Elective surgeries in the balance as coronavirus resurges – Times Union

ALBANY The state Department of Health is poised to direct a few dozen upstate hospitals to begin limiting elective surgeries this week, based on an executive order signed by Gov. Kathy Hochul late last month amid rising cases of COVID-19 and hospitalizations attributed to the virus.

Health department data indicates the order is expected to impact Albany Medical Center's system, and potentially the greater Capital Region, according to regional guidelines in the order.

"Elective surgeries" is a more limited term this time than during prior emergency declarations tied to the pandemic. Any facility selected on Monday by the health department to restrict elective surgeries would put the order into effect Thursday. It would be effective for at least two weeks.

The coronavirus has been impacting many upstate communities, particularly among the unvaccinated. Since the start of the fall, outside of the greater New York City metropolitan area, hospitals have reported nearly quadruple the amount of deaths attributed to COVID-19 than they did during the summer, according to a review of state data.

Hospital discharges attributed to the virus are roughly double this fall in upstate than they were in the summer, based on data of regions outside of New York City, Long Island and the Mid-Hudson Valley.

At the same rate, the availability of hospital beds is less than 10 percent in upstate New York, down from nearly 30 percent at the beginning of the summer which was central to Hochul declaring an emergency.

The data primarily reflects the influence of the COVID-19 delta variant, not the newly discovered, also highly contagious omicron variant. The state announced it confirmed its first five cases last week, with at least one case dating back to a late November infection.

Heading into last weekend, 31 hospitals would meet the state's threshold of less than 10 percent staffed acute care bed capacity. All of those hospitals are in upstate New York, according to the health department data.

Three of the hospitals are in the Capital Region: Albany Medical Center Hospital, Glens Falls Hospital and Saratoga Hospital, all of which are affiliated with Albany Medical Center.

"We have received the guidance but there is no final determination yet of which hospitals it effects," Albany Medical Center spokesman Matt Markham said in a statement Friday. "We will learn more on Monday."

The New York City metropolitan area is not experiencing a surge in cases or hospitalizations, but it also has higher vaccination rates and higher overall case counts from the first wave of the pandemic. That area, though, was the first to report confirmed cases of omicron variant.

The issue, Hochul has said, is also one exacerbated by a staffing crisis.

In upstate, the staffed bed capacity initially saw a substantial decline over the summer, before the governor's vaccination mandate for health care workers took effect. Between July 21 and 28, the available staffed beds in upstate dropped by 1,500, a 4 percent decline, according to state data.

Over the course of Hochul's vaccine mandate this fall, which has been opposed by some labor unions and lawmakers, staffed bed capacity continued to drop off by another 1,800 upstate. It is now around 35,000 beds in upstate that may not have staff to care for patients.

Hochul admitted last week that the decline is in part because of her mandate, but she was resolute in the purpose of it, which is to ensure a vaccinated person it taking care of a patient. Her position has been questioned by some who note vaccinated individuals may still carry the coronavirus, and many health care workers already had contracted the virus during the height of the pandemic, developing some level of immunity.

The mandate's effect also reduced capacity of nursing homes, group homes and other long-term care facilities, Hochul said. She told reporters last week that she was informed there are patients in hospitals who are waiting to be discharged to nursing homes, but the facilities do not have enough staff to appropriately care for thoseindividuals.

Hochul called on the National Guard to help mitigate the problem. The intended effect was to assist the facilities and free up bed capacity in area hospitals.

Medically trained National Guard members were initially deployed to 11 nursing homes, including one in the Capital Region, Shaker Place Rehabilitation and Nursing Center in Colonie, according to the state health department. Last month, the Albany County-run facility had to repair water damage to at least 50 bathrooms.

Gov. Kathy Hochul issued an emergency declaration to help free up hospital bed capacity by limiting elective surgeries.

Elective surgeries this time around is not expected to mean the same thing it had previously in the pandemic.

Instead, the health department listed a number of surgeries that are now considered essential: cancer, including diagnostic procedure of suspected cancer; neurosurgery; intractable pain; highly symptomatic patients; transplants; trauma; cardiac conditions with symptoms; limb-threatening vascular procedure; dialysis vascular access; and patients that are at a clinically high risk of harm if their procedures are not completed.

"We are encouraged by at least the procedures they consider essential," said Dr. John DiPreta, president of the New York State Society of Orthopaedic Surgeons.

The approach this time around is "more thoughtful" than it was last year, added DiPreta, who works primarily out of the Albany Medical Center system. He noted that more is known about the transmission of the virus and there is more of an emphasis on ensuring that prioritizing one health issue doesn't lead to other severe complications.

The health system, from what DiPreta said he has seen, has generally caught up its prior backlog of surgeries. He emphasized the need to treat people with intractable pain to avoid them falling and breaking a bone or continuing to rely on opioid pain killers to cope with chronic pain.

The baseline for a hospital to limit elective surgeries is triggered when its staffed acute care bed capacity is less than 10 percent over the course of a week.

The details become even more nuanced, based on a detailed memo issued by new state health Commissioner Mary Bassett on Friday.

A facility with 5 percent or fewer of its staffed beds available, based on a seven-day average, would need to defer non-essential surgeries not only in its hospital, but also ambulatory procedures.

But there are also facilities that may meet criteria under the new health department directive to suspend in-patient and out-patient procedures, even if they are not at the 5 percent threshold. Procedures at ambulatory surgery centers likely could continue.

The health department's determination is not limited to a hospital's bed capacity. Facilities within a region with severely limited bed capacity could also be regulated by the order.

The department also can restrict elective surgeries at hospitals in a region where staffed acute care beds are between 85 and 90 percent full, based on a seven day average, and the COVID-19 hospital admission rate for the region over the prior week is greater than four per 100,000 people.

The Capital Region would fall into the range for staffed beds, but is just short of the hospital admission rate, according to state data. On Nov. 26 and 27, the region would have fallen into both target rates, meaning all seven hospitals in the region could be guided to limit elective surgeries, regardless of their individual capacity.

Ellis Hospital in Schenectady is not at the 10 percent threshold, but it said through a spokesman that it has "proactively delayed some non-essential procedures in our operating rooms to free up staff to cover essential cases."

"Long before this pandemic, capacity has always been fluid, determined by available staff and patient volume on a given day," Ellis spokesman Philip Schwartz said in a statement Friday. "This is not new: We surge and flex every single day."

The hospital has experienced a 65 percent increase in hospitalized COVID-19 patients over the last three weeks, Schwartz said. He added that last month, more than two-thirds of admissions were unvaccinated individuals.

St. Peter's and Samaritan hospitals are also above the 10 percent threshold.

"With cases on the rise locally and regionally, we are flexing and scaling back to respond to the current surge," St. Peter's Health said in a statement.

Original post:

Elective surgeries in the balance as coronavirus resurges - Times Union