COVID-19 spike delaying other care
Many US hospitals push back surgeries for non-urgent cases
Echoes of the pandemic’s early months are resounding through the halls of hospitals, with an average of more than 90,000 patients in the United States being treated daily for COVID-19.
Once again, many hospitals have been slammed in the past two months, this time by the delta variant, and have been reporting that intensive care units are overflowing, that patients have to be turned away and even that some patients have died while awaiting a spot in an acute or ICU ward.
In this latest wave, hospital administrators and doctors were desperate to avoid the earlier pandemic phases of blanket shutdowns of surgeries and other procedures that are not true emergencies.
But in the hardest-hit areas, especially in regions of the country with low vaccination rates, they are now making difficult choices about which patients can still be treated.
And patients are waiting several weeks, if not longer, to undergo non-COVID-19 surgeries.
“We are facing a dire situation,” said Dr. Marc Harrison, chief executive of Intermountain Healthcare, the large Utah-based hospital group, which announced a pause of nearly all non-urgent surgeries Sept. 10.
“We do not have the capacity at this point in time to take care of people with very urgent conditions yet are not immediately life-threatening,” he said at a news conference.
In some of the hardest-hit areas, like Alaska and Idaho, doctors are taking even more extreme steps and rationing care.
When they can, some hospitals and doctors are trying to seek a balance between curtailing or shuttering elective procedures and screenings and maintaining those services to ensure that delays in care don’t endanger patients.
But doctors have also been monitoring some of the longterm effects of long waiting times for non-COVID-19 patients during the pandemic, wary of the specter of unchecked cancers or ignored ulcerative conditions
if screenings are postponed.
And the waiting is still extremely stressful, troubling both doctors and patients with pressing illnesses who do not view their conditions as non-urgent.
In Columbus, Georgia, Robin Strong’s doctor told her a few weeks ago that the rising COVID-19 caseloads there would delay a procedure to repair a vocal cord that was paralyzed in a previous surgery.
Because of her condition, she chokes easily and has a hard time breathing. “I just cry all the time because of my situation,” she said.
Compounding the physical discomfort is her frustration that so many people in her state won’t get vaccinated against COVID-19,
and they are getting sick and taking up hospital beds.
When the pandemic first slammed hospitals last year, many institutions found no alternative to postponing nonessential procedures.
“We weren’t sure what we were really going to face,” said Dr. Matthias Merkel, senior associate chief medical officer for capacity management and patient flow at Oregon Health & Science University, the state’s academic medical center in Portland. “We preemptively stopped elective surgeries and emptied out the hospitals.”
In this latest round, hospitals and doctors have been more willing to continue doing procedures like colonoscopies for some patients
if they can. “We want to continue to do as much as we can in all areas,” Merkel said.
Even so, some patients with serious conditions are living in a precarious limbo. Paul McAlvain, 41, had waited months to get a surgery opening at OHSU to repair a leaking heart valve.
“They kept saying how bad I was and how they needed to get me in right away,” said McAlvain, a helicopter pilot for Life Flight Network, which ferries critically ill patients to medical centers.
He had developed an irregular heart beat from his condition, and was finally scheduled for surgery Sept. 1.
But the spike in cases this summer further postponed his operation. “I had made work arrangements, life arrangements, got mentally ready,” McAlvain said. The surgery took place Sept. 8.
Merkel acknowledged the toll that uncertainty can take on patients. “It might medically make no difference, but emotionally it could have a huge impact,” he said.
Some hospital officials say they have been assessing the effects of delayed care caused by the shutting down of elective procedures earlier in the pandemic.
“It was very clear that many of these folks had decompensated or were more acutely ill than they would have otherwise been,” said Dr. Bryan Alsip, chief medical officer at University Health in San Antonio.
Though his hospital is confronting yet another wave of COVID-19 cases, Alsip said, it is still scheduling surgeries that do not require an overnight hospital stay.
While hospitals have generally been better able to predict what resources they will need as the pandemic ebbs and flows, making them less likely to halt elective procedures, more have started to do so recently, said David Jarrard, a hospital consultant.
Hospitals are also still struggling with a severe shortage of nurses, but are less worried about running out of critical equipment like N95 masks.
“We all learned a tremendous amount over the last year and a half,” said Dr. David Hoyt, executive director for the American College of Surgeons, which released guidelines to help surgeons adjust their caseloads rather than cancel non-urgent procedures.