Three months ago, the nation watched as COVID-19 patients overwhelmed New York City’s intensive care units, forcing some of its hospitals to convert cafeterias into wards and pitch tents in parking lots.
Hospitals elsewhere prepped for a similar surge: They cleared beds, stockpiled scarce protective equipment, and—voluntarily or under government orders—temporarily canceled non-emergency surgeries to save space and supplies for coronavirus patients.
In most places, that surge in patients never materialized.
Now, coronavirus cases are skyrocketing nationally and hospitalizations are climbing at an alarming rate. But the response from hospitals is markedly different.
Most hospitals around the country aren’t canceling elective surgeries—nor are government officials asking them to.
Instead, hospitals say they are more prepared to handle the crush of patients because they have enough protective gear for their workers and know-how to better treat coronavirus patients. They say they will halt nonessential procedures at hospitals based on local assessments of risk, but not across whole systems or states.
“What we now realize is that shutting down the entire health care system in anticipation of a surge is not the best option,” said Carmela Coyle, president of the California Hospital Association. “It will bankrupt the health care delivery system.”
But some health care workers fear that continuing elective surgeries amid a surge puts them and their patients at risk. For instance, some nurses are still being asked to reuse protective equipment like N95 masks and gowns, even though hospitals say they have enough gear to perform elective surgeries, said Zenei Cortez, president of the National Nurses United union.
“They continue to put us at risk,” Cortez said. “They continue to look at us as if we are disposable material.”
Elective surgeries, generally speaking, are procedures that can be delayed without harming patients, such as knee replacements and cataract surgery.
The suspension was always intended to be temporary, said Dr. David Hoyt, executive director of the American College of Surgeons.
“When this all started, it was simply a matter of overwhelming the system,” he said.
Today, case counts are soaring after many states loosened stay-at-home orders and Americans flocked to restaurants, bars, and backyards and met up with friends and family for graduation parties and Memorial Day celebrations.
Governors, county supervisors, and city councils have responded by requiring people to wear masks, shutting down bars and restaurants—again—and closing beaches on the July Fourth holiday weekend.
But by and large, government leaders are not calling on hospitals to proactively scale back elective surgeries in preparation for a surge.
“Our hospitals are telling us they feel very strongly ... they can manage their resources,” said Holly Ward, director of marketing and communications at the Arizona Hospital and Healthcare Association. If they feel the situation warrants it, “they on their own will delay surgeries.”
In some states, such as Colorado, public health orders that allowed hospitals to resume non-emergency surgeries in the spring required hospitals to have a stockpile of protective equipment and extra beds that could be used to treat an influx of COVID-19 patients.
But the decision to reduce elective surgeries in California won’t come from the state. It will be made by counties in consultation with hospitals, said Rodger Butler, a spokesperson for the California Health and Human Services Agency.
The question is whether hospitals have systems in place to meet a surge in COVID-19 patients when it occurs, said Glenn Melnick, a professor of health economics at the University of Southern California.
“To some extent, elective care is good care,” Melnick said “They’re providing needed services. They are keeping the system going. They are providing employment and income.”
In Los Angeles County, more than 2,000 COVID patients are currently hospitalized, according to county data. While that number is projected to go up by a couple of hundred people over the next few weeks, hospitals believe they can accommodate them, county Health Services Director Christina Ghaly says. In the meantime, hospitals are preparing to bring on additional staff members if needed and informing patients who have scheduled surgeries that they could be delayed.
“There are more patients with COVID in the hospitals than there has been at any point previously in Los Angeles County during the pandemic,” Ghaly said. “Hospitals are more prepared now for handling that volume of patients than they were previously.”
While hospitals have not stopped elective surgeries, many have not ramped up to the full schedule they had before COVID-19. And they say they are picking and choosing surgeries based on what’s happening in their area.
“We were all things COVID when it was just starting,” said Joshua Adler, executive vice president for physician services at UCSF Health. “We didn’t know what we were facing.”
But after a couple of months of treating patients, hospitals have learned how to resupply units, how to transfer patients, how to simultaneously care for other patients, and how to improve testing, Adler said.
At Scripps Health in San Diego, which has taken more than 230 patients from hard-hit Imperial County to the east, its hospitals have scaled back how many transfers they will accept as confirmed COVID-19 cases rise in their own community, said Chris Van Gorder, president, and CEO of Scripps Health.
A command center set up by the hospital system reviews patient counts and medical supplies and coordinates with county health officials to study how the virus is spreading. Only patients who need urgent surgeries are being scheduled, Van Gorder said.
“We’re only allowing our doctors to schedule cases two weeks out,” Van Gorder said. “If we see a sudden spike, we have to delay.”
In California’s Central Valley and in Phoenix, where cases and hospitalizations are surging, Mercy hospitals have suspended elective surgeries to focus resources on COVID-19 patients.
But the other hospitals in the CommonSpirit Health system, which has 137 hospitals in 21 states, aren’t ending elective surgeries—as they did in the spring—and are treating patients with needs other than COVID, said Marvin O’Quinn, the system’s president and chief operating officer.
“In many cases, their health deteriorated because they didn’t get the care that they needed,” said O’Quinn, whose hospitals lost close to $1 billion in two months. “It’s not only a disservice to the hospital to not do those cases; it’s a disservice to the community.”
