Houston hospitals to start phasing back more non-COVID-19 care

Texas Medical Center hospital systems Wednesday will begin phasing back more care of people with ailments not involving the coronavirus, a tacit acknowledgment they now feel equipped to handle COVID-19 and can’t overlook the community’s other health needs.

The resumption of some such care follows Gov. Greg Abbott’s order last Friday relaxing restrictions he’d placed on non-urgent elective surgeries a month ago and that medical center hospitals, among others, had imposed on themselves a few days earlier.

“What we’ve learned in the past few weeks is we can bifurcate care — that is, we’re confident that we can safely treat both COVID and non-COVID patients,” said Roberta Schwartz, president of Houston Methodist Hospital in the medical center. “We are concerned that other health care issues - cancer, heart disease, other problems that need treatment — may be being neglected. There’ll be long-term negative consequences for the community if they’re not treated.”

Methodist, Memorial Hermann and CHI St. Luke’s health systems all said Tuesday they will gradually start bringing back some services they had put on hold in March in anticipation of a projected surge of COVID-19 patients. Thus far, the number of cases has not overwhelmed Houston-area hospitals.

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Spokespeople for the three systems said they would start with non-invasive diagnostic appointments, such as CAT scans and MRIs. Some non-urgent surgeries will follow at some point in the near future, they said.

Non-urgent elective procedures are those in which there is no anticipated short-term or long-term negative impact due to a delay. Examples include non-emergency appendectomies and surgeries to reduce weight, replace joints and repair muscle or ligament tears.

Hospital officials said they would prioritize those procedures most needed, such as those for cancer patients and those for people in pain and those longest delayed. They said they would slowly resume procedures, not quickly “turn up the faucet.”

The exceptions to the resumption of elective procedures are the Harris Health System and MD Anderson Cancer Center. A Harris Health spokesman said it would be premature for its hospitals given they continue to see an increase in COVID-related patient care and an occupancy rate consistently between 70 and 90 percent. MD Anderson is continuing to perform “those procedures that meet current standards related to medical necessity and deferring those that do not” while it reviews Abbott’s order, said an institutional statement.

The order was one of a number Abbott announced April 17, all aimed at gradually restarting the Texas economy. The one concering hospitals allows a limited amount of nonessential procedures at hospitals, as long as such surgeries don't deplete the hospitals' supplies of personal protective equipment and capacity remains available in case the COVID-19 patient population surges.

Abbott’s original order prohibiting non-urgent elective surgeries, issued March 22, was part of a national trend of such actions, driven by a desire to be proactive in the face of COVID-19’s spread across the nation. Earlier in the month, U.S. Surgeon General Jerome Adams called for the stoppage, arguing in a tweet that each elective surgery “1) brings possible #coronavirus to your facilities; 2) pulls from personal protective equipment stores; and 3) taxes personnel who may be needed for #COVID-19 response.”

But except for Harris Health’s Ben Taub Hospital, Houston hospitals haven’t been that strained by the COVID-19 outbreak, their patient volumes and occupancy remaining flat or even declining in the last week, the period during which the number of people with the disease began closing in on peak levels. The Texas Medical Center dashboard currently shows a 63 percent occupancy rate in its hospital systems’ ICU beds. COVID-19 patients account for 19 percent of such beds.

The rates have not risen much above those levels since the pandemic hit the Houston area.

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At the same time, the prioritization of COVID-19 care has hurt many people with chronic conditions, both because some doctors offices and procedures have been shut down and because some are afraid to come for care. A Gallup poll taken March 28 to April 2 found 86 percent of people with heart disease said they would be either "very concerned" or "moderately concerned" about the coronavirus if they needed treatment.

“When you look at what’s happening in Houston community, you see the impact,” said Dr. Angela Shippy, chief medical officer of the Memorial Hermann Health System. “Chronic disease is not getting the care that it should be. We want to resume that, pivot back to helping all the community needs.”

Houston-area hospitals are continuing to emphasize precautions aimed at keeping people safe from COVID-19. Memorial Hermann, for instance, has instituted a “Safe Wait” program that enforces social distancing in waiting areas, staggers scheduled appointments and, when necessary, asks patients to wait in their vehicles before appointments.

Memorial Hermann is also screening all employees, doctors and patients entering its facilities and providing those who clear it with a surgical mask; minimizing the number of people in facilities; and testing patients for COVID-19 prior to surgery.

Most all Houston-area hospitals currently have no visitor policies.

Texas Children’s Hospital said that in light of Abbott’s loosening of restrictions, it is prioritizing cases that “initially may not have been urgent, but are now more important due to the several weeks delay.” Through a phased approach, officials said, its surgical team is working through a large number of pressing cases, most outpatient.

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MD Anderson’s decision to continue its policy of not performing non-urgent elective surgeries stood in contrast to that of Texas Oncology. That group called Abbott’s loosening of restrictions critical and said its nearly 100 surgeons “look forward to resuming our collaborative relationships with hospital surgery units and centers in Texas. Its president, Dr. R. Steven Paulson, said, “Cancer treatment cannot be paused during COVID-19.

Carrie Williams, spokeswoman for the Austin-based Texas Hospital Association, said it’s key that hospitals remain careful not to deplete personal protective equipment as non-essential services ramp up. “Protecting our front lines is critical to this response,” she said, “and that doesn’t change as we move toward opening up certain procedures.”

But Williams also signaled that Abbott’s order marks a new stage in the fight against COVID-19.

“Our hospitals are ready to safely move in the direction of giving people the care they have had to put off,” said Williams.

todd.ackerman@chron.com


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