The coronavirus pandemic has strained healthcare systems in the United States and globally to the breaking point, taxing doctors’ capabilities and decimating medical supplies. Now its latest victims are patients awaiting elective procedures.
In an attempt to preserve healthcare resources for the COVID-19 response, the U.S. Centers for Disease Control and Prevention (CDC) last week urged hospitals and surgery clinics to delay elective inpatient and outpatient surgeries and to “prioritize urgent and emergency visits and procedures now and for the coming several weeks.”
The CDC’s directive affects an untold number of patients who’ve been implanted with medical devices. Now these patients face uncertainty over when they can have an unwanted device removed or receive treatment for device-related complications.
Maria Gmitro, a patient advocate and director of community outreach at TrackMy Solutions, told MedTruth she’s heard every day from patients who are having their surgeries postponed or canceled due to the pandemic.
“A lot of these patients are immunocompromised, so it’s a double whammy because they’re not going to get the treatment they might need,” she said. (Immunocompromised individuals have a weakened immune system and a reduced ability to fight infections and other diseases.)
Worsening the blow, some patients facing delays are having surgeries that aren't covered by their insurance, Gmitro noted. These patients have had to save up for their procedures and book travel out of state to see specialists — money that they may not be able to recoup.
Another factor is a shortage of surgeons with the skill to perform complex device removal procedures — such as explant surgery involving breast implant-associated anaplastic large cell lymphoma, a type of cancer, or removal of Essure coils (a permanent method of birth control) — which makes demand for these specialists high, even in normal times.
“Some of the surgeons that perform device removal surgeries are already booked out for six months and even over a year,” Gmitro said. Patients may face added delays to see a surgeon even after the coronavirus crisis ends.
It’s difficult to say how many patients nationwide might be affected by the CDC’s guidance. Leading medical organizations, such as the National Center for Health Statistics and the American College of Surgeons, told MedTruth they don’t track the number of elective surgeries.
What constitutes an elective surgery also appears to depend on various factors, including the supply of on-the-ground healthcare resources. Guidance released by Centers for Medicare & Medicaid Services (CMS) at a White House Task Force briefing last week urged hospitals and doctors to consider the availability of beds, personal protective equipment and healthcare staff, along with the patient’s health and the urgency of the procedure in determining whether to delay a procedure.
The administrator of CMS said in a press release:
“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight.”
Each month, Ed Marty, 74, goes to a hospital in Washington state to get cobalt cleaned out of his blood in a dialysis-like process called plasmapheresis. The much-needed procedure combats the effects of a DePuy Pinnacle metal-on-metal implanted into his hip in 2009.
Some metal-on-metal implants release cobalt and chromium ions that may be responsible for toxicity and harmful health effects, according to research.
But Marty isn’t going to this hospital this month — and maybe not the next.
“His doctors told us that Ed's treatment will be put off indefinitely due to no beds available in the hospital (during the current pandemic),” Cat Shaw, Marty’s wife, told MedTruth.
Washington state is a hotspot of the coronavirus outbreak, with 2,469 cases and 123 deaths as of March 24, 2020.
Last week, Gov. Jay Inslee declared a statewide ban on elective surgeries and dental services. The decree carves out exceptions for patients who have had a heart attack, stroke or been injured in a car accident, or where delaying a procedure “would worsen the patient’s condition.”
In most places, Marty’s cobalt removal would be an outpatient procedure that could possibly be performed at a clinic. But because he has a heart pump and suffers from cobalt cardiomyopathy, which is heart failure due to cobalt, Marty’s procedure requires hospitalization.
Ridding Marty’s bloodstream of cobalt dramatically improves his quality of life. He can breathe easier, take longer walks and is less fatigued.
Still, his wife worries that taking him to the hospital now would expose him to too much risk as doctors race to treat a surge of patients infected with COVID-19. She believes that they’re in better shape than many people to ride out this crisis because they’ve stocked up on food, supplies and medicine.
“Those hospital beds are desperately needed for the people who are fighting for their lives,” she told MedTruth.