread in the US

1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.

Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average – everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.

2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you – it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth – it is only to keep you from touching your nose or mouth.

3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.

4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY “cold-like” symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.

I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.