COVID-19 Patient Impact at Washington University

The COVID-19 pandemic has greatly impacted the entire patient experience in interventional oncology at our institution.  This goes beyond the known infected patients or those under investigation with the newly expected, necessary personal protective equipment (PPE) and safety precautions taken. It also includes the patients who have tested negative or those with no or little level of clinical suspicion for the virus. 

In this current environment there is a sense of great fear that these patients may unknowingly harboring the virus i.e. the asymptomatic positive patient which has been speculated to be from 25%-50%. I believe this fear and paranoia arises from the experiences I would imagine most have encountered involving the patient who was brought for an intervention with “no clinical suspicion” for COVID-19 and then tested positive day(s) following the procedure with resultant exposure of many individuals along their hospital admission.

This exact scenario happened to us 3 weeks ago and relatively early in the Pandemic.  The patient had 15 radiology tests/procedures prior to the positive test.  We discovered later that many were not wearing the appropriate PPE for these examinations.  Fortunately, our division had made the decision a few days prior to this specific IO case to wear surgical masks and face shields for all cases and those that we deemed higher level of suspicion, or cases in which droplet contamination was considered a risk, an N95 was worn. The waters get even more muddied by another relatively new common scenario in that every patient who enters the hospital who might be surgical candidates are getting COVID-19 tested and placed as persons under investigation (PUI) regardless of their clinical presentation.  Many of these individuals are coming to us for biopsies, lines, etc. but because they are a PUI we have to use the necessary PPE, safety precautions, specimen handling on biopsies and aspirations, and room cleaning and shut down times for everyone one of these cases in which there was no clinical suspicion for infection rather pre-emptively testing for the possibility of surgery.  These two very different clinical scenarios have impacted work flow, efficiency, resources, staff utilization and the overall work environment.

It now seems that nearly every patient that comes through our section to some degree is treated as if they could be positive - even those who are coming with a recent negative test result.  While this gets into issues of conserving PPE and proper use, I just wonder when or if we will ever feel comfortable going back to our old practice patterns and not necessarily wearing a mask , shield, and gloves to consent all patients or when performing routine procedures. It makes me wonder if this the beginning of new practice standard changes that will be lasting.

Another impact that is becoming increasingly clear and is likely here to stay for the short term, and even possibly the longer term, is the financial impact to our medical institutions.  While the numbers are very fluid at this time, many practices are at least down 50% with some as low as 20%.  At this point it is unclear if there is disparity between academic institutions and private practices but regardless the financial impact has led to discussions and or decisions on furloughing office staff, nurses, physician assistants, nurse and study coordinators, and in some instances faculty physicians.  Across the board salary cuts are a reality for many. 

What does this mean for interventional oncologists?  Surely cancer doesn’t take a break during Pandemics and the same clinical demands still exist.  While it is challenging to predict what are practice volume will be like in three to six months, I am optimistic that interventional oncology will be one of the specialties that will rebound and fair better than some others. 

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