Rear view of surgeon putting her surgical mask in operating room at hospital.
In March the Centers for Disease Control and Prevention, along with some of the largest medical bodies in the U.S., advised hospitals to postpone non-essential planned procedures. This was to make sure that hospitals would have the supplies and wouldn’t be overwhelmed when dealing with cases of Covid-19. Many people waiting on surgery that was booked in months ago have had to sit tight. However, starting in early May medical centers in 20 states are rebooking non-emergency procedures and reproductive and gynecological specialists say that fertility treatments can’t be delayed. The American College of Surgeons has come together with the American Society for Reproductive Medicine among others to detail which procedures are high priority and emergency.
While the Covid-19 pandemic has been headline news for months many people have experienced cancelations and postponement of surgeries they had booked in for prior health conditions. Analysis of over 500 U.S. hospitals by TransUnion Healthcare highlighted that since March 11, when Covid-19 was declared a pandemic, total visits to hospitals nationwide have declined by 32 percent. A statement released by the American College of Surgeons, American Society for Reproductive Medicine, Society of Gynecologic Surgeons, Society of Reproductive Surgeons and other professional organizations prioritized infertility services such as endometriosis, fibroid and polyp surgery as Tier 3a, meaning infertility patients are now a high priority and their needed office, surgical and IVF services cannot be delayed.
Creating a traffic light system of red (emergency procedures), amber (high priority), yellow (not life-threatening but priority) and green (not life-threatening) the organizations detailed which fertility treatments should be considered first as procedures progressively start to be rebooked. The agencies said an endometrial biopsy where there’s a low risk for carcinoma could be delayed beyond 12 weeks. Vulvar Biopsies and non-neurogenic UDS were listed among the procedures that could wait four to 12 weeks. Endometrial biopsies where there’s a high risk for carcinoma, bladder cancer follow-ups, long-acting reversible contraception replacements and IUD insertions or replacements for non-contraceptive indications were all listed in the procedures which could be delayed for up to a month. Treatments for macroscopic hematuria, long-acting reversible contraception insertion (such as IUDs and implants) and retrograde pyelograms were listed as emergency treatments and shouldn’t be delayed at all.
“Covid-19 has delayed treatment for many who have diseases and conditions that weren’t emergencies but were needed or even urgent. This has caused some biological injury in a few people, decreased quality of life in almost all patients and significantly increased emotional burden in many,” says leading reproductive endocrinologist, Clinical Professor ACF at Stanford University and past president of the American Society for Reproductive Medicine Dr. David Adamson, “some have been harmed by a change in their personal economic situation that might make desired treatment not affordable. It is very important that people planning medical care take every precaution to avoid becoming infected because, if they do, their health care will almost certainly be delayed again and they’ll have to go through quarantine.”
The traffic light scale takes into consideration the seriousness of the condition and procedure, the threat to the patient’s life and the risk of the patient contracting Covid-19 during their time in the hospital or clinic. The statement reads, “the risk of Covid-19 infection still remains, but at a diminishing rate. In the trough, the risk of infection to individuals scheduled for surgery must be weighed against the morbidity of their benign condition. In this scenario, patients with severe comorbidities, or those who would require rehabilitation or a skilled nursing facility after surgery should consider delaying surgery until a vaccine or effective therapy is available.”
Surgeries with shorter rehabilitation times, shorter stays in the hospital or for conditions that pose a more serious threat to a patient’s life could be considered sooner, according to the statement. Going to the hospital is still risky and the statement details that as the situation with Covid-19 develops their advice can be flexible too.
