What began as some gastric issues last year has now progressed into painful gallstones and chronic problems for Hannah Gebhard, who lives in Naugatuck.
“It was really just a ramping up of the symptoms until I one day landed myself in the emergency room at 2 a.m. because I was in so much pain,” she said.
The solution? Surgery to remove her gallbladder, a small organ that aids in digestion when working properly.
Gebhard’s surgery date with the UConn Health system was scheduled for March 20.
“And they called me to cancel maybe three days before the surgery was going to happen,” she said.
The 26-year-old cellist and music instructor experienced an early effect of the COVID-19 pandemic in Connecticut, where hospitals and health systems in March began canceling and postponing elective or non-urgent surgeries and procedures in anticipation of a surge of sick patients.
As the state sees an overall decline in COVID-19 hospitalizations and enters a reopening phase, many of these services are slowly picking up again. But health care providers face a backlog of patient cases and decisions on who gets priority -- weighing the risks of an ongoing disease outbreak against the benefits of going through with a procedure.
“If you’re 62 years old and you’ve had severe osteoarthritis of your hip, you can’t even walk up and down the stairs at home, you’re living pain, potentially you’re taking narcotics at home, who’s that good for?” asked Dr. John Rodis, president of Saint Francis Hospital in Hartford. “That’s the kind of patient where if they don’t have a lot of comorbidities, we want to get in, particularly those who don’t even have to stay in overnight.”
Saint Francis and other Connecticut hospitals, outpatient centers and private facilities have announced safety protocols for incoming patients, including temperature checks, questionnaires and mandatory testing for COVID-19.
The goal, Rodis said, is to assure people that these are safe environments for procedures, and for the health care staff that will be performing them.
“We have COVID-free units, COVID-free entrances so that people can feel comfortable if they’re coming in for one of these not-so-emergent procedures,” he said, “[so] they know they’re going to be safe as well as they can.”
Most hospitals and facilities are requiring patients to get tested for COVID-19 no more than five days out from their scheduled surgery or procedure -- at some places, it will be a smaller window of time.
And it will be a while before health systems return to a pace they were operating at before the pandemic. Rodis said it could take months for providers to reschedule and catch up on a backlog of cases.
“We might be working six days a week through the summer and the fall, to be honest with you, just to catch up on these people who are out there, who are unfortunately suffering in pain, who’ve delayed a surgery that you really need to have,” he said.
When ‘Elective’ Doesn’t Feel Elective
Early on in the pandemic, medical experts agreed that postponing nonessential and elective surgeries and procedures was necessary in order to conserve personal protective equipment, redeploy staff to COVID-19 units and prevent disease exposure to more patients.
Gebhard understands the reasoning behind her canceled surgery, but it’s been difficult dealing with her symptoms.
“The symptoms of like gallstones and gallbladder issues are really the inability to eat high quantities of fat, and every time you do, you get pretty severe abdominal cramping ... I get really bad pain in my right shoulder,” she said. “The nonessential surgery thing I find very upsetting, because elective surgery in my brain is like, ‘I’m choosing to have this.’ And I’m not choosing to have my gallbladder removed -- I need my gallbladder removed.”
Many doctors agree that most of these delayed surgeries and procedures aren’t exactly elective. Dr. David Emmel, an ophthalmologist and medical director of the Hartford Hospital Eye Surgery Center in Newington, said it’s true that things like knee replacements, arthritis repairs and non-emergent aortic valve replacements can be safely deferred, but only up to a point.
Delaying some cases even further leaves time for a patient to develop a new comorbidity, a complication or a deterioration in their condition that affects their health and way of life, Emmel said.
“I had a patient who I knew needed cataract surgery,” he said. “She was scheduled [and] canceled because of the pandemic. And she called me up and said, ‘You know, I’m falling. I’ve had three falls in the past month, I can’t see well enough to see steps.’ So, her surgery was done. She’s doing extremely well, she’s very happy.”
Emmel said the decision to reschedule a surgery or procedure will likely be done on a case-by-case basis.
“The sort of patient who has an advanced age, maybe overweight, have hypertension and diabetes -- these are the risk factors we know for COVID-19 -- we’re trying to hold them off a little longer if we can until it’s safer,” he said.
Economic Recovery For Health Institutions
There’s a financial incentive for hospitals and practices to bring patients back as they rely on elective surgeries and procedures for a significant portion of their revenue.
The Connecticut Hospital Association estimated that statewide, health systems face a total of $1.5 billion in losses generated during the pandemic, a result of canceled elective surgeries and an increase in COVID-19-related expenditures.
“What we did to prepare for COVID-19 was we decreased the number of patients in the hospitals or coming in for services by 30 to 40 percent, and so that’s just 30 to 40 percent of our revenue out the door right away,” said Jennifer Jackson, CEO of the association.
Nationwide, the American Hospital Association estimates that hospitals will have lost more than $50 billion a month from impacts of the pandemic from March through June. The effect on individual hospitals and health systems will vary, depending on their financial stability before the pandemic.
Jackson says it’s unlikely that Connecticut hospitals will be able to recoup the money they’ve lost from cancelations, but “they’re managing it well.”
“I think we need to assume that those losses will continue for some period of time,” she said.
Going forward, Jackson said the focus lies on getting emergency federal funding to health systems, containing the epidemic, and encouraging people to get their annual exams, screenings and procedures done.
After weeks of observing stay-at-home orders, managing her symptoms, and staying in touch with her doctors, Gebhard will get tested for COVID-19 this week, two days before her rescheduled gallbladder surgery.
“I keep thinking, ‘Oh my God, my surgery is going to be canceled, something is going to go wrong,’” she said. “But I really just try to center myself back to today and say, ‘OK, well, what am I going to eat today? What am I going to do today?’ And try to really just focus on the day by day.”