US hospitals postpone non-emergency procedures amid coronavirus pandemic

Hallie Golden
Photograph: Angela Weiss/AFP via Getty Images

Hospitals across the US are postponing non-emergency procedures as they deal with staff shortages and a dangerously low supply of protective equipment amid the coronavirus pandemic.

The CDC and the American College of Surgeons have recommended that hospitals, health systems and surgeons work to postpone or cancel elective and non-urgent procedures. The college of surgeons said this practice should stay in place until it’s clear “that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs”.

Ali Santore, group vice-president for government and public affairs at Providence St Joseph Health, which includes 51 hospitals across seven US states, said in its Everett and Seattle hospitals there was “serious concern” that they will run out of surgical masks and face shields in a matter of days.

Nurses and caregivers from their Spokane, Washington, location recently had to drive about six hours to deliver face masks to Everett because they were running out, she said. Other staff members have started making their own face shields from what’s available on their shelves.

Their healthcare locations, which includes a hospital in Everett that treated the first person in the US diagnosed with coronavirus, have seen more than 100 cases and 556 potential cases.

Santore said the hospital has started using a chatbot to virtually screen patients before they come in, which has helped to curb the “worried well” visitors. But they are still facing challenges with staffing, as nurses and physicians call in sick or struggle to come in because of childcare issues resulting from school closures. Santore said nursing staff have started contacting retired nurses who still have active licenses, to see if they can help.

“Right now, the situation is fairly stable, what we’re concerned with is if there’s a surge like we are anticipating, as the numbers and the modeling show us,” she said.

Last week, the governor of Washington, Jay Inslee, ordered a halt to all elective surgeries and dental services, including non-urgent cardiac procedures and most joint replacements and cataract procedures. He said this was meant to help the state conserve protective equipment, which has been “severely disrupted” amid the outbreak.

Robert Cruickshank was due to have his gallbladder removed in Seattle this week, after doctors found several gallstones inside. One had already gotten dislodged, and they were worried others could follow.

But three days before the procedure, he received a call from a staff member at University of Washington Medicine, who said the hospital needed to postpone the surgery to conserve resources, and that they would follow up sometime soon about rescheduling.

“My concern is that all of a sudden something happens, I have another attack, and either there’s a serious complication or I go to the ER and there’s no room for me because they have even more urgent concerns,” he told the Guardian.

In a statement released this week, Bonnie Castillo, executive director of National Nurses United, a registered nurses union, said the healthcare capacity in this country is nowhere near what is necessary to address this pandemic. She stressed the importance of substantially increasing the supply of powered air purifying respirators and N95 respirators, along with protective clothing and gear.

“We should also prioritize testing and paid quarantine for nurses and other healthcare workers who are exposed, to prevent the further spread of the virus and to meet the demand of a surge,” she said.

In New York, health centers like NewYork-Presbyterian and Rochester Regional Health have postponed all elective procedures and surgeries. The Mount Sinai Health System announced this week it is prohibiting all visitors, with exceptions only for healthy people visiting such areas as the NICU, maternity and palliative care areas.

“Preventing avoidable exposure is critical to ensure that we can continue to respond to this public health crisis,” the health system said in a statement.

Officials think the virus spreads mainly from person to person through coughs or sneezes. Most coronavirus infections cause mild symptoms, but for some at a higher risk, including older people and those with chronic illness, it can cause more severe issues.

New York’s governor, Andrew Cuomo, has repeatedly called on the federal government for assistance, and said the state does not have enough hospital beds to address the crisis. On Monday, Cuomo confirmed that coronavirus cases in the state had ballooned to more than 20,000 – by far the highest total in the United States.

Cuomo said he would issue an emergency order requiring the state’s hospitals to up their capacity by at least 50%, though he would ask facilities to double their capacity if possible.

He announced last week that the navy’s Comfort hospital ship will be deployed to New York harbor to boost the state’s hospital surge capacity. Both Washington and California leaders have requested navy hospital ships for their own efforts.

The Zuckerberg San Francisco general hospital and trauma center, along with other hospitals in the city had also started postponing certain non-emergency procedures, said Susan Ehrlich, its CEO. They had also started only allowing essential staff and few visitors, as well as screening everyone for a fever, cough or unexplained shortness of breath, she said.

Even with all of these measures in place, Ehrlich said the hospital was still in need of more personal protective equipment, including face shields, masks, gloves and gowns, and also tests for the virus.

“We don’t have the ability to test everybody who should or wants to get a test, not even close,” said Ehrlich.

She said she did not know a hospital that wasn’t struggling with supply of these things, calling this a national issue.

“It’s hard to understand how our country can’t produce enough of these supplies or enough tests to be able to make sure there’s plenty of them on hand to meet the challenge of this disease,” said Ehrlich.

Donald Trump has so far refused to invoke the Defense Production Act, a Korean war-era law that allows government to mandate private businesses to produce needed goods during a national emergency. Instead, the federal government has relied on voluntary efforts from private industry.

The CEO of 3M, Mike Roman, has said the company was urgently ramping up production of N95 respirator masks, and that New York and Washington state would receive half a million masks, beginning on Monday.