What if I am seriously ill and not COVID-19? | Nation / World

At the world-famous cancer center in Toronto-Houston, a woman was told that her lung cancer surgery booked weeks ago might be canceled at the last minute. In New York City, none of the physician clinics in the major hospital systems operate. In Toronto, the operating room of a hospital specializing in organ transplantation and cardiac treatment was left empty, and the surgeon took a break at home as the ward was ready for the future.

The pandemic of COVID-19 requires unprecedented amounts of medical resources and personnel, and care for other conditions, even those that are life threatening, are pending. In many parts of North America, everything except emergency surgery has been canceled, and face-to-face treatment has been delayed, except in the most worrisome cases.

“This is a great ethical dilemma,” said Ashish Jha, head of the Harvard Global Health Institute. “There is absolutely a danger of ignoring those who are very in need of healthcare services without COVID.”

North America supports its healthcare system in hopes of avoiding more serious consequences, as the world has already seen in China and Italy. There, the hospital was facing a surge of coronavirus cases, so even urgent cases not related to the pandemic could not be treated.

When a large number of acute cases occur in a hospital, triage is a battlefield technique that determines the order of treatment for patients based on urgency. For short-term measurements, triage works as long as the patient’s flow continues to move. Once stable, move to another location to recover.

There are two problems with COVID-19. In the worst scenarios, hospitals have gone beyond their ability to treat life-threatening cases, as revealed by the devastation of Italy, and COVID is instead facing a painful decision on who to save. You. But even when the emergency room is floating, the decision to draw resources from elsewhere in the system and postpone procedures such as cancer surgery or organ transplantation for weeks or months poses a life-threatening risk There is a possibility.

Calling for judgment is painful for doctors. Cancelable surgery is already underway at Houston’s MD Anderson Cancer Center, said Mara Antonov, an assistant professor of thoracic and cardiovascular surgery.

Texas is still in the early stages of the curve, and in preparation for more cases, physicians are trying to understand that non-surgical options such as radiation and chemotherapy may be available for cancer patients. They are also asking if reversing surgery three or six months affects survival. When Antonov met a woman in her 60s this week with one of her pre-operative lung cancer patients, she had to send news that next week’s surgery could be canceled.

“The situation is changing every hour,” she said. “In our department, we absolutely do not plan new cases unless the patient is really at risk of imminent death if nothing else is done.”

Pushing back non-emergency surgery to prepare for COVID-19 can create challenges for doctors treating cancer, Antonov said. “The Catch-22 is an early person who feels we can postpone a little longer during this unprecedented pandemic.”

This is not just a patient care crisis. Hospital crisis. Elective procedures are a major source of income for US hospitals. (In Canada, medicine is socialized.) Their deferral poses a major financial challenge for the healthcare industry, just as its services are needed more than ever. For example, a US hospital lobby has called for $ 100 billion in relief funds for healthcare providers and hospitals from the government.

This week, Tenet Healthcare Corp was forced to retract its Q1 and 2020 forecasts due to the business impact of COVID-19. The Dallas-based company operates 65 hospitals and about 500 other medical facilities.

In a statement on Friday night, the American Hospital Association issued a strict warning. “Considering that virtually all normal operations, including selective or scheduled procedures, have ceased, limited revenues have led to significant cash flow concerns and the viability of hospitals. Causing historical financial crises and threatening our ability to keep our doors open to both insured and uninsured. “

For doctors, the concerns are more personal. In addition to examining the health effects of delaying surgery, patients who still have access to treatment may be I am worried that it can be avoided.

Jenny Ahlstrom, a 52-year-old from Salt Lake City, lives with multiple myeloma but has no plans to take bone augmentation agents or even perform routine laboratory tests. Ahlstrom’s myeloma recurs after remission and requires treatment at some point, but we are concerned that it will make it more susceptible to COVID-19.

“I’m really nervous right now, just before I need to start treatment,” she said. “I’m going? I don’t think I’m going.”

Healthcare providers are addressing these issues every day. In mid-March, the U.S. Medicare and Medicaid Service Center states that hospitals should restrict all non-essential surgeries and procedures during the outbreak of COVID-19, and has been widely adopted by major North American hospitals. Recommendation. However, it is not easy to define a medical term that is “selective”, meaning that it is actually not scheduled but scheduled, especially during a pandemic.

The Seattle Cancer Care Alliance continued treatment and basic surgery for those receiving chemotherapy and radiation therapy when the city became the first US hotspot for COVID-19.

However, healthcare providers have delayed non-emergency procedures that require significant amounts of face-to-face care and explored other treatment options, said Steve Pergam, medical director of infection prevention. He said, bone marrow transplants had a serious impact on the immune system and required about prolonged hospital stays, reducing them by about 50%.

In Toronto, the fourth largest city in North America, most hospitals have cut everything except emergency surgery, procedures, and imaging, creating surge capacity for COVID-19 cases.

Thomas Forbes, Chairman of the Department of Vascular Surgery at University Health Network, said: “It may be as easy to measure as death, or difficult to quantify, such as a decrease in life expectancy because someone who needed cancer surgery had to wait longer for treatment It may be something. “

A few weeks ago, San Francisco is facing an increasing number of cases of COVID-19, which is very similar to New York, said Robert Wokter, director of medicine at the University of California, San Francisco. However, the positive social distance seems to work, coupled with the early telecommuting decree. This week, the hospital has begun to “respond very carefully” to patients who need scheduled COVID-19-free procedures.

“We are every day,” Okay. If you stay where you are, is there room to start the surgery? ” But the hospital “is ready to close tomorrow if needed.”

In New York City, where more than 50,000 cases are currently occurring, a naval vessel arrives and transports 1,000 hospital beds to a temporary emergency room under a central tent, where the medical system is launched. The point of destruction is well documented. Park.

In a city full of closed offices, restaurants, schools and shops, the health system NYU Langone, while in a much more limited way, leaves doctors’ offices open for face-to-face healthcare.

Andrew Rubin, vice president of clinical and ambulatory care at NYU Langone, said: “Well, many patients are sick, sick, and will be ill far beyond Covid-19.”

(Editor: The story can end here)

The healthcare system is working to reduce office space as much as possible, including virtual doctors and emergency medical visits aimed at keeping high-risk and COVID-19 people at home. Rubin also noted that while office use has fallen by 80%, some people are still hospitalized, including those with chronic illness and who “can’t actually wait for a doctor”.

“It was a very difficult decision to be open,” he said. “But we need to be there for the patient, and we won’t fall into another kind of healthcare crisis.”

Dara Kas, associate professor of emergency medicine at Columbia University Medical Center, said that limited resources could already be burdening the healthcare system, which could have serious consequences if the situation in New York City deteriorates Said there is. Kass, who is recovering from COVID-19 himself, says she and her colleagues treat patients with respiratory failure or cardiac arrest hourly and intubate the city 200 to 300 patients per day. I said.

“Does the choice people don’t actually treat save COVID patients today or another tomorrow?” She said. “If you run out of all resources quickly without thinking about what will happen in a week or two, you will fail.”

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(Bohobe reported by courts in Toronto and New York)

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