‘I’m kind of scared’: Hospitals delay surgeries, empty wards

Janice Ense never actually got to talk to her doctor, or anyone else for that matter.

While she was out on Monday, an assistant left Ense a voice-mail message announcing that the unfolding COVID-19 crisis had forced the postponement of her kidney cancer surgery.

The operation was supposed to take place next Thursday at Toronto’s St. Michael’s Hospital. Now the 47-year-old from Manitoulin Island, an eight-hour drive north, has no idea when the tumour will be removed. As the pain from it continues unabated.

“I’m kind of scared, because I don’t know if it’s going to metastasize … It has grown substantially in the past year,” Ense said in an interview Wednesday. “I was really disappointed. I was psyched physically and mentally to have major surgery and then, boom, it’s delayed.”

She is not alone.

Relatively few Canadians have contracted the novel coronavirus and fewer still have died from it. But COVID-19 is already having a tangible impact on thousands of the ill in Canada as hospitals postpone elective surgeries and transplants and clear out clinics and wards to ready for a possible wave of infected patients.

The moves — many announced in just the last few days — are designed partly to prevent sick and immune-compromised patients from being infected by COVID-19, but mostly to free up critical-care space and equipment should the pandemic suddenly spike.

The rationale is that even if a surgery is not urgent, those patients often spend time in the intensive-care unit and occupy a ward bed, resources that would be desperately needed if Canada experiences an Italy-like surge in COVID-19 cases.

“This is a big deal, we are doing a lot less,” said Vancouver cardiologist Dr. Andrew Krahn, a spokesman for the Heart and Stroke Foundation and president of the Canadian Cardiovascular Society.

The cardiac care system has years of experience managing wait lists and ensuring the most urgent cases get looked after quickly, but there is always a concern with delaying treatment, especially if the coronavirus disruptions last for more than a few weeks, said Krahn.

“Of course there’s worry,” he said. “There’s no question indefinite delays will lead to people having bad things happen while they are waiting.”

With some variations from province to province, hospitals across the country are postponing all elective cardiac procedures, resulting in a reduction in bypass, stent and other operations of 50 to 75 per cent, said Krahn. The society is also recommending that clinics and diagnostic services essentially be closed, “except for very ill people.”

That means, for instance, that a patient who fainted because of a heart condition would be treated immediately. But those who have a routine stress test that indicates they have a borderline need for a stent will have to wait, he said.

Toronto’s University Health Network, which encompasses four major hospitals, tends to care for “the most acute patients in the country.” But it is delaying most elective surgeries — from non-urgent gall bladder and hernia operations to hip replacements — a reduction of 25 to 40 per cent, said CEO Dr. Kevin Smith.

Also postponed are kidney transplants except those involving dead donors and recipients who are “highly sensitized or quickly deteriorating,” and lung transplants for any patient who is not declining rapidly.

Smith said the process is being carried out with care, each potentially postponed case reviewed by a panel of doctors. Some cancer surgeries, such as those involving slow-developing tumours, can be delayed safely, he noted.

“No patient wants to hear ‘You’ve got a malignancy and I’m going to wait to take it out,’ ” said the CEO. “But we’re trying to balance that against the risk and needs of other patients we anticipate coming to the hospital.”

Still, a study of the spillover effects of the 2003 SARS outbreak in the Toronto area — relatively small compared to the scope of the COVID-19 changes — found that efforts to reduce the demand on hospital services had some unintended, and troubling, consequences.

There were actually reductions in high-acuity visits to Toronto emergency departments and of hospital admissions for heart attacks, gastrointestinal bleeding and pulmonary embolisms — blood clots in the lung.

Emergency physician Dr. Michael Schull, who headed the research, said some emergency departments are now also seeing significantly reduced patient volumes. Public health authorities should remind Canadians they can still go to the hospital if they have a serious problem, said the CEO of the Institute for Clinical Evaluative Sciences.

“As much as we’re telling patients ‘Stay home, don’t go out unless you have to’ … we should also be telling people: ‘If you need the health system, it’s there for you and make use of it.”