As the novel coronavirus surges with renewed vigor, the region’s two top health systems are beating a strategic partial retreat.
A limited pullback of elective surgeries announced this week by Rochester Regional Health and UR Medicine partly restores a total ban on electives imposed in the spring. It comes as hospitals are seeing COVID-19 admissions soar past the peak reached during the pandemic’s first wave.
At that time, local cases plateaued and then fell to comparatively negligible numbers for several months; state and local officials eased restrictions and many area residents breathed a sigh of relief. But as local and national public health officials warned it would, the virus returned in the fall, hitting with even greater force.
On Dec.3, there were 654 new COVID-19 positive cases in Monroe County, with a seven-day average of 518 positive cases. Hospitalized patients in the Finger Lakes region totaled 470. Since March, the county has confirmed 17,079 COVID-19 positive cases.
The drop in COVID cases provided “a welcome and needed respite,” says RRH chief medical officer Robert Mayo M.D. But now “we have definitely exceeded the spring numbers substantially.”
As RRH’s and UR Medicine’s new electives policies kicked in Wednesday, both systems’ hospitals were treating more COVID patients than at the pandemic’s spring peak and the numbers were still rising, hospital officials reported midweek.
At 221, the number of COVID patients being treated by UR Medicine’s six hospitals more than doubled the system’s spring peak, Michael Apostolakos M.D., UR Medicine’s chief medical officer, reported Wednesday. RRH’s five hospitals were treating 224 COVID patients, Mayo says.
To accommodate the rising tide of COVID cases, hospitals have been forced to turn over floors previously devoted to other treatments to COVID care and pull nurses and doctors from other assignments to staff them.
Until this week, hospitals were able to keep up by spreading the load with moves of patients to other units within hospitals and transfers to other hospitals.
As COVID cases continue to rise, says Apostolakos, “it is harder to fully staff units, so … UR Medicine is selectively postponing procedures. This frees up hospital beds and staff to treat patients who are seriously ill.”
RRH’s Mayo echoes Apostolakos, describing similar measures at RRH hospitals.
The cutback on elective surgeries will see some procedures delayed for as much as 12 weeks, Apostolakos says.
But unlike the total ban the state imposed last spring, doctors now will triage procedures, to ensure that no necessary surgeries are postponed. Surgical teams will meet daily to decide which procedures to greenlight and which to put off. The goal, says Apostolakos, is to put off as few as possible. Unless they hear otherwise, patients with surgeries already scheduled should assume they will take place on the appointed date.
Area hospitals are still working off a backlog built up by the spring ban.
“In the first surge, when elective surgeries were ended totally, we (brought) staff from all ambulatory and other areas to staff the hospital. We made capacity for 200 to 300 patients and those beds sat empty. We were so prepared for COVID; we opened up so much capacity for COVID, that, I believe, patients were harmed,” Apostolakos says.
That is an outcome he is hoping not to repeat in the new surge. Though the numbers are worse than they were in the spring and the current rate of increase is worrisome, Apostolakos and Mayo say, doctors know more now about how to treat the virus, making the current surge somewhat easier to manage.
Still, if the numbers climb too quickly, hospitals could be overwhelmed. And as the Rochester Beacon recently reported, area hospital staff is already stretched thin.
If the COVID caseload increases too quickly, Apostolakos fears, Gov. Andrew Cuomo could reimpose a complete ban on electives, increasing the non-COVID backlog. In Erie County, only 60 miles from Rochester, Cuomo has already done so.
How dire the situation becomes depends largely on the community. Contact tracing has shown that the biggest source the disease’s transmission locally has been social gatherings, says Michael Mendoza, Monroe County commissioner of health. And after months of restrictions, some may be less inclined to adhere to social distancing and masking protocols.
Like the hospital officials, Mendoza thinks the community is some ways better positioned to deal with the pandemic. But in other ways, we could be worse off, he cautions.
On the upside, “we know more about COVID-19 now. We are better prepared from the standpoint of treatment. There are vaccines on the horizon.”
But on the downside, “we now have a community that is tired. We have a health care community that is just as frustrated. People don’t want to necessarily take these precautions. The reality is we can enforce in bars and restaurants and we have methods to do that. But at the end of the day we can’t, and we don’t want to, be in everybody’s living room.
“This is where we expect everybody to do the right thing, not because somebody’s forcing you to, or because somebody’s enforcing a rule, but simply because it’s the right thing to do for ourselves, for our loved ones and for our community.”
Will Astor is Rochester Beacon senior writer.