Cancer surgeries and organ transplants are being delayed throughout the world as hospitals focus on treating coronavirus patients, pushing off some lifesaving operations.
As the coronavirus outbreak spread throughout Israel, the country postponed all voluntary medical procedures and cancelled non-essential surgeries and other health visits.
Referring to a report by the State Comptroller published in March, Dr. Yotam Rosner, head of Information, Research and Development for Physicians for Human Rights, lamented that “The report acknowledged that the system is overloaded, which we have said many, many times and means that there are no reserves whatsoever in hospital beds or ventilation machines and which means that effectively when we do have address this pandemic, everything else has to be stopped and delayed because now you need to direct all your medical staff toward this pandemic.”
The Health Ministry announced on March 19 that all elective procedures would be cancelled, excluding lifesaving oncological procedures, certain procedures for pregnant women, chemotherapy, dialysis, heart and blood vessel catheterizations, urgent cardiac, gastroenterological and lung tests, certain ambulatory rehabilitation services and certain psychiatric services. Each hospital was instructed to have a committee for extraordinary cases. Transplants were not included on the list of accepted elective procedures.
In the US, the American College of Surgeons recommended on March 13 that physicians halt all nonessential procedures, according to ProPublica. Elective surgeries include any surgery that is scheduled, meaning cancer surgeries, organ transplants and other lifesaving procedures are being delayed under the new recommendations.On March 24, the American College of Surgeons released a bulletin detailing triage guidelines for cancer, cardiac and pediatric surgeries and recommending that the removal of cancerous colon polyps be deferred for three months and breast cancer surgery be delayed if the disease responds to hormone therapy.
Hospitals with heavy COVID-19 caseloads are being urged to avoid all surgical procedures unless the patient is likely to die within the next few hours or days, unless delaying the treatment would harm the patient.
Russell Green, a 63-year-old from Vermont, was diagnosed with "aggressive" prostate cancer and advised to schedule a surgery as soon as possible, but his surgery was canceled after the coronavirus outbreak began. After some push back, the surgery was rescheduled, according to ProPublica.
The delays aren't always due to a lack of capacity, but rather a side effect of a lack of protective equipment being redirected to those treating coronavirus patients. Ventilators and ICU beds are being reserved for patients with the virus and doctors are concerned about immunocompromised patients entering hospitals where they could be exposed to the virus.
The delays are affecting patients throughout the country, with a 7-year-old boy in the Washington DC area having a kidney transplant delayed and a 33-year-old in Colorado who may only have a month to live without a liver transplant had his surgery cancelled as well, according to NBC News.
“I think this is incomparable to anything that we’ve experienced before,” Dr. Emily Blumberg, president of the American Society of Transplantation, told NBC News. “We’ve been very concerned always about the safety of the organ donor pool, and we pay a lot of attention to lots of things to make that safer. This is a whole different level of concern.”
Dr. Howard Huang, the medical director of the lung transplant program at Houston Methodist hospital, added that the inability to rapidly test for the coronavirus makes matters more complicated, as doctors have to weigh the risks of waiting to do a transplant against the risks of importing the coronavirus into a transplant center.
"That would basically, in one swoop, disable your ability to do transplants," said Huang to NBC News.
A great deal of uncertainty remains concerning when surgeries will be able to be rescheduled.
"All this has happened in two weeks. We went from business as usual to we have to cancel everything and stay home,” said San Francisco Bay Area surgeon Mary Cardoza to ProPublica. “I’ve never seen things change on a daily basis the way they are now.”
A backlog of surgeries is likely to build up as well, according to ProPublica, as over 1 million people usually have some form of surgery every month. Preventive measures such as mammograms, prostate cancer screenings, stress tests and cardiac checkups are also being delayed.
“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,” said Cardoza. “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.”Maayan Jaffe-Hoffman contributed to this report.