A strategic step back

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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.

Robert Mayo

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.

Michael Apostolakos

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.

2 thoughts on “A strategic step back

  1. Warnings about Virus protection measures are not impacting enough people.
    Why doesn’t Monroe County sound the alarm, with hourly reminders for MASKING, etc?

    Dr. Mendoza seems to be doing a great job, but he is not a communications expert.
    Surely, we have people, in Rochester, who can sound the alarm, more effectively, now.

    What about the use of ROBO-Calls, for reach every home?
    What about using more impactful TV, radio and web reminders?

    We can stop the spread, with more effective reminders. Why not do so, ASAP?

  2. Though social gatherings are now the biggest problem for the spread of Covid , it is not the only problem . Literally millions of cases of Covid of individuals and their families were contracted in the workplace . Employees in meat processing and farming , as well as health
    care , have suffered greatly . Extra unemployment ran out over three months ago and in many states regular unemployment is poverty . Millions are going to work or looking for work and income outside the home . Unemployment benefits and landlord rent subsidies are running out and more small businesses are closing permanently . Millions do not want to get sick or risk their family getting sick , but have few options . The biggest lie came from the main stream media and resulted in Trump getting a 62% approval rating on the economy , even in the middle of a pandemic with millions of job losses . Only when we had a long government shut down did they print that nearly half of workers made less than $15 an hour, $12 median wage for 40% , and almost all of those did not have a $1,000 in the bank . How often did you read that the richest 10% of Americans added over a trillion dollars to their wealth during the pandemic? Well they did . Many people are exposed and not at home with immediate family only because they have little choice if they want a place to live , with heat and food this winter . We have to do better .

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