'New start:' Medics juggle surgery backlogs and virus fight

Hospitals are increasingly grappling with giant backlogs of surgeries that were postponed when COVID-19 hit

Virus Outbreak Under The Knife (Copyright 2020 The Associated Press. All rights reserved)

Chatting before they go under the knife, the two women picture their lives after surgery. Caroline Erganian hopes to be rid of her pain. Lolita Andela imagines being able to be active with her kids.

After multiple false dawns, they scarcely dare believe that their Paris hospital, no longer monopolized by COVID-19 patients, is once again able to perform their intestinal tucks to treat chronic obesity. When the pandemic was burning through France s health system, the women s surgeries were repeatedly pushed back. But after months of waiting, their turn has now come.

Lying on a gurney, ready to be wheeled into the operating room, Erganian, a retired secretary, tells the surgeon: “I’m doing this surgery to have a better life. So I'm enthusiastic, not a bit scared."

“A new start,” replies the surgeon, Lara Ribeiro Parenti, thrilled to be back at work with her scalpel. “This is what we know best and what we enjoy doing. It’s a renewal, a new start, for us, too.”

For these women, yes. But many thousands of others in France and other European countries hardest-hit by the pandemic are still waiting for medical procedures that could change their lives and improve their health, but which were deemed nonessential when the virus ripped through hospitals.

To prevent the collapse of public health systems, their decks were cleared. People who had been scheduled for joint replacements to free them from pain, for cataract removals to defog their sight, for cancer checks, and myriad other life-improving and even potentially life-saving procedures, were told to stay home as staving off COVID-19 took priority.

At the Bichat Hospital in Paris, one of the French capital’s largest with 900 beds, wards fell silent as resources were poured into critical care units in the basement.

But doctors are now better able to treat virus patients and better equipped for the double challenge of fighting COVID-19 while also doing other medicine. With France’s most recent virus spike now stabilized, Bichat is using the lull to tackle the backlog of surgeries. An Associated Press team spent two days this month with its staff, seeing how they are recovering from virus surges that left more than 55,600 dead in France.

Bichat was the first hospital outside Asia to report a COVID-19 death, back in February, and was turned upside down when the pandemic struck with full force in March. Makeshift plastic screens were erected to stop contamination spreading, held up with duct tape and bits of wood. Operating rooms and a recovery room the size of a tennis court were among spaces hastily converted for floods of sick people, who were plugged into ventilators, one next to the other.

“It was cataclysmic," recalls Simon Msika, the head of digestive surgery whose unit was among those that emptied. “The basement was teeming with people.”

When President Emmanuel Macron declared that France was at war with the virus and put the country into lockdown in March, Erganian and Andela both immediately understood that their surgeries wouldn't happen as planned.

“It was a hammer blow for the family, because we were ready," says Andela, who is the carer for a man with disabilities.

Admissions for COVID-19 aside, hospitalizations across France plunged, with 2 million fewer hospital stays from March to July compared to the same period of 2019, the French Hospitals Federation says. Cataract surgeries stopped almost entirely for eight weeks, and colonoscopies used to spot cancers plummeted by 87%. There were half as many kidney transplants from March to September, according to the federation. Its statisticians estimate that the number of patients waiting for postponed procedures has swelled by hundreds of thousands.

Neighboring Spain was battling long waiting lists for non-urgent surgeries even before the virus caused more than 45,600 deaths there. Public health data shows that in the first half of 2020, surgeries plunged by more than a third year-on-year. The average waiting time has grown from 115 days to 170. At the end of June, 691,508 people were registered as waiting for non-urgent procedures — 20,000 more than a year earlier.

In Portugal, almost 100,000 surgeries had been postponed by October. And the association of hospital surgeons in Italy says more than 600,000 operations have been canceled there, 50,000 of them for cancer. By June, the association was already warning that more than 13 months would be needed to clear the backlog.

Delays are more than mere inconveniences for patients. Erganian weighed 140 kilograms (308 pounds) before surgery; Andela was 133 kilos (293 pounds). Both were terrified of becoming infected by the virus, acutely aware that obesity puts them at greater risk of dying from COVID-19. Other than for work and groceries, Andela says she barely left the house. Erganian says she lived in “monstrous fear.”

Both gained additional kilos in lockdown. Andela wept when her nutritionist weighed her.

“I have three kids. I dream of doing lots of things with them that I cannot do now: rollerblading, scootering, hoverboarding, going to the swimming pool without having to hide,” the 33-year-old said the afternoon before her gastric bypass surgery.

Erganian, 58, hopes to shed more than a third of her weight as a result of having a large part of her stomach cut out and be free of knee and back pain — and of her cane. She prayed in the final weeks that her phone wouldn’t ring with news of another delay.

“In a European country as developed as France, I find it abnormal that surgeries that should have been done couldn’t be carried out because of COVID,” she says. “We should not be choosing between one sick person and another.”

The pandemic hit with such force initially that hospitals in many countries barely coped, but that is changing. During France's second lockdown from Oct. 30, surgeons at Bichat performed many more operations than during the first shutdown. All 22 of the hospital's operating rooms were functioning again this month.

The operating room schedule that Aurelie Gouel manages was largely filled with gaping holes in March but is now a tightly packed puzzle of colored blocks, each representing a surgery. She likens the task of fitting in as many operations as possible to the computer game Tetris.

Gouel calculates that the pandemic has so far forced the postponement of more than 600 surgeries at Bichat. Even with operating rooms again going full tilt, she can't see how the hospital will catch up.

“There will always be other patients who take priority," she says. "It is going to be complicated for a long time.”

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Associated Press writers Aritz Parra in Madrid, Barry Hatton in Lisbon and Frances d'Emilio in Rome contributed.

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