Illustration: Aïda Amer/Axios
Hospitals in coronavirus hotspots are not scaling back their elective procedures, even as their intensive-care units are filling up with coronavirus patients.
Between the lines: Hospitals are ignoring federal recommendations and their own industry's guidance, which says non-urgent procedures should not restart until there is a "sustained reduction in the rate of new COVID-19 cases in the relevant geographic area for at least 14 days."
The big picture: Federal and state officials encouraged hospitals, doctors and outpatient centers to delay non-urgent care when the coronavirus outbreak ignited in March.
- The goal was to free up hospital capacity for COVID-19 patients and to prevent the spread of infection among health care workers and patients, while still being available for other serious, non-COVID care like transplants and cancer treatments.
Where it stands: Many elective procedures have resumed in conjunction with states reopening — but now the surge of COVID-19 cases is consuming a lot of hospital beds.
- More than 90% of Arizona's ICU beds are full, as of this week.
- 56 Florida hospital ICUs have reached capacity, and overall hospital bed availability in the state has decreased drastically in the past month.
- Some of the most populated areas in Texas have only a handful of ICU beds open.
"Elective" care does not mean "unnecessary" care. Many doctors and patients don't want to delay certain treatments any longer.
- However, hospitals have a financial incentive to keep operating rooms open and beds full. More procedures equals more revenue.
- That's risky for capacity and infection control.
What they're saying: Federal, state and local officials are mostly deferring to hospitals on whether they should pull back on elective care again.
- A spokesperson for the Arizona Hospital and Healthcare Association said the group is not advising hospitals on what to do: "They know how to manage their business."
- The Texas Hospital Association pointed to an executive order from Gov. Greg Abbott that says hospitals in certain hotspot counties "must postpone all surgeries and procedures that are not medically necessary." However, there's a loophole that allows hospitals to pretty much do what they want: "The order does not prohibit any surgery or procedure that would not deplete any hospital capacity needed to cope with the COVID-19 disaster."
- Some hospital systems, especially those in south Florida, have paused some surgeries. A spokesperson for the Florida Hospital Association said "facility readiness to resume elective surgery will vary by geographic location."
- The American Hospital Association said in a statement that "there are major differences between slowly and safely resuming elective surgeries and continuing to offer these clinical services once they have resumed."
The bottom line: "Most of these elective procedures are things that need to happen at some point," said Payal Patel, an infectious disease physician at the University of Michigan. "It's really difficult to do guidelines because of how fluid the situation is."