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.

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.

"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."

Go deeper

20 hours ago - Health

Nurses rally nationwide to demand protection amid pandemic

Healthcare workers on their way to work walk past demonstrators taking part in a national day of action in Miami on Wednesday. Photo: Joe Raedle/Getty Images

Nurses took more than 200 active demonstrations inside and outside U.S. hospital facilities in at least 16 states and the District of Columbia on Wednesday to demand full personal protective equipment and federal government action.

Driving the news: National Nurses United (NNU) members are demanding that the Senate pass the HEROES Act, House Democrats' $3 trillion pandemic recovery package, which they said would protect health care workers by ensuring domestic production of PPE through the Defense Production Act.

Coronavirus hotspots begin to improve

Data: The COVID Tracking Project, state health departments; Map: Andrew Witherspoon, Danielle Alberti, Sara Wise/Axios

Coronavirus infections are falling or holding steady in most of the country, including the hard-hit hotspots of Arizona, California and Florida.

The big picture: A decline in new infections is always good news, but don't be fooled: the U.S. still has a very long way to go to recover from this summer's surge.

Updated Aug 4, 2020 - Axios Events

Watch: How hospitals have responded to the pandemic

On Tuesday, August 4 Axios health care reporter Caitlin Owens hosted a virtual event on how hospitals have been responding to the coronavirus pandemic, from getting PPE to building the future of resilient health systems, featuring Atrium Health CEO Eugene Woods, K Health co-founder & CEO Allon Bloch and Columbia University Medical Center professor and FemInEm founder Dr. Dara Kass.

Allon Bloch argued that a rise in the usage of telemedicine presents an opportunity for people to reimagine how the U.S. health care system can be more efficient and cost-effective.

  • On integrating more data analysis into medicine: "There's a massive opportunity to give people a much more nuanced approach to medicine, a much more personalized one, based on information [from] their own personal history or from similar situations...It's a little bit overlooked in medicine."
  • On how telemedicine can positively impact the health care system: "There's a lot of people that are either not insured or underinsured. They have really high deductibles. They can't afford doctors...[telemedicine] can give people access to really high quality primary care at a much lower cost."

Eugene Woods discussed his company's "virtual hospitals" and how this model has the potential to reduce overflow into physical hospitals.

  • On his company's "virtual hospital" treating COVID-19 patients: "We've treated about 13,000 patients in our virtual hospital and only three percent have had to be transferred or admitted from the virtual hospital into [a physical] hospital."
  • On reducing disparities in COVID-19 testing: "[Coronavirus] has laid bare the racial disparities that have existed in these communities for decades...Back in March, we realized there were disparities in terms of testing. So we have roving medical vans and went into those [affected] communities. We so far have hit about 55 different community host sites."

Dr. Dara Kass unpacked her experience of working in the ICUs in New York City during the initial COVID-19 outbreak, and how safety measures like masks and social distancing impacted the rate and spread of the virus.

  • How wearing masks reduces the volume of COVID-19 patients coming to the ICU: "We saw the effects of our work of social distancing and wearing masks as early as April take effect pretty dramatically...We also saw the peak come down as almost as quickly as it went up."
  • How this crisis compounds existing gender inequities: "Our child care crisis was bad before, pay inequity was bad before — it's exacerbated by this at this moment. We're worried about frontline healthcare workers now, not even being able to go back to work because of the fact that child care will be inaccessible and schools are probably not going to open."

Thank you Philips for sponsoring this event.