It seems a lifetime ago that we were facing the second COVID-19 wave when the numbers of COVID cases, hospitalizations and ICU admissions were rapidly increasing in Saskatchewan. At that time, we had no vaccines, and had just gone thru a three-month period when more than 11,000 non-urgent surgeries were postponed.
I wrote then advocating for the implementation of proven public health measures to mitigate COVID-19 transmission and avoid overwhelming the health-care system. We are now facing that dreaded scenario with our hospitals overwhelmed, our ICUs full and the acute health-care system near collapse.
The blanket cancellation of non-urgent surgical procedures to provide COVID surge capacity, for the second time, has devastating and long-lasting consequences for surgical care in our province. The reallocation of resources to cope with COVID admissions at the expense of surgical care has created new “COVID victims” as patients in need of surgery have their care postponed. The standard of surgical care has also been affected. Entire programs such as the organ donation and transplantation services have been placed on hold. Patients requiring cardiac surgery have their care delayed because of lack of ICU beds. There are challenges to provide surgery to cancer patients because there are no beds for their postoperative recovery. Joint replacements, cataract surgery and other so called “elective” surgeries are indefinitely postponed, resulting in prolonged pain, suffering and decreased function.
The surgical backlog in Saskatchewan has ballooned to more than 33,000 patients waiting for surgery. The postponement of these surgeries causes cumulative harm and disability down the road. For example, it is well established that patients on long waiting lists that need total joint replacement lose function that cannot be fully regained after surgery. This back-breaking buildup will take several years and millions of dollars to clear up.
Vaccination is crucial to curb COVID infections, reduce hospitalizations and decrease community transmission. Timely institution of public health measures to fight the pandemic is the responsibility of our elected officials, but we all have a personal responsibility to get vaccinated, wear masks and comply with public health directives. The health of our fellow citizens depends on our actions.
Recovery strategies to safely maintain surgical volumes during and immediately after COVID outbreaks need to be instituted. Preservation of our experienced surgical teams should be a priority. Especially vulnerable are operating room and recovery room nurses who have had a high rate of attrition during the pandemic. Optimization of surgical capacity across the province by providing surgery in different surgical units regardless of the patient’s place of residence. Maintaining COVID-free surgical units that can function independently of COVID surges should also be considered.
COVID-19 and its variants will be with us for the foreseeable future; we must stop using surgery cancellations as a tool to cope with preventable COVID surges. To get over the onslaught of this fourth wave, we need the prompt implementation of “circuit breaker” measures. We cannot continue to fight COVID at the expense of surgical care ignoring the needs of tens of thousands of patients that require surgical interventions.
Dr. Ivar Mendez is the head of surgery for the University of Saskatchewan and the Saskatchewan Health Authority.