12/7/2020 by Share Your Story

Being Elective In the Age of Covid

The growing number of Covid cases caused hospital restrictions to be put in place that limited elective and non-essential care. What's next?

The year 2020 will not be easily forgotten, although many would like to wipe it from their memories. In the early days of the COVID-19 pandemic, poor understanding of SARS-CoV-2 led to overly cautious approaches by both patients and health care providers. The pandemic raged and hospitals were inundated with COVID-19 patients. Meanwhile, Centers for Medicare & Medicaid Services advised hospital restrictions on elective surgeries and non-essential dental, surgical, and medical procedures.   

Factors That Led to Hospital Restrictions

  • Minimal understanding of how the virus spread, who was most vulnerable, and how it could be eliminated
  • Absence of preventive care or treatment against SARS-CoV-2
  • Reallocation of health care providers to COVID-19 patient care
  • Shortage of personal protective equipment for health care workers
  • The need to keep hospital beds and ventilators open for COVID-19 patients

Rolling Restrictions

The virus had disproportionately affected the country, with states in the Northeast seeing a surge in the early days while the South saw few to no outbreaks. As a result, some states retracted earlier mandates and opened up health systems and clinics for non-emergency care and elective procedures by the end of May, but reimposed restrictions in late-June as new outbreaks emerged across the nation.

How patient services and access to care have been affected over the past few months:   

Impact on Elective Services

Back in May 2020, two months into the lockdown across several states in the U.S., an analysis conducted by Strata Decision Technology using data from 228 hospitals across 40 states found a decrease in cardiology (57%), breast health (55%), and cancer care overall (37%). The number of unique patients that visited a hospital dropped by 54.5%.

The most common inpatient services were drastically affected:

  • 79% drop in hip replacement procedures
  • 99% drop in knee replacement procedures
  • 81% drop in spinal fusion procedures
  • 38% drop in fracture repair
  • 44% drop in coronary stents

Impact on Outpatient Care

A series of articles were published by leading health policy researchers on The Commonwealth Fund’s website. They showed the trend seen in outpatient visits:

  • Fell in April by 60%
  • Saw a rebound by mid-May, but were still down by 31%
  • Plateaued by June
  • Dropped in late July in a few hotspot states (Arizona, Florida, and Texas), held steady in other hotspot states, but continued to lag in the Northeast

Boost in Telemedicine Use

Telemedicine, which is the use of audio/video platforms for delivering medical care, saw a sharp rise in use by mid-March, peaked by mid-April, and plateaued by mid-July, but remains at 7% above the weekly visits pre-COVID.

Comparison of nearly 126 million primary care visits over two and a half years (Q1 of 2018 to Q2 of 2020) found:

  • A 50.2% drop in office-based visits in Q2 2020 compared with Q2 2018-2019
  • Telemedicine visits increased to 35.3% in Q2 2020, compared with 1.1% of total Q2 2018-2019 visits

Importantly, the pandemic saw a significant reduction in restrictions on telemedicine use from both private and government health care insurers. Telemedicine significantly compensated for the hospital restrictions that otherwise limited access to care. 

What Does This Mean in Terms of General Health in the Coming Months and Years?

A weekly survey disseminated since June 2020 by the Primary Care Collaborative, a non-profit organization focused on building a strong foundation for primary care, found that the mental health of both patients and the clinicians who have been delivering care has been worsening:

  • 86% of the 457 primary care clinicians who responded to the survey said that the mental health of their patients had been deteriorating during the pandemic
  • 49% said their patients’ physical health declined during the pandemic
  • 41% said the condition of their patients with chronic conditions was noticeably worse
  • 53% of physicians said they themselves were mentally or emotionally exhausted
    • 35% reported video fatigue
    • 28% reported that their team members had either quit or taken early retirement because of COVID-19

Impact of Elective Surgery Ban

Pushing off elective surgeries and maintaining patients non-operatively may result in advanced diseases then needing more intense and expensive treatment. There are also implications for patients’ quality of life—pushing off a joint replacement surgery, for example could affect a person’s mobility; delaying a cataract surgery could affect vision and indirectly, a person’s independence.

Loss of Insurance Coverage

Additionally, pandemic-related unemployment or income loss could have led to loss of insurance coverage and forced people to compromise on their health care needs. Experts are concerned that a delay in routine care and preventive screenings such as colonoscopies, mammograms, and biopsies will lower diagnoses of disease now, but once clinic and hospital restrictions are lifted, the number of diagnoses will surge.

As the nation continues to struggle with restricting the spread of the SARS-CoV-2 virus, it’s quite obvious that the health impact of this pandemic will be felt for a long time.

Additional Resources

  1. More on the impact of the pandemic on non–COVID-19 patients: https://www.nejm.org/doi/full/10.1056/NEJMms2009984.
  2. Advice on seeking hospital or emergency care during the COVID-19 pandemic: https://www.hopkinsmedicine.org/coronavirus/hospital-care.html
  3. What to do when you’ve lost your health insurance as a result of job loss:

The information in this article was researched and summarized by Surabhi Dangi-Garimella, Ph.D., Principal, SDG AdvoHealth, LLC. Improving patient access is our mission and we are happy to utilize a variety of experts to carry that out.

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