COVID-19 Update from Dr. Smith: 4/30/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

With great relief, today I watch the cruel month of April come to an end, and look forward to better things.  What better new beginning than to think about scheduling patients for surgery?  A large quantity of deferred benefit is waiting to be delivered, to those for whom it’s not already too late.  Starting from the most mundane, preop testing needs to be considered.  The new preop routine includes testing for infection within 24 hours of the procedure, using a nasal swab assessed for presence of viral nucleic acid by PCR.  A positive test will result in cancellation unless the urgency of the operation outweighs the additional risk of operating in a COVID-infected patient.  Unfortunately, there is almost no data to drive that decision, but it is prudent to assume that there is some added risk.  Scheduling is also a good time to begin setting appropriate expectations and building confidence, particularly in patients wary of Manhattan.

The presence or absence of visitors plays an important role in this process.  Banning visitors is foreboding and signals risk.  Welcoming them back is an important declaration to the visitors, to the patients, to the region, and to ourselves that we have confidence in our COVID security.  Properly controlled visitation carries other advantages.  Visitors reduce patients’ sense of isolation.  They help impaired patients move through the system.  Even for unimpaired patients having simple procedures, visitors help at key points like drop-off, pick-up, and receipt of discharge instructions.  Visitors are a portal for communication between caregivers and extended family and friends.  Visitors walk the hallways, cruise the lobby, go to Starbucks, interact with office staff, and experience our overall environment more broadly than the patient.  They are fully conscious and pain-free witnesses.

There are risks.  Visitors are a drain on PPE, which may become scarce again.  If welcomed back too soon in our recovery, or exposed to the wrong scenes, their impressions might set us back.  Visitors add stress to social distancing, and they add an infection transmission risk that is hard to measure accurately or eliminate entirely.  For that reason, testing visitors could be important.  Testing could also be a way to build good will and advertise our emphasis on safety for all.  Why not test a designated visitor at the same time the patient is tested? 

Our path forward is bounded significantly by NY State policies.  In the rapid acceleration phase of our surge, in late March, all visitors were banned.  Symptomatic visitors still are, sensibly.  Restrictions have been slowly rolled back to allow one parent or guardian for a child, and one visitor for obstetrical deliveries.  Even more recently permission has been granted for end-of-life visits, and a visitor is allowed for a patient requiring functional assistance, presumably past the ICU phase when the assistance required exceeds what nursing can provide.  None of these policies are aimed at rebuilding consumer confidence in our products, and even with revisions they remain more cautionary than optimistic.  Ideally, regulations will relax or be lifted at a realistic pace, and we can reinstate visitation gradually as we see fit.  Beginning with one visitor for every ambulatory or inpatient procedure seems safe and sensible to me, in case the Governor asks.  Pre-pandemic visitation policies can wait awhile.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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