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Patients, visitors and other guests come and go from the main entrance of Our Lady of the Lake Hospital Friday afternoon, December 4, 2020, in Baton Rouge, La.

As hospitals across the country scale back on certain procedures to meet the need of a deluge of coronavirus patients, Louisiana clinics and hospitals plan to continue optional -- but often necessary -- surgeries and operations even as health systems dig in for a third wave of infections.

When the coronavirus outbreak intensified in the spring, Louisianans diagnosed with diseases or needing surgeries had to wait weeks for follow-up care as hospitals were forced to push back certain surgeries and procedures.

But now, unlike the early stages of the viral outbreak, hospitals say they plan to balance their resources and ability to provide elective procedures — like joint replacements and heart and cancer surgeries, among others that aren't considered an emergency.

Hospitalizations due to the coronavirus-borne illness, COVID-19, doubled in a month's time across Louisiana and have shown little sign of abating. That has raised alarms for hospital and state leaders that the growing surge could jam up hospitals once again.

Compared to the early stages of the pandemic in Louisiana, hospitals say they are more equipped to handle a third wave. They’ve stocked up on more protective equipment supplies and ventilators, which are at times needed for surgeries and other medical operations, and overall understand the virus better.

"We can take care of the COVID patients. We have a good grasp on that now," said Dr. Ralph Dauterive, vice president of medical affairs at Ochsner Medical Center Baton Rouge. "But we're running out of rooms to put them in and we're running out of nurses to take care of them."

Hospital bed availability has continued to shrink across the state, according to Louisiana Department of Health data. As of Friday, there were only four intensive care unit beds at hospitals in the Acadiana region, and about two-thirds of overall hospital beds in and around Baton Rouge, New Orleans and the North Shore were also occupied.

With more people landing in hospitals due to severe bouts of the virus, state health officials say some facilities may be forced to scale back on non-emergency operations, such as knee and hip replacements, heart surgeries and screenings, among others.

But any decision to scale back on elective procedures will likely come from the facility itself, rather than a mandate from the state of governor’s office.

Dr. Joseph Kanter, the Office of Public Health interim assistant secretary at the state Department of Health, said hospitals now have a better idea of what other types of services they can continue, especially procedures that involve overnight stays in the hospital.

"The preference across the board ... is that it's a better situation for everyone when hospitals can make these kinds of rollbacks themselves when they think they need to," he said.

St. Tammany Parish Health System recently stopped certain surgeries and operations due a rise in COVID-19 patients that hospital leaders expect could grow. The Covington hospital joined a growing number of health systems, many in the Upper Midwest and other hard-hit states, that have made similar moves recently.

Smaller, rural hospitals may also be more vulnerable to putting back certain procedures because they lack the flexibility of more space and workers than larger facilities.

“If one or two nurses that get sick that’s a huge deal for us,” said Kassie Roussel, a spokeswoman for St. James Parish Hospital. “In a small hospital, those resources are even more important.”

The 25-bed hospital in Lutcher saw the realities of an overstretched rural hospital when it was caring for more than double the number of inpatients it usually sees.

The facility has been able to resume elective services when the height of the spring surge abated, a factor the hospital credited to staff being more familiar with the virus and more resources like protective equipment.

Limited supplies of ventilators and protective equipment for medical workers were a significant part of the decision near the start of the pandemic to tap the brakes on in-person clinic visits, screenings and non-emergency operations.

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Health chains like Oschner managed to clear the nearly two-month-long backlog of surgeries and procedures when they were allowed to resume in May, but the health impacts of those delays are still unknown.

Putting off certain procedures could lead to worse outcomes for people who've suffered recent injuries or had to forgo operations like cancer removal or heart surgery.

In some cases, delaying a procedure like a minor heart blockage could worsen to the point where emergency intervention is needed, leading to riskier operations and other complications.

"The whole survivability of the disease changes, and that's just heart disease,” Dauterive said.

The Baton Rouge hospital also noticed another potentially troubling trend: a spike in emergency admissions for serious infections, kidney and heart complications.

Dauterive think the rise may have been due to people putting off doctor visits due to worries about going to the doctor. Another possibility could be damage inflicted on peoples’ organs after they unknowingly contracted the coronavirus but never had symptoms.

The hospital also saw declines in emergency room admissions during the spring and summer for things like heart attacks and strokes. Ambulance service also saw a rise in people who cited concerns about the virus when they declined to go to hospitals.

Medical centers have also taken significant steps to isolate COVID-19 patients and staff who work with them from the rest of the hospital. That includes negative-pressure rooms that keep infections contained in an area, wider use of rapid tests and other protective safeguards.

Our Lady of the Lake Regional Medical Center COO Stephanie Manson exhorted people who may be having health emergencies to seek care.

"If you need care, don’t delay it. We have safety precautions in place," she said.

Manson also called on the public to help blunt infections and the strain it puts on health systems by social distancing, wearing masks and avoiding large crowds.

She and other health system leaders also say reducing the virus's spread is especially important this fall and winter because the outbreaks are much more acute across the country than in the past, making it difficult to bring in outside health workers.  

Amid concerns of medical workers contracting the coronavirus and reducing hospitals’ ability to care for patients, plans to provide emergency vaccinations are nearing reality.

Pending emergency federal approval, vaccines could be administered to some frontline health workers before month’s end, though decisions on how to divvy up the first small batch of doses are still being ironed out.

Nevertheless, the added layer of protecting staff may also be a significant factor in allowing them to balance caring for coronavirus patients while also providing emergency and non-emergency care, health officials say.

“We're ready to go, we just need a vaccine,” Dauterive said. “My goal is to not waste one drop of it.”


Email Youssef Rddad at yrddad@theadvocate.com, and follow him on Twitter @youssefrddad