Introduction
The recent novel coronavirus disease 2019 (COVID-19) pandemic has brought the world to a standstill. This outbreak not only affected the healthcare systems but the resultant economic losses were enormous. COVID-19 has demanded that the health care systems globally evolve, develop new strategies, identify new models of functioning, and at times, fall back on the old conservative methods of orthopedic care to decrease the risk of disease transmission.
The usual incubation period of the disease is 5-14 days but with reported outliers up to 24 days [1]. It is not just the contagiousness of the COVID-19 but the alarming fatality as well (approximately 3.6%), which far exceeds the other severe acute respiratory syndrome (SARS) viruses [1]. Although the recent World Health Organization (WHO) report suggests that the asymptomatic cases are less likely to transmit the virus, this is debatable with conflicting evidence. Moreover, the presymptomatic cases are as likely to transmit the virus [2,3].
Infection among health care workers (HCWs) is further straining the already overburdened workforce due to a sudden spike in the caseload. Although, the majority of hospitals are refraining from performing elective surgeries, emergent and urgent procedures cannot be delayed. Various strategies have been developed at the institute level to reduce the risk of infection transmission among the theatre team from an unsuspected patient (asymptomatic and presymptomatic) during the perioperative period [2,3].
India has rapidly surged its capacity of reverse transcription-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but with its 1.3 billion population and a rapidly increasing infection rate, a selective testing approach was adopted initially. The policy regarding testing in India formulated by the Indian council of medical research (ICMR) has been revised with evolving evidence regarding the spread of infection [4]. 
Since testing could not be performed in all patients in need of surgical intervention due to time or resource constrain, nor an initial negative test can surely rule out infection, a “consider all positive” approach was adopted by the authors' institute to manage patients requiring emergent or urgent care including the available recommendations regarding reducing the risk of exposure to the surgical team during the perioperative period,
We developed a “caution at each step” model in an effort to minimize the risk of exposure to the theatre team from an unsuspected patient. In this study, we elaborate on this model in detail along with our experience of its use in emergency spine surgery cases.