Is It Really Safe To Begin Elective Procedures Again?

On Friday afternoon, Texas Governor Greg Abbott announced the formation of a task force, aimed at re-opening Texas after a near shutdown to limit the spread of COVID-19. The pandemic has impacted our populations in countless ways, but especially financially. Businesses are struggling as they have been forced to shut down or limit operations in an attempt to limit the spread of this disease or to provide more support to those businesses working on the front lines, like healthcare workers, grocery stores and other essential businesses. The impact has been incredible and many are antsy to resume life as normally as possible. However, even though the Governor has given the green light to begin some normalcy, we must be cautious. COVID case numbers are continuing to increase every day. As of Saturday the 18th, there were 992 confirmed cases in the San Antonio area. The number continues to grow every day and some have speculated that San Antonio and Texas have yet to see peak numbers. Many predicted that cases would peak towards the end of April and early May. Per a local ordinance that was released late last week, San Antonio citizens will be required to wear a cloth face mask in public settings - this increased protection does not give the impression that we are ‘out of the woods.’ As such, we as a community are still very much at risk. The loosening of guidelines will only encourage the spread if we truly have not reached our declines. Businesses and people need to be equally vigilant. Of the restrictions being loosened is the limitations on elective surgical cases. Over the last month or so, elective surgeries and procedures have been postponed to ensure that healthcare workers, equipment and PPE was available to front line workers. It was also done so that patients who did not require urgent care could continue to shelter in place and avoid the opportunity to spread germs. As such, hospitals and ambulatory surgery centers have been requiring physicians to have surgeries approved by a board to ensure only emergency cases are being performed. This has dropped the number of cases by up to 80% at some facilities. The financial impact of this has been huge and many physicians and health systems have lobbied to return to normal in order to gain some financial relief. But is this financial relief going to be worth the possibility of increased infections? Governor Abbott provided some restrictions to providing elective procedures, including access to both personal protective equipment and plenty of open hospital beds to continue to treat COVID-19 patients. 25% of hospital capacity must be reserved for COVID-19 patients and PPE cannot be requested from any federal or state resources. Our experience is that PPE is still not readily available for our providers. One of our physicians has been completing emergent surgical procedures and is given one mask upon entering the facility to use for all of his cases. He has also had to bring that mask with him to other surgical centers in order to provide services. This does not constitute ample access to PPE. We have not been able to receive masks, Caviwipes, or sanitizers from our medical supply companies and a neighboring physician had all of his face shields stolen out of his office. This order, coming at the state level, will also have to be compared to local ordinances, healthcare insurance organizations, including CMS, and healthcare agencies, such as AHA and AMA. The American College of Surgeons, American Society of Anesthesiologists, Association of periOperative Registered Nurses and American Hospital Association released a joint report, recommending that there be a “sustained reduction in the rate of new COVID-19 cases in the geographic area for at least 14 days and the facility should have appropriate number of beds, PPE, ventilators and trained staff without resorting to a crisis standard of care.” There is a strong case to be made that San Antonio does not meet this criteria yet. Many other organizations have not commented, including the local government. More information will continued to be released over the next few days, but our community and healthcare facilities must continue to be vigilant to ensure our community is safe.