On April 13th , it will be exactly one month since the American College of Surgeons released its statement that surgeons should “minimize, postpone, or cancel elective operations at the current time until we are confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs.” 5 days later, on March 18th, CMS echoed the call for a halt to elective surgeries. CMS Administrator Seema Verma said, “The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight”.
The week of March 13th was a whirlwind week. At the start of the week, it seemed as if ASCs were going to remain open and help hospitals by allowing hospitals to shift their elective surgeries to nearby ASCs. A few short days later, it became clear that all elective surgery was effectively going to be shut down.
The rationale for this was twofold: First, as Seema Verma noted, there were critical shortages of PPE, and ASCS, by remaining open, would be consuming gowns, gloves and masks that could be otherwise used by hospital staff on the Covid – 19 front lines. In addition, because of the anticipated large numbers of patients who would need a ventilator, it was theorized that anesthesia machines in ASCs would be needed in hospitals as ventilators. The second reason for cancelling elective surgeries in ASCs was that with the highly infectious nature of Covid -19 and “shelter at home” orders/recommendations in most states nationwide, it was necessary to shut down ASCs to comply with these recommendations so that ASCs doing elective surgeries didn’t contribute to the spread of the virus.
A lot has changed over the last month: Americans have stepped up and largely followed the CDC’s recommendations. The daily news clips of deserted streets in New York, L.A., and Washington, DC attest to this fact. We are now used to wearing masks in public and standing on the “X” at the grocery store. The good news: the curve is flattening, the peak cases are dropping in most places, and the initial predictions of millions of dead Americans are wrong (thank God!). Nonetheless, with over 500,000 Americans who’ve tested positive and 20,000 Americans dead, it is nonetheless a very devastating and deadly outbreak.
Circling back to the two reasons that elective surgeries were halted at ASCs: (1) PPE shortages and (2) social distancing to stop the spread of the virus, where do we now stand? The PPE shortages are now largely non-existent and the supply chain continues to strengthen every day (at the community hospital where I work, there are now plenty of N-95 masks). Secondly, the spread of Covid – 19 has been largely stopped. Lastly, I trust my local ASC to be orders of magnitude better at strictly enforcing cleaning and other infection prevention guidelines than my local grocery store or home improvement big box store that were never shut down. Putting this all together, there is no reason that ASCs should stay closed any longer.
Why May 1st? May 1st will give an additional 2 weeks for the number of Covid-19 cases to drop even further (the slope down is supposed to be as steep as the slope up) and an additional 2 ½ weeks for supplies of PPE to get even more plentiful. In addition, a May 1st re-opening will also give administrators 2 ½ weeks to get staff back, supplies replenished, and get patients and surgeons scheduled.
I want to close by stressing this is a very fluid situation, and things can, and will, continue to change rapidly. Regions of the Northeast may not be able to follow the above. I would love to hear what everyone thinks about May 1st. In an upcoming blog, I will write about what the “new normal” will be like, and steps that ASCs can take to re-open in a way that is safe for both patients and staff alike.
About the Author: Stephen Punzak, MD is a practicing Anesthesiologist as well as the CEO of One Medical Passport. He founded One Medical Passport because he has always had a vision of how healthcare could run more efficiently using technology. He frequently writes on medical topics, workflow efficient measures and ASC industry trends.