Medical providers must tread carefully as elective care resumes

Minnesota doctors, hospitals and many political leaders praised this week's decision by Gov. Tim Walz to lift COVID-19 restrictions on elective and nonessential medical procedures. But one vital group of health care professionals — Minnesota's 22,000 nurses — voiced understandable reservations about the potential impact on supplies of face masks, gowns and gloves and other personal protective equipment (PPE).

National, even international shortages of this gear were a key reason why elective care was halted. While inventories are improving, those who care for COVID-19 patients also know the frightening speed with which it's possible to burn through inventories of critical gear.

For example, it can take up to seven people to turn over an adult COVID-19 patient in respiratory distress, said Mary Turner, who is the head of the Minnesota Nurses Association union and a COVID-19 nurse at North Memorial Health. That's seven gowns, seven pairs of gloves and seven face masks just for one routine task.

"I hope we're not just planning to open it back up and fill up surgery schedules," Turner said. "If it's back to business as usual, we will run out [of PPE] really quickly."

Turner and the nurses association sent a strongly worded letter on May 2 to state health officials, saying they are "frustrated and disappointed" with the decision to resume elective surgeries "without adequate protection for workers." Their concerns about PPE, staffing and infection control illustrate the challenge ahead.

There will be a balancing act to meet pent-up demand while still maintaining PPE inventory and ensuring adequate hospital bed capacity critical for a COVID-19 surge. Elective procedures will ratchet back vs. snap back to pre-COVID-19 levels of care. That will require patience of patients who had their care delayed earlier this year as facilities work through the backlog. Minnesotans also need to be ready for providers to react if PPE supplies fall behind or COVID needs pressure hospital capacity.

Elective surgery and procedures generally involve care that can be planned in advance vs. an emergency. Examples include mammograms, colonoscopies, cataract surgery, joint replacement and some heart procedures, just to name a few. To put a priority on COVID-19 care, a March 19 Walz executive order required providers to postpone elective procedures. The decision lifting the order came on Tuesday, permitting care to resume this coming Monday.

The decision is good news for patients and medical providers. Elective care is important and cannot be delayed indefinitely. The procedures are also a critical source of revenue. Delaying them caused economic pain — job furloughs and layoffs of health care staff.

The Walz order on resuming care requires facilities to have a plan to monitor PPE, prioritize procedures, implement social distancing and take other common-sense COVID-19 prevention measures. It would have been preferable for state health officials to review and sign off on these plans, but the order does not require that.

Fortunately, the Minnesota Hospital Association has put out a solid framework for providers to follow. The Walz administration has also improved the state dashboard tracking PPE.

Minnesotans now get more than raw numbers. They can now see "days on hand" metrics for face mask, gloves, gowns and other gear. The numbers are reassuring, though the Star Tribune Editorial Board continues to have concerns about PPE supplies for long-term care centers. The state is also frequently monitoring health care facilities' PPE inventory to prevent shortfalls.

Health care facilities should follow the state's lead when it comes to PPE transparency. Some have already done so. North Memorial, the metro hospital where Turner works, provides online and other updates to employees so they can monitor critical supplies. This is good policy that builds employees' trust as medical institutions tread carefully toward resuming care.