Kai Giesen's wisdom teeth surgery was supposed to happen in March. Then it got pushed to mid-May. Then, June. When Giesen, 26, finally arrived for the surgery, he was told to wait in his car until he got a text message saying he could enter the dental office in Lagrangeville, New York. Once inside, a masked employee took his temperature, and upon confirming that Giesen did not have a fever, gave him some hand sanitizer and walked him to the operating room.
This is an experience Americans across the country are having as they begin to undergo elective surgeries or procedures that many had put off, or had canceled by their physicians or because of an elective surgery ban in their state, during the coronavirus pandemic. Nearly half of all adults say they or someone in their household has skipped or postponed medical care due to the virus, according to a report from the Kaiser Family Foundation. And experts have estimated that the total number of elective surgeries canceled or postponed worldwide in 2020 could be more than 28 million, creating a 45-week backlog.
Now that states are reopening, physicians are starting to work through that backlog, and the medical community is working to find the right balance when it comes to patient safety.
"One of the biggest challenges for hospitals and doctors is that you don't want to delay something elective for so long that it ends up becoming urgent, so getting that timing right is a challenging piece," said Dr. Allen Kachalia, the senior vice president of patient safety and quality at Johns Hopkins Medicine and the director of its Armstrong Institute for Patient Safety and Quality.
Hospitals also want to keep capacity open in case of another spike of COVID-19 cases.
"It creates this difficult balance that hospitals have to find," Kachalia said. "How many surgeries can we do while keeping space for a potential surge?"
And hospitals, doctors' offices and clinics are also grappling with adequately testing both patients and employees, as well as making sure they're stocked with enough personal protective equipment.
How important is the surgery or procedure?
If the procedure isn't urgent, now might not be the time to get it. Having elective procedures now still carries some risk.
"Anything that can be delayed should be delayed," said Dr. Miles Varn, the CEO of PinnacleCare, a health advisory firm, who mentioned sports medicine and cosmetic surgeries as types of procedures that might be able to wait. "There's no reason to put yourself at risk if the surgery isn't essential at this time."
There's no reason to put yourself at risk if the surgery isn't essential at this time.
Dr. Miles Varn
Patients should also ask their doctors about alternatives to surgery — and both Varn and Kachalia say that goes for non-pandemic times, too.
Will I be tested for COVID-19? When?
Most likely — especially if you're going to a hospital. The protocols of doctors' practices vary depending on the rate of transmission in their area, but at the very minimum, patients can expect to answer coronavirus-related screening questions and have their temperature taken.
If COVID-19 testing is required, it should happen as close to the surgery or procedure as possible. But since test results can take days to arrive, that means there will likely be a window between the testing and the surgery or procedure during which a patient could still become infected. So it's important for patients to self-isolate and take precautions during that time, Varn said.
What type of precautions are being put into place?
Patients should feel comfortable asking the hospital, clinic or doctor's office about the precautions they're taking to make sure their staff members don't contract the virus. This includes making sure there's an adequate amount of protective equipment and that staffers are being routinely screened and tested, as well as having strict disinfectant procedures in place. Many businesses already have this information on their websites, Kachalia said.
If the facility treats COVID-19 patients, that creates greater concern. In a recent article he wrote on the topic, Varn suggested asking your doctor if those patients are using a separate entrance of the hospital and if the medical personnel who are treating you will also treat coronavirus patients.
What happens on the day of my surgery or procedure?
This might be different from past procedures, too. For example, will you be instructed to text someone, as Giesen did, when you arrive, or will you be able to walk right inside? Will you be allowed to bring anything with you? Do you need to have a face mask, or will one be provided for you? Who you're allowed to bring with you may also change, as visitor policies (more on that later) are also being affected during the pandemic.
What are the visitor policies?
It's also important to consider what happens after a surgery or procedure. Many hospitals are limiting visitors to prevent spread of the virus — which can be a problem, if you're spending a few days in a hospital to recover and want your family there, for example. So make sure you ask about the visitor policy before committing to a surgery.
"Surgeries can be uncomfortable," Varn said. "And with that post-op period, you're sort of going through it alone, or via FaceTime, but not in person with a partner or a family member, and I think that's an important consideration in terms of recovery and success, because stress is certainly associated with worse outcomes."
Moving forward with the new normal
On the bright side, patients say all these precautions make them feel safer if they do have to go in for surgery or a procedure.
"I wasn't too concerned (about catching the virus)," Giesen said. "I was pretty confident with the dental office. They had had the opportunity to open a couple of weeks earlier, but they chose to wait until they were comfortable."
Tedra Moriggia, 32, of Queens, New York, recently got a liposuction procedure at Shafer Clinic Fifth Avenue, where she works as a surgical coordinator. Because she has a firsthand look at the precautions being taken at the plastic surgery office, she wasn't nervous about contracting COVID-19.
"Everyone wears masks, hats, gowns — now they're even wearing shields," she said. "To me, it wasn't a scary process because of the coronavirus. It was scarier that it was surgery."
To me, it wasn't a scary process because of the coronavirus. It was scarier that it was surgery.
She added that she and her coworkers get tested for the virus biweekly.
Yet many others might be hesitant to get a surgery or procedure done during a pandemic — and rightfully so, according to experts. Varn even went so far as to say that maybe some of the elective surgeries that were put off during the pandemic weren't really all that necessary in the first place.
"Maybe we're over-treating patients," he said. "Because there are certain diseases that are doing perfectly fine (during the pandemic) being treated with telemedicine or extended time between visits. Pharmacies have been willing to give 90 days worth of supply instead of 30 days.
"I think at the end of the day, when things open up and the virus is gone, there's going to be a lot of analysis about what we did before (the pandemic) and what we should do after. And one of those considerations might be that maybe the elective surgeries that were canceled weren't all that necessary anyway."