Doctors debate surgery during COVID-19

TALI FEINBERG

In a letter to his patients two weeks ago, gynaecologist and obstetrician Dr Theo Kopenhager wrote, “Extremely worrying reports from Europe, the United States, and recently South Africa indicate increasing rates of morbidity and mortality not related to COVID-19.

“This phenomenon results from the frantic efforts of doctors involved in managing the pandemic on the one hand, and patients staying away from doctors, clinics, and hospitals for fear of the virus on the other. Consequently, there’s a deterioration in – or increased mortality from – cardiovascular disease [heart attacks], strokes, metabolic disease [diabetes, etc], and missed diagnoses of early cancer and other diseases.”

In his practice, fewer women are coming for appointments. These include women who have chronic conditions, women requiring assessment for suspicious lesions, masses, or malignancies, and those whose complaints can’t be accurately or safely diagnosed over the phone.

“Doctors have special guidelines and arrangements to ensure the maximum mitigation of viral risk and as little chance as possible of transmission from them or their staff to you or from you to them. If you feel you should be medically checked, there’s no need to be fearful,” he wrote. “A visit to your doctor should be safer than a visit to the supermarket.”

Cape Town orthopaedic surgeon Dr Jason Crane says that in his practice, “Patients should be seen initially, then two weeks later, and then usually every six weeks for six months, to ensure that nothing is missed and that they are healing according to plan. I want to pick up any complications early.

“Unfortunately 50% of patients – especially the elderly – are terrified to come to the hospital or go for X-rays as they are concerned about coronavirus. I’ve also noticed that a further 10% cancel the day before the follow-up appointment out of fear of COVID-19.”

He usually sees between 10 to 15 new patients a week, “but I’m now seeing only five new patients a week. If injuries or deformities are seen early enough, they can be treated with the correct conservative therapy or occasionally minor surgery. As patients start waiting longer, the injury or deformity worsens, it’s no longer amenable to conservative therapy, can start affecting other body parts, and can lead to permanent pain and suffering.”

In terms of surgery, “There is definitely a 50% drop in new patients that have booked surgery. These patients need surgery, but have elected to wait until the coronavirus settles down rather than have surgery now. This could take as long as 18 months according to some scientists’ estimations.”

“A hospital is probably one of the safest places to be. Infrastructure and infection control protocols have always been in place,” Crane says. “However, high-risk patients with non-urgent problems should consider a telephonic consultation. If it’s an urgent problem such as a fracture or a cardiac issue, then they should still attend the doctor and adhere strictly to all COVID-19 protocols.

“If the patient needs surgery, and waiting will make the condition worse or permanent, then I would advise the patient to go ahead with surgery. If I suddenly needed surgery now, I would go ahead with it.”

Even after 26 people tested positive for coronavirus at the hospital where he practices, he wouldn’t change this advice. “The fact that the hospital shut down for a week shows that it has the staff and public’s best interests at heart, and re-opened when it was safe for all concerned.”

However, a doctor in the Cape, speaking on condition of anonymity, says he has chosen not to do non-emergency surgeries because of the high incidence of COVID-19 in the province. He says he is seeing only about 10% of patients, but feels the loss of income is less important than patients possibly putting themselves at risk. At the same time, he urges people to make appointments if they feel it’s urgent. He has already seen one patient during lockdown that had a minor complaint that turned out to be cancer and should have been seen sooner.

A Jewish mother says she chose to go ahead with minor surgery for grommets (ear tubes) for her 17-month-old son. “The procedure was necessary. We didn’t want him to have further complications with his ears or hearing loss, and the hospital managed everything perfectly. I felt safe and secure. I’m happy we’ve done it, our child is perfectly fine, and we’ve done all that we can for his health.”

A 61-year-old Jewish woman chose to go ahead with minor laparoscopic surgery during lockdown. She could have waited a few weeks, but she would have had to be on antibiotics and strong painkillers until then. Her doctor advised her to go ahead as soon as possible as hospitals could fill up as the virus reaches its peak and at the time, the hospital was still quiet.

She had a coronavirus test two days before surgery, and was assured all staff were similarly being tested. “Being admitted was quite a surreal experience. There was a huge amount of paperwork, the test, taking temperatures, and providing lists of contacts,” she says.

In theatre, the doctors and staff were in full personal protective equipment. “My anaesthetist looked like an astronaut,” she says. She was in her own ward with no other patients in that corridor. “It was incredibly quiet, everything was sanitised. It’s difficult not to have visitors, but I felt reassured and grateful that I chose to have the surgery when I did.”