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    U.S. Healthcare System Devastated By Canceled “Elective” Surgeries, Stay at Home Orders

    U.S. Healthcare System Devastated By Canceled “Elective” Surgeries, Stay at Home Orders

    “At a time when we feared that hospitals would get overwhelmed by a surge of patients, they have been emptied out. At a time when we thought medical personnel would be at a premium, they are being idled all over the country.”

    While the Wuhan coronavirus is a real problem, our often one-size-fits-all response appears to be creating still more problems, particularly in terms of our nation’s health care system.  Cancer screenings and surgeries, most diagnostic screenings unrelated to the coronavirus, and many necessary quality of life surgeries have been canceled or postponed indefinitely to keep hospitals free to handle a massive influx of coronavirus patients. An influx that in most parts of the country hasn’t happened.

    The resultant loss of medical professionals’ jobs, loss of revenue to hospitals, and potential loss of patient life (or quality of life) are creating a whole new healthcare crisis across the country.

    The problem appears to have begun when “elective” medical attention and surgeries meant anything not related to the Wuhan coronavirus or not immediately life-threatening.  Or abortions, those were perversely deemed essential to human life in some quarters. Cancer screenings and treatment?  Not so much.

    Reuters reports:

    Routine medical tests critical for detecting and monitoring cancer and other conditions plummeted in the United States since mid-March, as the coronavirus spread and public officials urged residents to stay home, according to a new report by Komodo Health.

    Diagnostic panels and cancer screenings typically performed during annual physician visits fell by as much as 68% nationally, and by even more in coronavirus hotspots.

    These tests, office visits, surgeries and other medical care tied to them, are key sources of revenue for hospitals and healthcare systems that had to curb lucrative elective procedures to assure room for a crush of patients with COVID-19, the illness caused by the new coronavirus.

    Millions of patients postponed tests considered crucial for detecting early signs of disease, monitoring its progression and improving patient outcomes, according to Komodo, which has one of the nation’s largest medical claims data bases and provided its new findings exclusively to Reuters.

    Cervical cancer screenings were down 68%, cholesterol panels fell by 67% and the blood sugar test to detect diabetes were off 65% nationally. This could all prove very costly down the road.

    “We’re seeing a tremendous impact on preventive care, as well as on chronic conditions with massive implications for the healthcare system,” said Komodo Health Chief Executive Dr. Arif Nathoo. “It speaks volumes to just how much COVID is impacting everyone’s health and wellness.”

    The Atlantic has more in their March 17th article, “What It Really Means to Cancel Elective Surgeries: To make room for coronavirus patients, hospitals are delaying procedures that would make major differences in people’s lives”:

    Three weeks ago, Robert Cruickshank went to the ER in Seattle with terrible abdominal pain. The diagnosis? Gallstones. The hospital gave him strong painkillers and urged him to come back again—and soon—to have his gallbladder removed. “It doesn’t have to happen tonight,” he recalls the doctors saying, “but get it scheduled as soon as possible.” No one yet knew that the coronavirus was already spreading undetected through the city. Cruickshank briefly wondered if this virus in the news would affect things when scheduling the surgery for yesterday, but his doctor didn’t seem worried.

    By this past Friday, everything had changed. The doctor’s office called to say that his gallbladder-removal surgery would be postponed indefinitely.

    All over the country, patients are finding their nonemergency surgical appointments canceled as hospitals prepare for a spike in coronavirus cases. Surgeries for early-stage cancer, joint replacements, epilepsy, and cataracts are all getting pushed back—to ration much-needed personal protective equipment, keep hospital beds open, and to shield patients from the virus. On Friday, the American College of Surgeons recommended that hospitals reschedule elective surgeries as needed. Hospitals in outbreak hot spots such as Seattle, New York, and Boston were the first to act, but more are likely to follow suit.

    Some patients are left wondering if they have a ticking time bomb inside them. Others are upending carefully made plans for life-altering surgeries with long recovery times.

    Elective surgery does not mean optional surgery. It simply means nonurgent, and what is truly nonurgent is not always so obvious. Gerard Doherty, the chair of the surgery department at Brigham and Women’s Hospital in Boston, which began postponing elective surgeries on Friday, says surgical procedures can fall into one of three categories. About 25 percent of the surgeries performed at his hospital can be delayed without much harm. These might include joint replacements and bariatric surgeries for weight loss. Another 25 percent are for life-threatening emergencies that need to be treated right away: perforated bowels, serious heart problems, bones that have broken through the skin. [emphasis in original]

    Another consequence of postponing “elective” surgeries, screenings, and procedures is that a large number of our health care professionals have been laid off, and hospitals are losing millions of dollars.

    ABC News reports:

    As the novel coronavirus leaves a path of human devastation in its wake, the financial future of some of the nation’s largest health care systems is also now in jeopardy — leading many of these institutions to let go of health care workers at a time when patients need them most.

    While private practices and smaller health systems were some of the first to be affected, as time has stretched on, some of the country’s largest health systems have shown that they too are vulnerable.

    COVID-19 has kept many doctors and nurses busy, but diversion of health care resources towards the care for those with the virus has been an unprecedented financial drain, since then many of the hospitals’ usual stream of revenue — including pricey elective surgeries — has been shut off. Now, some of the nation’s biggest health systems claim they cannot weather this storm without sacrificing employee jobs or cutting their pay.

    The frenzy also hit primary care physicians hard.

    GoLocal Prov reports:

    Care New England reports that the hospital group lost a total of $44.5 million in March.

    . . . . The losses were primarily due to the canceling of elective surgeries, closing of ambulatory sites, and a significant reduction in office and emergency room visits.

    . . . . Dr. Michael Fine, the former Director of Health in Rhode Island, warns that primary care physicians are in significant economic peril.

    “Oh they’re struggling — I mean they’ve done an amazing job making the transition like in a second to telephonic care but lots of people became afraid of going to the doctor because of you know afraid of being infected in waiting rooms and so their actual business vanished,” said Fine on GoLocal LIVE on Thursday.

    He says upwards of 30% of primary care physicians may be forced to close due to lack of revenue, lack of reserves, and little chance of federal bailouts.

    It’s not just patients, hospitals, and health care professionals suffering during the widespread shutdown and stay at home orders.

    Parents are not vaccinating their children due to concerns about Wuhan coronavirus, and there are significant long-term problems that could arise due to delays in vaccination and routine child wellness and health checkups.

    The New York Times reports:

    As parents around the country cancel well-child checkups to avoid coronavirus exposure, public health experts fear they are inadvertently sowing the seeds of another health crisis. Immunizations are dropping at a dangerous rate, putting millions of children at risk for measles, whooping cough and other life-threatening illnesses.

    “The last thing we want as the collateral damage of Covid-19 are outbreaks of vaccine-preventable diseases, which we will almost certainly see if there continues to be a drop in vaccine uptake,” said Dr. Sean T. O’Leary, a member of the American Academy of Pediatrics’ committee on infectious diseases.

    It seems counterintuitive to see a decline in health care, a loss of health care revenue, and medical professionals losing their jobs during a global pandemic, but that does seem to be a growing concern.

    The New York Post reports:

    Many hospitals and health centers are getting pushed near, or over, the financial edge. At a time when we feared that hospitals would get overwhelmed by a surge of patients, they have been emptied out. At a time when we thought medical personnel would be at a premium, they are being idled all over the country.

    We are experiencing an epidemic that bizarrely — and in part because of the choices of policy-makers — has created a surfeit of hospital beds and an excess of doctors and nurses.

    That doesn’t hold true everywhere, of course. Hospitals in New York City and parts of New Jersey have been tested to their limits. But throughout much of the country, hospitals are drastically underutilized, both because states have banned elective procedures and because people have been afraid to show up.

    One reason that we didn’t want hospitals to get overrun by COVID-19 patients is that we’d crowd out everyone else needing care. But we’ve ended up crowding out many people needing care as a deliberate choice — even where COVID-19 surges haven’t happened and probably never will.

    . . . . As with the lockdowns in general, it isn’t clear how much of the reduced traffic in the hospitals has been the result of people changing their behavior on their own based on fear of the virus — and how much has been the result of state edicts. But it’s certainly true that the prohibitions on elective surgeries — more than 30 governors had issued some form of them as of late April — were too clumsy and sweeping, and not geographically selective enough.

    They can’t be loosened up fast enough. In retrospect, they fail the cardinal rule of health care: First, do no harm.

    The Wall Street Journal reports that some states are looking at resuming procedures, screenings, and surgeries postponed by the Wuhan coronavirus.

    Hospitals, clinics and surgery centers are moving tentatively to resume surgeries and other procedures that were halted when the coronavirus pandemic reached the U.S., a shift that could help stanch the sector’s financial losses but presents new risks to infection control and public health.

    Tenet Healthcare Corp. […] is preparing to restart some surgeries in Texas, said people familiar with the hospital and surgery-center company’s plans. HCA Healthcare Inc., […] a national hospital chain, said on an investor call Tuesday it expects to reopen across its 43 markets by the end of June. California Gov. Gavin Newsom said Wednesday that the state is working with health-care providers to resume postponed procedures.

    One independent rural Missouri hospital is already advertising for patients to return. “If you stub your toe at 3 a.m. and think you broke it, yes, come in even if it’s not life-threatening,” said Randy Tobler, chief executive of Scotland County Hospital in Memphis, Mo., who went on a local radio show to announce the news. “We’re open for business.”

    Hopefully, state officials will move as quickly as possible to address this growing problem before the damage to patients, hospitals, and the healthcare industry is irreversible.


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    AF_Chief_Master_Sgt | April 29, 2020 at 10:57 am

    I see lots of whining from people who are incensed because others aren’t wearing masks. Stop your complaining. Hide in your homes in fear of a boogeyman.

    I have a medical condition that prevents me from wearing a mask. I can’t breathe C02 that is captured within a mask, so I am exempt from wearing one.

    I am sick and tired of the same nasty people who bitch about whether someone should park in a handicapped spot whining about me not wearing a mask. I don’t need to park in a handicapped spot, but I damn sure have no intention of causing myself harm because not wearing a mask makes some of you uncomfortable.

    Get over yourself. Stay inside, hide. Cower in fear. Me, I am living my life and worrying about me. Worry about you.

    chocopot | April 29, 2020 at 11:03 am

    Am I the only one who thinks this is all part of a plan to bankrupt what’s left of the private health care system so the government can take it over and give us their long-desired “one payer plan” which will be an unmitigated disaster for the American people?

    CommoChief | April 29, 2020 at 1:13 pm

    What will be noticed is the total number of deaths vs excess deaths on a 2019 v 2020 basis. Some of the data on a weekly basis is out there and the interesting thing is that the excess deaths are far below the reported covid deaths.

    It will take some time to slice and dice these numbers but obviously traffic fatalities would be expected to fall while suicide might be expected to increase during our stay at home order period.

    Going to be harder to tease out preventable deaths due to delayed/ deferred treatment. Not just surgical procedures. How many folks didn’t get a ‘stress test’ and will be undiagnosed for a heart condition?

    Carry that throughout the nation and we can say with confidence that many deaths will be attributed to the second order effect of closing down the nation. It will take time to accurately measure the total but it is possible that the rate of death attributed to shutting down will equal or exceed the direct covid death toll. Certainly it will be a much larger number that the general population realizes.

    Albigensian | April 29, 2020 at 1:44 pm

    It’s not just “medical tests critical for detecting and monitoring cancer” that have been cancelled but also procedures to remove tumors for newly diagnosed cancer patients.

    “TURBT” in the link below means “trans urethral resection for bladder tumor”: it’s a procedure used to remove early-stage cancerous tumors from the bladder.

    Patients who have been diagnosed with early-stage bladder cancers and who were scheduled for this (almost always outpatient, ambulatory) surgery got cancelled indefinitely. Apparently because hospital operating rooms have been re-purposed as ICU treatment rooms, just in case these may be needed to treat the COVID-19 patients who have yet to present in sufficient numbers to require use of this resource.

    Perhaps there’s a nicer way to put this, but it appears that known, intentional harms are being inflicted to obtain a resource which may never actually be needed.

    Have our “medical ethicist” geniuses been at work again?

      Barry in reply to Albigensian. | April 29, 2020 at 6:22 pm

      “Have our “medical ethicist” geniuses been at work again?”

      The other, more common name, for “medical ethicist” is communist.

      Once you understand that, everything else falls into place.

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