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How the coronavirus is delaying life-altering surgeries

The coronavirus is reshaping the way some Americans live and even how they receive healthcare. One challenge that has emerged from this crisis is which patients get life-changing surgeries that have been deemed elective medical procedures during the pandemic and which ones wait. NewsHour Weekend’s Christopher Booker reports on how doctors and patients are being impacted by the delays.

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  • Hari Sreenivasan:

    One challenge facing hospitals during the pandemic? Deciding which patients have to wait for medical procedures they've been counting on to change their lives for the better. Now, as restrictions begin to loosen, some hospitals say they will begin rescheduling "elective surgeries." But, as NewsHour Weekend's Christopher Booker reports, an "elective" procedure doesn't mean that it is not a "critical" one, and postponement for some could be a matter of life and death.

  • Christopher Booker:

    27 year-old Melissa Siller started worrying about covid-19 long before the U.S. Had any known cases.

  • Melissa Siller:

    I was watching the trends in what was going on in countries like Italy. And I was very nervous.

  • Christopher Booker:

    As someone with a weakened immune system, siller, knew contracting the virus could be devastating. She was once a college tennis player but three years ago she was diagnosed with Ehlers-Danlos syndrome. It's a group of genetic connective tissue disorders that left the ligaments in her spine too loose to support her head. She gets dizzy, loses her balance, has vision problems and is in a lot of pain. But just this month she was planning to get some relief.

  • Melissa Siller:

    So I was supposed to have a cervical spine fusion or a cranial cervical fusion. So it fuses my skull and to a few of the vertebrae in my cervical spine. And because of the number of covid cases in New York City, the hospital that I would be having the surgery at is really over flooded with covid patients.

  • Christopher Booker:

    Siller found out late last month the surgery would be postponed indefinitely. That's because it is considered elective. Last month the Surgeon General and the CDC urged hospitals to postpone or cancel non-emergency surgeries in preparation for a spike in covid-19 patients. Across the country procedures including organ transplants, joint replacements, even cancer surgeries were taken off many hospital schedules. A handful of states also included abortions on the list of temporarily restricted procedures.

  • Dr. Jeffrey Matthews:

    We have really never been in this situation before where we've had to triage and think about which types of procedures need to get done first .

  • Christopher Booker:

    Dr. Jeffrey Matthews is the surgeon-in-chief at the University of Chicago Medicine. The hospital began delaying medical procedures in mid March in order to open up ICU beds.

  • Dr. Jeffrey Matthews:

    We really stopped doing things that we felt could wait, like joint replacement. And a lot of other types of operations, bariatric surgery was the other example I used. But then we started to think about could we give alternative therapy that would buy us some time say for cancer patients.There are many cancer patients who chemotherapy could come before surgery and that might buy a few weeks or months to be able to get some time so that patients weren't coming into the hospital in the middle of a pandemic.

  • Christopher Booker:

    According to Matthews, surgeries at the University of Chicago Medicine are down 75 percent. To decide who does receive surgery, the hospital uses a newly-devised scoring system in which it calculates factors including the size of a surgical team and how long a patient will be in the ICU.

  • Christopher Booker:

    What does the scoring system allow you to do as a doctor and what does it allow the hospital to do as an organization?

  • Dr. Jeffrey Matthews:

    So if we have room on the schedule, say, for 10 or 15 of these medically necessary time sensitive operations, I've got to figure out which ones. Is the orthopedic patient or the vascular surgery patient or the cardiac surgical patient or the gynecologic patient, the one that needs to be done. So what the scoring system allows us to do is in an objective way and one that feels right across many different specialties and many types of patient situations. It seems to get the balance right.

  • Dr. Sander Florman:

    We made the decision rather early on that we wanted to be able to continue to offer transplant to our patients most in need.

  • Christopher Booker:

    And what about life-saving surgeries? At Mount Sinai hospital in New York City doctor Sander Florman is still performing liver and kidney transplants.

  • Dr. Sander Florman:

    For the patients that we're transplanting now and that we wanted to continue to be able to transplant their mortality risk without transplant is upwards of 80 or 90 percent at one month. So when you start to put it in that perspective, you start to get an understanding of why we were so committed to being able to still offer that. In order to continue providing transplants, the hospital created a covid-19 negative ICU. Patients are tested for the virus before they undergo a transplant. But there has been one change: for now organs are coming almost exclusively from deceased donors. It probably wasn't right to do living donors, because while the recipients are willing to take a lot of risk, even unknown risk, it was, didn't seem fair to put that on a donor. Somebody who's completely healthy doesn't need the operation and is only doing it because they're trying to save someone's life.

    The change means fewer organs are available. Across the u.S. Transplants are about 40 percent. As for using equipment to provide life sustaining services for a transplant patient instead of someone with covid-19. Now, we have not run out of ventilators here. So the idea that maybe we're using one of these ventilators for one of these patients and not offering it to somebody else isn't accurate.

  • Christopher Booker:

    Have you had to contemplate questions like this before? Even in a theoretical sense?

  • Dr. Sander Florman:

    Well transplant surgeons and physicians are very used to life and death, decision making and having a shortage. Our world has always been about not having enough organs for those who are in need, right? There are one hundred and twenty thousand people in the United States waiting for an organ. And yet there are only about 17,000 donors. And how to stratify that and how to accept that and how to discuss that with patients, how to know that half the people on your list waiting for a kidney will die before they ever get the opportunity. It's something we've always lived with. This is just adding on top of that.

  • Christopher Booker:

    The kinds of life and death decisions that are routine in transplant cases are suddenly being made across the board. One person facing it is a friend of Melissa Siller's, Rachael Wilson. She was once a thriving ballet and lyrical dancer before her diagnosis. In fact, the two met in an online support group for people battling ehlers danlos-syndrome.

  • Rachael Wilson:

    My case has somewhat been elevated just within the past few days.

  • Christopher Booker:

    Just a few weeks ago Wilson was stable enough to wait while her doctors decided the best course of treatment for her disorder. But in recent days a related condition has caused excessive fluid to build up in her brain putting pressure on her neurological system.

  • Rachael Wilson:

    I'm having a lot of seizures. I'm not able to walk properly or much at all. Actually, I need a lot of help walking. I'm having vision loss, which is another, you know, neurological type thing. Pretty much everything, you know. Another one is not being able to remember things. So it's very difficult to, you know, live any type of life.

  • Christopher Booker:

    Wilson lives in northern Kentucky. Prior to the covid-19 pandemic she was traveling to the Washington, D.C. area to see specialists who treat her condition. But those doctors can't see her now, though her condition has become life threatening.

  • Rachael Wilson:

    My doctors are basically working really hard, but they can't do the surgeries right now because the hospitals are so full of coronavirus patients that they're pretty much saying, you know, you just have to wait. And in the meantime, we're searching for someone that might be local.

  • Christopher Booker:

    As she waits for her own surgery, Melissa Siller says she's relying on Wilson's encouragement to help keep her spirits up.

    Melissa Siller So Rachael is one of my biggest supporters and other people with our condition. We all support each other and that sort of gives us hope. And I know for some of us, we've just been praying and hoping for a change and hoping that the virus doesn't last much longer and that nothing happens to us before, you know, it's too late.

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