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| The Coronavirus Is Forcing Hospitals to Cancel Surgeries | The Coronavirus Is Forcing Hospitals to Cancel Surgeries |
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| SEATTLE — Alison Krupnick was mentally preparing herself for the surgery set for early in the coming week that could eliminate her early-stage cervical cancer. But on Friday, she got word from the hospital: Because of the crush of coronavirus patients, her surgery was being called off. | SEATTLE — Alison Krupnick was mentally preparing herself for the surgery set for early in the coming week that could eliminate her early-stage cervical cancer. But on Friday, she got word from the hospital: Because of the crush of coronavirus patients, her surgery was being called off. |
| Ms. Krupnick was left feeling as if a time bomb was inside of her, and no firm word on when her surgery would be rescheduled. | Ms. Krupnick was left feeling as if a time bomb was inside of her, and no firm word on when her surgery would be rescheduled. |
| “I’m mindful of the greater good and understand we’re all suffering and there’s a world of need and a hierarchy of need,” Ms. Krupnick said. But, she added, she could not help but worry about the risks that might come with waiting. | “I’m mindful of the greater good and understand we’re all suffering and there’s a world of need and a hierarchy of need,” Ms. Krupnick said. But, she added, she could not help but worry about the risks that might come with waiting. |
| As hospitals face rising coronavirus caseloads and are preparing for the possibility that a worsening outbreak could overrun the health system, hospital administrators in some of the hardest-hit areas, in Seattle and in New York, have begun canceling elective surgeries to focus on the highest-priority cases. | As hospitals face rising coronavirus caseloads and are preparing for the possibility that a worsening outbreak could overrun the health system, hospital administrators in some of the hardest-hit areas, in Seattle and in New York, have begun canceling elective surgeries to focus on the highest-priority cases. |
| Their goal is to preserve resources — from hospital beds and protective gear to nursing and doctor time — to prepare for what could become a deluge of coronavirus cases. | Their goal is to preserve resources — from hospital beds and protective gear to nursing and doctor time — to prepare for what could become a deluge of coronavirus cases. |
| “We recognize based on current data that our local Covid-19 trajectory is likely to be similar to that of Northern Italy,” read an email one hospital in the Seattle area sent to its surgeons. “While our supplies may be sufficient today, we are practicing the responsible allocation of those resources that will be necessary to continue our care into the future we have yet to see.” | “We recognize based on current data that our local Covid-19 trajectory is likely to be similar to that of Northern Italy,” read an email one hospital in the Seattle area sent to its surgeons. “While our supplies may be sufficient today, we are practicing the responsible allocation of those resources that will be necessary to continue our care into the future we have yet to see.” |
| The hospitals are following new recommendations from the Centers for Disease Control and Prevention advising hospitals in and around Seattle, New Rochelle, N.Y., and Santa Clara, Calif., which have seen the most serious outbreaks, to cancel elective procedures. The guidelines said hospitals in Florida and Massachusetts should consider doing the same. | The hospitals are following new recommendations from the Centers for Disease Control and Prevention advising hospitals in and around Seattle, New Rochelle, N.Y., and Santa Clara, Calif., which have seen the most serious outbreaks, to cancel elective procedures. The guidelines said hospitals in Florida and Massachusetts should consider doing the same. |
| On Friday, the American College of Surgeons recommended that every hospital, health system and surgeon in the country review the necessity of each elective procedure they have scheduled. “Time is of the essence,” the guidance said. | On Friday, the American College of Surgeons recommended that every hospital, health system and surgeon in the country review the necessity of each elective procedure they have scheduled. “Time is of the essence,” the guidance said. |
| Surgeries that have been postponed so far include hip and knee replacements, A.C.L. reconstruction and pediatric apnea surgery. “The gray area are the cancer patients,” said Dr. Arooj Simmonds, co-executive medical director of surgical services at Swedish Medical Center, which operates several hospitals in the Seattle area. | Surgeries that have been postponed so far include hip and knee replacements, A.C.L. reconstruction and pediatric apnea surgery. “The gray area are the cancer patients,” said Dr. Arooj Simmonds, co-executive medical director of surgical services at Swedish Medical Center, which operates several hospitals in the Seattle area. |
| Dr. Simmonds said slow-growing cancers, like prostate and cervical cancer, were more likely to be delayed. On Friday, the first day of widespread deferrals, Swedish Medical Center performed about 20 percent as many surgeries as is typical, she said. | Dr. Simmonds said slow-growing cancers, like prostate and cervical cancer, were more likely to be delayed. On Friday, the first day of widespread deferrals, Swedish Medical Center performed about 20 percent as many surgeries as is typical, she said. |
| Doctors at EvergreenHealth, whose hospital in Kirkland, Wash., has borne the brunt of the pandemic like no other in America, canceled more than 30 procedures planned for Friday alone. | Doctors at EvergreenHealth, whose hospital in Kirkland, Wash., has borne the brunt of the pandemic like no other in America, canceled more than 30 procedures planned for Friday alone. |
| The hospital saw the new C.D.C. guidance late Wednesday night, said Mark Freeborn, the chief surgeon. The next morning at 6:30 a.m., a committee of doctors who work on surgeries convened. By 9 a.m., they finalized the decision to delay elective surgeries, and began developing their protocols and notifying surgeons. | The hospital saw the new C.D.C. guidance late Wednesday night, said Mark Freeborn, the chief surgeon. The next morning at 6:30 a.m., a committee of doctors who work on surgeries convened. By 9 a.m., they finalized the decision to delay elective surgeries, and began developing their protocols and notifying surgeons. |
| The committee, which had been meeting regularly since the outbreak began, said its decisions were driven by the need to protect resources, like the protective gear that medical staff need to keep from getting infected. But the doctors also wanted to limit the medical and support needs that patients regularly require after surgery, Dr. Freeborn said. | The committee, which had been meeting regularly since the outbreak began, said its decisions were driven by the need to protect resources, like the protective gear that medical staff need to keep from getting infected. But the doctors also wanted to limit the medical and support needs that patients regularly require after surgery, Dr. Freeborn said. |
| Some people develop infections or have poor reactions to anesthesia, which all require care from the kind of medical professionals who are busy treating patients who have tested positive for infection with the coronavirus. | Some people develop infections or have poor reactions to anesthesia, which all require care from the kind of medical professionals who are busy treating patients who have tested positive for infection with the coronavirus. |
| An older person who has a total hip replacement may need to recuperate at a skilled nursing center — institutions that have been hit hard by the coronavirus. “As you can imagine, in this time, that’s probably not the best thing for that patient,” Dr. Freeborn said. “There are a lot of downstream consequences of these decisions to either proceed or, in our case, not to proceed.” | An older person who has a total hip replacement may need to recuperate at a skilled nursing center — institutions that have been hit hard by the coronavirus. “As you can imagine, in this time, that’s probably not the best thing for that patient,” Dr. Freeborn said. “There are a lot of downstream consequences of these decisions to either proceed or, in our case, not to proceed.” |
| If physicians at EvergreenHealth believe a surgery should still occur, they could appeal to a panel, which aims to decide in 30 minutes. | If physicians at EvergreenHealth believe a surgery should still occur, they could appeal to a panel, which aims to decide in 30 minutes. |
| Kim Dammann, 45, was scheduled to have surgery to repair her Achilles tendon on Tuesday at a Seattle hospital, but on Friday she got an email saying it would be delayed. | Kim Dammann, 45, was scheduled to have surgery to repair her Achilles tendon on Tuesday at a Seattle hospital, but on Friday she got an email saying it would be delayed. |
| “It is not voluntary surgery, but I guess it is not critical enough to do now,” she said. | “It is not voluntary surgery, but I guess it is not critical enough to do now,” she said. |
| As an oncology nurse herself, “I get it,” Ms. Dammann said. “We do need the beds, and we do need the doctors.” | As an oncology nurse herself, “I get it,” Ms. Dammann said. “We do need the beds, and we do need the doctors.” |
| If she cannot get the surgery, she may need to wear a cast for several months instead so the connective tissue does not tear entirely. With a cast on her right foot, she may not be able drive to work at the hospital. | If she cannot get the surgery, she may need to wear a cast for several months instead so the connective tissue does not tear entirely. With a cast on her right foot, she may not be able drive to work at the hospital. |
| Updated June 16, 2020 | |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| People across the country have begun reporting delays in getting access to medical care. A woman in San Jose said her surgery had been canceled. A man said his father was notified that his planned lung cancer surgery in Boston, set for Monday, was going to be canceled. Later, he said, his father was told that the hospital had decided to do the surgery after all. | People across the country have begun reporting delays in getting access to medical care. A woman in San Jose said her surgery had been canceled. A man said his father was notified that his planned lung cancer surgery in Boston, set for Monday, was going to be canceled. Later, he said, his father was told that the hospital had decided to do the surgery after all. |
| Many transgender people expressed worry on social media that surgeries they had long looked forward to would be canceled. “Really worried my top surgery will get canceled among the coronavirus stuff,” Rachel Davis, a woman in Colorado, posted on Twitter. “It’s most of what’s keeping me going right now.” | Many transgender people expressed worry on social media that surgeries they had long looked forward to would be canceled. “Really worried my top surgery will get canceled among the coronavirus stuff,” Rachel Davis, a woman in Colorado, posted on Twitter. “It’s most of what’s keeping me going right now.” |
| Even some hospitals that are not treating coronavirus patients, or are treating very few, were nonetheless halting procedures. Seattle Children’s Hospital, which had not admitted any coronavirus patients as of Saturday, said it was doing so in part in order to preserve its protective gear. | Even some hospitals that are not treating coronavirus patients, or are treating very few, were nonetheless halting procedures. Seattle Children’s Hospital, which had not admitted any coronavirus patients as of Saturday, said it was doing so in part in order to preserve its protective gear. |
| “As of now, we have not seen a dramatic impact on capacity,” said Dr. Jeff Sperring, the hospital’s chief executive. He said he was on daily calls with adult hospitals and had discussed transferring younger patients they might have under their care. He said his hospital might admit more young adults to relieve the pressure on general hospitals. | “As of now, we have not seen a dramatic impact on capacity,” said Dr. Jeff Sperring, the hospital’s chief executive. He said he was on daily calls with adult hospitals and had discussed transferring younger patients they might have under their care. He said his hospital might admit more young adults to relieve the pressure on general hospitals. |
| Cassie Sauer, chief executive of the Washington State Hospital Association, said hospitals should not bear the sole burden of rationing protective equipment. Dental offices and outpatient surgery centers also use gear that could be redeployed, she said. “We would like this to be a community standard,” she added. | Cassie Sauer, chief executive of the Washington State Hospital Association, said hospitals should not bear the sole burden of rationing protective equipment. Dental offices and outpatient surgery centers also use gear that could be redeployed, she said. “We would like this to be a community standard,” she added. |
| Ms. Sauer said that hospitals had tried to think about the psychological effect of postponing surgeries. “If I have cancer, and I don’t get the cancer removed, I think the mental health impacts of that could be pretty dramatic,” she said. | Ms. Sauer said that hospitals had tried to think about the psychological effect of postponing surgeries. “If I have cancer, and I don’t get the cancer removed, I think the mental health impacts of that could be pretty dramatic,” she said. |
| Ms. Krupnick said she had not been told how long she would have to wait for her surgery. | Ms. Krupnick said she had not been told how long she would have to wait for her surgery. |
| The medical staff said she had time, perhaps a few months, before the risk to her health would grow. She hoped they were right. | The medical staff said she had time, perhaps a few months, before the risk to her health would grow. She hoped they were right. |
| Karen Weise and Mike Baker reported from Seattle, and Nicholas Bogel-Burroughs from New York. | Karen Weise and Mike Baker reported from Seattle, and Nicholas Bogel-Burroughs from New York. |