Most states begin to reopen from coronavirus shutdown — starting with elective surgeries
The coronavirus forced a near total shutdown in states across the U.S. What’s the starting point for reopening?
For many, it’s elective surgeries.
More than half of states — about 30 — have begun lifting restrictions put in place to help curb the spread of the coronavirus, The Hill reported. At least 16 of those resumed nonessential medical procedures this week.
Other states like California, which has no expiration date on its current stay-at-home order, has said it will begin allowing “important medical procedures like heart surgery,” CNN reported. In North Carolina, major hospital systems like Atrium Health and Novant Health have said they’ll resume some non-emergency surgeries starting April 27 and May 4, respectively, according to the Charlotte Observer.
Elective surgeries were among the first things health and policy experts recommended postponing to make room for a possible insurgence of COVID-19 cases.
According to the Ambulatory Surgery Center Association, the Centers for Medicare & Medicaid Services issued guidelines on March 18 for limiting procedures and conserving resources. At least 36 states and Washington D.C. followed suit with their own statements addressing the issue.
ASCA was tracking those restrictions on a state-by-state basis until April 20, when CMS reversed course with guidelines to resume such surgeries under phase one of President Donald Trump’s Opening Up America Again plan.
The American Hospital Association, American College of Surgeons, American Society of Anesthesiologists and Association of periOperative Registered Nurses have also issued their own “road map” to restarting, according to a news release.
Under both sets of guidelines, states are expected to meet certain benchmarks known as “gating criteria” before resuming elective procedures.
Those include a “sustained reduction” in the number of COVID-19 cases for at least two weeks, meeting the required need for coronavirus test kits, maintaining enough hospital beds, ventilators and other medial supplies and keeping enough healthcare workers on staff to meet the demand.
“The CMS recommendations are not meant to be implemented by every state, county, or city at this time and Governors and local leaders ultimately need to make decisions on whether they are appropriate for their communities,” the government’s guidelines state.
But there will likely be a second set of issues once medical facilities do reopen — a backlog of cases.
In parts of New York state, the governor’s executive order only allows elective procedures at hospitals — “not ambulatory surgery centers” — in 35 counties, the Observer Dispatch reported. Ambulatory centers are where a large swath of local surgeries are reportedly performed.
“It’s a capacity problem,” orthopedic surgeon Dr. Andrew Wickline told the newspaper.
AHA acknowledged the issue in its set of recommendations.
“When the first wave of this pandemic is behind us, the pent-up patient demand for surgical and procedural care may be immense, and health care organizations, physicians and nurses must be prepared to meet this demand,” the release states
According to their guidelines, healthcare facilities have to find a way to prioritize non-essential cases when it comes time to reopen.
That should include considering the list of canceled and postponed surgeries, prioritizing specialties like cancer and organ transplants and weighing what devices are needed for the procedure as well as their availability, the release states.
That could be easier said than done.
NBC News reported it’s no easy task for hospitals to weigh “patients’ needs with safety and equipment requirements.”
“I think people need to ramp up at some rates, not just do it all overnight,” Dr. David Hoyt, executive director of the American College of Surgeons, told NBC.
This story was originally published May 1, 2020 at 11:08 AM with the headline "Most states begin to reopen from coronavirus shutdown — starting with elective surgeries."
