After every shift in his Seattle emergency department, Dr. Matt Beecroft comes away with some new story of how the omicron surge is making his patients sicker.
And not just from the coronavirus that causes COVID-19.
Instead, it’s the delays and disruptions in medical care — a consequence of overcrowded and short-staffed hospitals — that are leading to, at times, life-threatening complications.
“It can be just heartbreaking,” says Beecroft, who recalls one recent patient of his who had a heart attack. “She had been scheduled for a cardiac bypass,” a procedure done to improve blood flow when there’s an obstructed or partially blocked artery, “but that surgery had been canceled.”
Beecroft, who’s affiliated with the American College of Emergency Physicians, told two other doctors about the patient. That’s when it became clear to him that this was far from an isolated event: “Between the three of us, we had seen four patients who had cardiac complications from not being able to get a cardiac surgery.”
There’s no way to quantify how many Americans are now suffering serious, if not irreversible, harm to their health because hospitals are buckling under the weight of the omicron variant of the coronavirus. But doctors say the consequences are far-reaching, given how many procedures have been postponed.
“The impact on surgery is incredibly broad,” says Dr. Patricia Turner, executive director of the American College of Surgeons. “It’s going to be felt for a long time.”
The bottom line is that “we’re seeing patients suffer,” says Beecroft. “Everything from major traumas to heart conditions to cancers needing an operation are being affected.”
“Elective” surgeries are still essential
As the omicron variant hit in full force last month, hospitals all over the U.S. started pausing “elective” procedures — a term that can be misunderstood to mean surgery that is optional or not needed, but in fact refers to essential, time-sensitive procedures.
An elective procedure is one that doctors can schedule, says Turner. “It may not need to happen today, but scheduling one’s cancer operation for this week is very different than having it put off for a month.”
The decision comes down to resources. Patients have grappled with unexpected delays periodically throughout the coronavirus pandemic. But omicron swept through the country with incredible speed, filling hospitals with more COVID-19 patients than ever before and sidelining many doctors and nurses at a time when the health care workforce was already depleted.
In many places, the surge has backed up the entire health care system. Hospital beds are filled, which in turn prevents patients who come to the emergency room from being admitted quickly. That leaves little room for someone who needs a hospital stay after a procedure. Some states, such as Washington, have ordered hospitals to pause non-urgent surgeries to save room, while others have left it up to individual hospitals.
“Our patients are getting a raw deal,” says Durrani, who practices at several hospitals in Phoenix.
He explained how one of his patients needed gallbladder surgery and came down with a serious infection during the delay.
“She was in pain all weekend, didn’t want to go to the ER, wanted to wait to see us in the office, but we cannot admit patients to the hospital,” Durrani says.
Another of Durrani’s patients whose surgery was delayed had a paraesophageal hernia — a condition in which the stomach can protrude into the chest — that eventually caused a loss of blood flow to the patient’s stomach.
In both circumstances, what was once an elective surgery he could schedule had become an emergency. Durrani says the only option was to send these patients to the emergency department.
“It’s incredibly frustrating because those patients should have had their surgery and they should have been just fine,” he says.
Cancer elicits particular concerns
Treatments like chemotherapy are being postponed along with operations to remove tumors, says Arif Kamal, an oncologist at Duke University and chief patient officer for the American Cancer Society.
“We’re seeing cancer patients come to the hospital who are sicker and a bit later in their course [of disease] than we would typically see them,” says Kamal.
On top of that, a critical shortage of blood has led to more stringent requirements for which patients get blood than Kamal has seen in his career. “We wait for their hemoglobin to get even lower than we normally have done before.”
All of this is compounded by the fact that cancer patients are reluctant to go to the emergency department in the first place — out of concern they might catch COVID-19 from the other patients who are there, Kamal says.
“For someone with a very low immune system, who may be receiving cancer treatment, that’s a scary proposition,” he says. “So they’re waiting for their pain to get to 10 out of 10,” which means excruciating pain, “or some complication to get truly bad.”
The consequences are enormous for those who do contract COVID-19 because they typically need to wait out a 20-day quarantine before getting their procedure. Several of Kamal’s patients with aggressive cancers have dealt with these painful delays.
“Once you give it an opportunity of a month or two to grow uncontrolled, it can be really difficult to get control back,” he says.
Hospitals have processes for evaluating which operations can’t afford to wait. The American College of Surgeons publishes guidelines for decision-making around elective surgeries.
But with hospitals inundated, it can sometimes be hard to predict exactly what the downstream effects will be for patients, says Eric Stecker, a cardiologist at Oregon Health & Science University who chairs the Science and Quality Committee for the American College of Cardiology.
“We cannot always tell the future,” he says. “For some cardiovascular conditions, delaying elective care by two weeks to three months can really adversely impact patients.”
A striking example comes from the spring of 2020, when hospitals deferred care in anticipation of a huge wave of patients. That wave didn’t materialize in some parts of the U.S. until later.
Among those who had their procedures delayed were patients with aortic stenosis — a narrowing of the heart valve that restricts blood flow into the aorta. A study of 77 patients at Mount Sinai Hospital in New York City found that eventually about a third of the patients who had their procedures delayed ended up with a serious cardiac event. Two of them died. In the three months before the surge of COVID-19, no patients died while awaiting the same procedure, the authors noted.
Stecker says this made it clear to hospitals that these particular patients need to be at the top of the priority list and not have their care put off, but “there are many other conditions for which we’ve not recognized that and are probably being inappropriately delayed or deferred.”
An international study of more than 20,000 cancer patients early in the pandemic found that 10% of patients who were awaiting surgery during lockdowns did not receive surgery after a median follow-up of 23 weeks. Researchers in the U.K. and Canada analyzed more than 30 studies to estimate the impact of delayed treatment for a variety of cancers. They concluded that over the course of a year, 12-week delays in breast cancer surgery could lead to 6,100 preventable deaths from breast cancer in the U.S. alone.
Omicron cases are now falling in the U.S. overall, but the pressure on hospitals will not evaporate so quickly, doctors say. Hospitalizations generally trail infections by a week or two, and critically ill patients can require lengthy hospital stays.
And while some hospitals have restarted elective surgeries, others are still too overwhelmed to do so.
“Most facilities have lists of hundreds of people who have had procedures or non-urgent care delayed,” says Dr. Tammy Lundstrom, senior vice president and chief medical officer for Trinity Health, which has hospitals in 25 states.
Like so many doctors, Matt Beecroft sees patients stuck in a painful limbo — unsure of when they’ll be able to get care. One in particular stands out to him. He’d come into the emergency department for recurrent, worsening headaches related to a tumor that needed to be cut out but wasn’t yet, because the hospital where the surgery was scheduled was too full.
“He got his surgery canceled a couple of times,” says Beecroft. “He told me, ‘You know, this was a really bad time to get cancer.’ ”