Doctors are now facing an unprecedented crisis as the United States has come under the full grip of coronavirus pandemic. With hospitals full of sick patients and many areas lacking sufficient COVID-19 testing and crucial medical equipment, administrators are being forced to make difficult decisions about how to best allocate limited medical resources.
This means cancer patients and others in need of lifesaving procedures, such as organ transplants, are now falling by the wayside. There’s never a “good” time to be diagnosed with cancer, but now, the timing is worse than ever.
On March 13, two days after the virus was declared a pandemic, the American College of Surgeons instructed physicians to reconsider all nonessential, or elective, procedures. This comes as a devastating blow to tens of thousands of Americans awaiting new organs, according to transplant experts.
What is an elective procedure?
Elective procedures are essentially any surgery that can be scheduled. To the layman, “elective” might not sound critical. However, these procedures encompass anything from cancer surgery to organ transplants, as well as other potentially life-saving measures. These procedures have since all been placed on hold—in some cases, for the indefinite future.
If this sounds like a potential death sentence to those in dire need of these types of procedures, you would not be entirely wrong. Yet, many doctors and hospitals are finding that their hands are now tied. Additionally, in some cases, performing these procedures pose too great of a risk to take.
The risks associated with elective procedures during coronavirus pandemic
Doctors in some parts of the country are finding that the inability to quickly and efficiently test potential organ donors for COVID-19 has forced them to decline viable organs, which means longer waits for sick patients. But even in the event that a donor can be cleared from transmitting the virus, another hurdle lies in the immunosuppressive drugs required to prevent organ rejection.
As such, many doctors who had treated transplant recipients before the pandemic broke out have since canceled most routine follow-up visits.
“After careful consideration and consultation with the majority of transplant programs across the country, UCHealth University of Colorado Hospital is putting our living donor liver and kidney transplant program on hold for two weeks, in keeping with recommendations reflecting the national pandemic,” Dr. Elizabeth Pomfret, chief of transplant surgery at UCHealth, told NBC News. “We and the remainder of the transplant community do not believe that choosing to immunosuppress a recipient and expose a donor to excess risk right now is in the interest of either the donor or recipient.”
A report from Forbes also noted that social distancing has played a role in declining transplant options, because less people are dying in car accidents and other “trauma-related injuries” since so many people are now staying at home. The major decline of airline travel has also affected the industry since it’s now much more difficult to transfer transplant organs across the country.
A lack of ventilators—which is being used for coronavirus patients—also has an effect. As Forbes wrote, “Ventilators are also crucial for organ transplants; they keep donor organs oxygenated if a patient is brain dead.”
The ripple effect for cancer patients
Many doctors are rescheduling or outright canceling cancer treatment procedures to prevent patients who may already be immunocompromised from being exposed to the virus. In pre-pandemic times, those diagnosed with cancer could expect to start treatment in days—now, many are seeing waits of weeks or even months before starting a regimen. This means that when the surgical freeze thaws, the backlog of those needing critical surgeries will likely overwhelm medical providers and put countless lives at risk.
Also, the delay of preventive measures like mammograms, prostate cancer screenings, stress tests, and cardiac checkups will likely cause a surge in late diagnoses.
“At this point, we’re only diagnosing people who have symptoms—for breast cancer, it’s someone feels a mass; for colon, someone has bleeding,” breast cancer surgeon, Dr. Mary Cardoza, told ProPublica. “We’re going to pick up the late ones, but the early detection we try to do is going to go by the wayside. All these ripple effects are just incomprehensible.”
Even in the event that cancer surgery or transplants can be safely performed, many hospitals are limiting operations to only the direst of cases—as beds in intensive care units are quickly filling up with coronavirus patients.
“Physicians should engage with patients and families to make care decisions that minimize potential risks to patients while ensuring they receive necessary care that cannot be safely delayed,” suggests the Ambulatory Surgery Center Association (ASCA). The statement adds that a significant consideration should be placed on potential post-surgical complications that could place added stress on local hospitals.