Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study

Abstract

declared a global pandemic of coronavirus disease 2019 (COVID-19), which has exacted a massive global impact on health, politics and the economy. 1 With some jurisdictions past the peak of the first wave, the strain on the health care system is becoming apparent-specifically, the impact on surgical care. 2 The CovidSurg Collaborative estimated that 28 404 603 surgeries would be cancelled or postponed across 190 countries in the initial 12 weeks of COVID-19, including 37.7% of cancer surgeries and 81.7% of other (benign) surgeries. 3 If countries increased normal surgical volume by 20%, it would take a median of 45 weeks to clear the backlog. Modelling postpandemic recovery for elective orthopedic surgery in the United States suggested it would take 7-16 months to reach a steady state with a backlog of more than 1 million surgeries. 4 On Mar. 15, 2020, Ontario's Ministry of Health directed hospitals to begin a measured "ramping down of elective surgeries and other nonemergent clinical activity" in anticipation of a COVID-19 surge. 5 On May 26, 2020, the Ministry of Health lifted the directive, allowing hospitals to gradually increase elective and time-sensitive surgeries. 6 The reduction in nonemergent surgeries in Ontario because of COVID-19 has created a substantial surgical backlog. Our objective was to estimate the size of the nonemergent surgical backlog owing to COVID-19 in Ontario, and the time and resources required to clear this backlog. Methods The framework for developing these estimates is outlined in Figure 1. At the recommendation of our regional and hospital partners for feasible surge scenarios, we considered a +10% (1 d per week at 50% capacity) surge scenario, adding 8 hours per day incremental to a 5-day operating week. We included surgeries performed in a fully equipped operating room and categorized RESEARCH HEALTH SERVICES

COVID-19: Rethinking the Lockdown Groupthink

“…95,96 In high-income countries, the collateral damage has also been staggering (Table 3), affecting visits to emergency departments and primary care for acute (e.g., myocardial infarction, stroke) and 'nonurgent' ('elective' surgery, and cancer diagnosis and treatment) conditions, intimate partner violence, deaths of despair, and mental health. 12,[97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] Of excess deaths occurring during the pandemic in highincome countries, 20-50% are not due to COVID-19. 62,[113][114][115] There was an unexplained 83% increase of 10,000 excess deaths from dementia in England/Wales in April, and an increase in non-COVID-19 Alzheimer disease/dementia deaths in the US, attributed to lack of social contact causing a deterioration in health and wellbeing of these patients.…”

A way forward: Considering the sustainability, equity and unintended effects of social control measures as a response to the COVID‐19 crisis

“…The pathway ahead, although uncharted, was simple: the population would be sent home for a few weeks, the “curve would be flattened” and eventually the virus would be supressed. As medical resources were diverted to COVID‐19 responses, hospitals ended up working under capacity, as patients waited for needed clinical services broadly understood as “elective” and piled onto already long waiting lists 18 …”

Development of a Model to Estimate the Association Between Delay in Cancer Treatment and Local Tumor Control and Risk of Metastases

“… 1 , 2 Routine procedures, including cancer screening, diagnosis, and treatments (ie, surgery, chemotherapy, and radiotherapy), have been postponed or delayed to accommodate the current situation. 3 , 4 , 5 , 6 In addition, even after the peak of the pandemic, patients have continued to avoid or postpone medical center visits and treatments because of concerns about the risk of COVID-19 exposure. 4 In parallel, sharp increases in the unemployment rate nationally will likely lead to a significant loss in access to medical care.…”