Irene Johnson would love to go home, where her 8-year-old tomcat, Shelly, is waiting.
She’s been in a wheelchair since late December, when she had an artificial knee removed due to an infection. By March, when the infection had cleared after an antibiotic regimen and it was time to schedule the surgery to have her new knee put in, Johnson, 73, was told that wouldn’t be possible.
Unable to get around her Barrington, N.J., home alone, Johnson moved in with her son, in nearby Oaklyn, and that’s where she’s been ever since — losing muscle mass and hope in equal measure. She calls her doctor’s office frequently to ask about scheduling her procedure, but the answer is always the same: “Not yet.”
As the coronavirus pandemic surged, health systems across the country put off all but the most essential medical procedures in an effort to preserve resources for treating critical COVID-19 patients and reduce the risk of already vulnerable patients contracting or spreading the virus.
But as hospitalizations peak in outbreak hot spots such as Philadelphia, public leaders and health officials are beginning to plot a course to reopening services and getting patients like Johnson back on their feet. Gov. Tom Wolf on Monday authorized hospitals to resume elective and non-urgent surgeries, assuming they have sufficient protective equipment, staff, and capacity to treat patients who are both positive and negative for COVID-19.
Hospitals and surgery centers said they are eager to bring their operations back up to speed; these types of procedures account for a sizable portion of hospitals’ revenue, and doctors are eager to bring back patients whose procedures have been delayed, but are still absolutely necessary.
Still, returning to something like normal will take months. Providers will need to work through backlogs of thousands of patients, while still taking on new urgent cases. At the same time, social distancing guidelines that remain in effect will mean office appointments must be more spread out, meaning they can’t see as many patients in a day.
While some Philadelphia-area hospitals outlined aggressive plans to resume elective surgeries as soon as May 1, others are taking a more cautious approach.
“We all want to get back to normal. ... There’s a huge economic incentive for all of us to get back,” said Jack Lynch, CEO of Main Line Health. But, he added, “I’m not convinced Philadelphia is in a position to be opening anytime soon.”
Main Line administrators want to see a steady, two-week decline in COVID-19 hospitalizations before phasing in elective procedures, which Lynch said he hopes will come by mid-May. As of Tuesday, the system had about 230 coronavirus patients, down from a peak of 280 on April 15, but the decline has not been steady — plateauing and even increasing on certain days.
Main Line currently has enough personal protective equipment and has reassigned medical staff from other departments to care for COVID-19 patients. But Lynch worries that supplies — and staff — could run short if Main Line hospitals prematurely bring back too many elective surgery patients, especially if the region experiences a second wave of coronavirus cases.
“All you need is one infected person who infects a lot of people and we’re back to where we started,” Lynch said.
In the meantime, Main Line is urging its doctors to continually reevaluate patients whose surgeries have been delayed, as some may have become more urgent cases that should be treated immediately.
Hospitals have remained open for urgent and emergency cases and have implored patients in distress to seek care, as a troubling decline in heart attack and stroke patients raised concern that people are avoiding hospitals out of fear of contracting the virus.
Philadelphia health systems offered a range of plans:
Temple Health is developing a plan to resume elective surgeries, but declined to say when that might be.
Einstein will resume elective surgeries once it has seen a “sustained decline in COVID cases,” a spokesperson said.
Jefferson Health hopes to begin phasing in delayed surgeries “in the next few weeks,” by prioritizing patients for whom continued delays would result in significant health risks, Edmund Pribitkin, an executive vice president at Jefferson Health and president of Jefferson Medical Group, said in a statement.
Penn Medicine expects to begin resuming delayed surgeries in early May. “We are mapping plans to resume these services carefully, in a way that balances the safety of our entire community with the urgency of individual health care needs that can no longer wait," Kevin Mahoney, CEO of University of Pennsylvania Health System, said in a statement.
Crozer-Keystone Health System will resume elective surgeries May 1, a spokesperson said.
Rothman Orthopaedic Institute will resume surgeries on Monday, but it will be another three months before the institute is operating as usual, said Alexander Vaccaro, the institute’s president.
Since elective procedures were shut down in March, Rothman has built up a backlog of 4,300 surgeries and procedures. Working through that list will require extending weekday hours and adding weekend shifts.
Resuming surgeries as quickly as is safe to do so is critical — the institute loses about $20 million every month it’s closed. As a result, the institute furloughed about 1,300 office and administrative staff, as well as 60 doctors, and took out a $35 million line of credit to support operations and keep up with health benefits for employees, Vaccaro said.
Rothman will focus at first on patients who are in severe pain and who can be released within 24 hours after surgery, to reduce the amount of time anyone must spend in a hospital or ambulatory care center and to increase the number of cases they can work through.
“When we get this stuff up and running, we want to have simpler cases, so we can make sure we have it down cold,” Vaccaro said. “You don’t want to burden the hospital until we know this whole thing is over and we know there’s not going to be another resurgence.”
Johnson, who is a Jefferson patient, hopes to hear her phone ring soon.
She worries that her health is deteriorating and recovery will be harder the longer she remains in a wheelchair. Being away from her own home and socially isolated from her extended family — especially her 1-year-old grandson — has taken a toll emotionally.
“Sometimes they come to the front door so I can see him, but I haven’t been able to hold him in a long time,” she said, her voice wavering. “I just want my life back.”