Mar 24, 2020 9:01 AM

Most KC-area hospitals put off elective surgeries to prepare for COVID-19

Posted Mar 24, 2020 9:01 AM
The University of Kansas Health System has postponed elective surgeries to prepare for an influx of coronavirus patients. KU Hospital
The University of Kansas Health System has postponed elective surgeries to prepare for an influx of coronavirus patients. KU Hospital

By DAN MARGOLIES
Kansas News Service

As the coronavirus continues its relentless spread, hospitals are making tough decisions about postponing or canceling elective procedures.

Earlier this week, the Centers for Medicare and Medicaid Services recommended that providers consider a range of factors in determining whether to postpone surgery or other procedures. They include patient risk, urgency of the procedure, bed availability, staffing and the availability of personal protective equipment.

“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,” CMS Administrator Seema Verma said in a statement Wednesday.

The University of Kansas Health System, which operates the area’s largest hospital, has indefinitely postponed all elective procedures.

“It’s part of our conservation efforts to make sure that we have enough supplies,” said spokeswoman Jill Chadwick. “And it's to help protect patients whose annual check-up, etc., can wait. We know social distancing works and we are assessing everyday how to do our part.”  

In a conference call with reporters Friday, Steve Stites, KU’s chief medical officer, said the hospital’s operating rooms were currently operating at about 25% capacity because most elective procedures had been canceled or deferred.

He said KU had prioritized cases into three tiers: ones that can readily be postponed, such as cosmetic surgery; ones with a risk of harm, where the physician and patient need to make an informed decision about what the relative harm and risk may be; and ones that can't be postponed.

“So cases that you have to do are cancer surgery,” Stites said. “You can’t let the tumor grow.”

Stites said the measures were being taken to conserve personal protective equipment in the expectation of an influx of COVID-19 patients in coming weeks.

“We're trying to conserve as much as we can right now for the eventual rapid increase in the number of COVID-19 patients inside the hospital,” Stites said. “And that’s the reason we've been holding back surgery, in order to preserve our personal protective equipment.”

At Saint Luke’s Health System, another large hospital network, elective procedures are being deferred, although what constitutes “elective” in some cases is being left to physicians’ discretion.

“We are deferring all cases that can be safely deferred,” spokeswoman Laurel Gifford said. “Some technically elective procedures are still medically necessary so our physicians and surgeons are reviewing them on a case-by-case basis. But I think it’s safe to say that all cases that are not required at this point and where it’s in the best interests of the patient, are being rescheduled and deferred to a later date.”

HCA Midwest Health, the largest hospital operator in the Kansas City area, said it’s following CMS’ guidelines but also deferring to the clinical judgment of its physicians.

“Our COVID-19 preparedness efforts include reinforcing infection prevention protocols and guidance from the CDC, sourcing necessary supplies and equipment, and emergency planning, so our hospitals are prepared to safely meet the needs of all of our patients and protect the health and well-being of our colleagues,” HCA spokeswoman Christine Hamele said.

Safety-net hospital Truman Medical Centers is postponing “anything that’s true elective surgery,” according to spokeswoman Leslie Carto.

“There are some, like a malignancy that can possibly wait but they have the diagnosis, those are being done. But anything truly elective – those are being canceled,” Carto said.

At least one local healthcare provider, AdventHealth System, which operates AdventHealth Shawnee Mission (formerly known Shawnee Mission Medical Center), has not postponed elective procedures.

“We haven’t told (physicians) that they need to cancel things. I will tell you that’s something that’s being reviewed daily and that position can change,” Adventist spokeswoman Morgan Shandler said.

At the top of its website, AdventHealth posted this notice: “While preventing the spread of COVID-19 and treating COVID-19 patients is of highest priority in our community, we recognize that we have many patients with medical needs unrelated to COVID-19 that still need addressed. At this time, AdventHealth Shawnee Mission has not cancelled or delayed scheduled procedures. However, individual physicians are reviewing their scheduled cases and may opt to postpone elective cases that are not time sensitive. If your case will be postponed, your physician’s office will contact you directly. We will continue to update this policy as the situation with COVID-19 evolves.”

Dan Margolies is a senior reporter and editor at KCUR. You can reach him on Twitter @DanMargolies.

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Mar 24, 2020 9:01 AM
UPDATE: What Kansans need to know about the COVID-19 coronavirus
Health officials say one way to stop the spread of the new coronavirus is to wash your hands for at least 20 seconds. Celia Llopis-Jepsen / Kansas News Service

Kansas News Service

Note: A Spanish-language version of this article can be found HERE.

The new coronavirus is spreading quickly around the world, including across Kansas, and setting off a range of responses.

The Kansas News Service is boiling down key developments in the state and updating the status regularly here. To read this information in Spanish, go here. This list was last updated at 4:10 p.m. April 7.

CASES AND DEATHS

900 cases (see map for counties) and 223 hospitalizations

27 deaths  (the state is no longer disclosing which counties are seeing deaths)

NOTE: These figures only include cases confirmed with lab tests and do not represent the real, unknown total. Community transmission is occurring in parts of Kansas. View additional charts showing the disease’s spread over time and other trends here.

Gov. Laura Kelly is instituting a statewide stay-at-home order as of 12:01 a.m. March 30. It will last until at least April 19. Stay-at-home orders allow people to take care of essential activities (such as grocery shopping or going to work) as well as exercise outside, but otherwise keep to themselves. 

The state’s stay-at-home order supersedes at least 13 county-by-county orders. Should the state’s order lift before a county’s is through, the county can choose to keep its own in effect.

SHOULD I SELF-QUARANTINE?

The Kansas Department of Health and Environment (KDHE) is now mandating home quarantine for 14 days if you've traveled to the places listed below. If you come down with symptoms (such as a fever of 100.4 degrees or higher, coughing or shortness of breath) during those 14 days, contact your health care provider and explain your potential COVID-19 exposure.  

  1. Connecticut on or after April 6.
  2. Louisiana or anywhere in Colorado on or after March 27.
  3. States with known widespread community transmission (California, Florida, New York and Washington) on or after March 15.
  4. Illinois or New Jersey on or after March 23.
  5. Eagle, Summit, Pitkin and Gunnison counties in Colorado (if your visit was March 8th or later).
  6. Cruise ships or river cruises on or after March 15. Anyone previously told to quarantine because of their cruise ship travel should also finish out their quarantine.
  7. International destinations on or after March 15. Anyone previously told to quarantine because of their international travel should also finish out their quarantine.

Some doctors recommend patients with COVID-19 symptoms stay home even if they test negative for the disease, because of concerns that current testing approaches may be producing a significant number of false negatives.

TESTING AVAILABILITY

Several hospitals across the state now offer drive-through testing, but patients must get doctor approval in advance or else will be turned away. Many Kansans can’t be tested unless they’re sick enough to be hospitalized, and results may take up to a week. 

That’s because testing supplies remain limited and private labs helping many clinics and hospitals have large backlogs of samples. Hospitals trying to buy equipment for in-house testing say vendors are backlogged, too. The state will soon have several portable machines that can conduct 5- to 15-minute tests, and plans to lend them out to facilities most in need.

Some Kansas hospitals have succeeded in getting the testing materials and can give patients their results within a day. The state health department lab in Topeka can handle several hundred samples per day — a fraction of the demand.

Under a new federal law, you should not have to pay for your coronavirus test, regardless of insurance status (but patients could still see related bills). Separately, Blue Cross Blue Shield of Kansas, the state’s largest private insurer, says some patients won’t have to pay for coronavirus treatment.

HOW ARE UNIVERSITIES RESPONDING?

Public and private universities and community colleges in the state will finish this semester via online classes. Spring sports have been canceled. Most staff travel has been suspended. Graduations at KU, K-State and Wichita State are postponed or rescheduled.

The University of Kansas and Wichita State also plan to hold summer classes online. KU and K-State announced hiring freezes in early April. 

HOW ABOUT K-12 SCHOOLS?

In mid-March, Kansas became the first state in the U.S. to shut down school buildings for the rest of the 2019-20 school year. A state task force then issued guidance for distance learning, for which students aren’t expected to spend more than a few hours a day. 

Some districts that make high schoolers earn more credits than required by the state will graduate them this year based on the state’s lower bar. 

Districts across the state are still providing free meals to eligible children, but some have stopped because of concerns about the coronavirus spreading at meal pickup sites.

WHAT IN DAY-TO-DAY LIFE IS AFFECTED? 

  1. Church gatherings and funerals: Effective April 8, the governor has prohibited services of more than 10 people. That doesn’t count people performing the rituals or funeral workers, but they must stay six feet apart from each other.
  2. State tax deadline: Extended until July 15, in line with a delay for filing federal tax forms.
  3. Evictions: Business and residential evictions are banned until May 1 if a tenant is unable to pay because of the coronavirus.
  4. Mortgage foreclosures: Foreclosures are banned until May 1.
  5. Small businesses: May be eligible for emergency federal loans. Find information here.
  6. Hospitality businesses: Kansas created an emergency loan program, which quickly ran out of funds, but businesses can still apply to help the state assess the need for more assistance.
  7. Utilities: Evergy, which serves 950,000 customers in Kansas, will not disconnect residential or business services for an unspecified amount of time. 
  8. Gatherings: Restricted to fewer than 10 people throughout the state.
  9. State of emergency: Kansas’ declaration is good through May (and can be extended). It gives the government more power to marshal resources and Kelly the ability to make certain decisions when lawmakers aren’t in session.
  10. State workers: Access to the Statehouse is limited to official business only through April 19. Most state workers are doing their jobs remotely.
  11. Prisons and jails: The Kansas Department of Corrections ended visitation at all state facilities, and will “re-evaluate on an ongoing basis.” It urges families to talk to inmates through email, phone calls and video visits. County jails largely have ended visitations as well. 

HOW BAD IS THE VIRUS? 

COVID-19 usually causes mild to moderate symptoms, like a fever or cough. Most people with mild symptoms recover in two weeks. More severe cases, found in older adults and people with health issues, can have up to six weeks’ recovery time or can lead to death.

HOW CAN YOU AVOID IT?

  1. Wash your hands for at least 20 seconds. Frequently.
  2. Cover your coughs.
  3. The CDC now recommends wearing a cloth mask in situations where social distancing isn’t possible; instructions for sewn and non-sewn versions are here.
  4. If you’re an older Kansan or medically fragile, limit your trips to the grocery store or any public space.
  5. Stay home if you are sick — this goes for all ages.

FOR MORE INFORMATION ON COVID-19

Kansas Department of Health and Environment: http://www.kdheks.gov/coronavirus/

The Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-nCoV/index.html

The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.