CORONAVIRUS

Non-coronavirus health care shifts in pandemic response

'It's a complete redefinition of how we do our work'

University of Iowa Hospitals and Clinics CEO Suresh Gunasekaran meets Nov. 19, 2019, with The Gazette's editorial board
University of Iowa Hospitals and Clinics CEO Suresh Gunasekaran meets Nov. 19, 2019, with The Gazette’s editorial board and reporters in Cedar Rapids. (Liz Martin/The Gazette)

IOWA CITY — Just before Christmas, David Mahncke got a respiratory infection that wouldn’t go away.

Because the 35-year-old Cedar Falls husband and father had received a kidney transplant in 2013, the sickness was troubling — and lab work revealed his new organ was failing.

“They called him down to Iowa City to admit him into the hospital, and essentially it was there that they told him he was going to lose the transplant,” his wife, Mandy Mahncke, 35, told The Gazette.

The first step was hooking David up with a temporary port for dialysis, which he started doing immediately at a local center. He eventually had a second surgery, placing a port in his stomach for home-based dialysis, which he’s been doing for about a month.

He was supposed to be evaluated at the University of Iowa Hospitals and Clinics for placement back on the transplant list — on which patients can spend three to five years,

“But that’s been delayed by the COVID-19 stuff,” Mandy said.

And her husband is not alone.

As Eastern Iowa health care providers move to beef up their coronavirus response and limit the spread, they’ve canceled elective surgeries and curtailed in-person appointments. Beyond postponed physicals and routine checkups and screenings, even patients with more acute needs — other than flu-like symptoms — aren’t coming into the clinics at the same clip they were.

Instead, providers across the region are — in many cases — rerouting them to virtual platforms in hopes on-call practitioners and physicians can diagnose a problem and potential solution without seeing the patients in person.

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“It’s not necessarily business as usual,” UI Hospitals and Clinics Chief Medical Officer Theresa Brennan said. “We are seeing every patient that needs to be seen. But our care might be delivered in a little bit different way.”

Because of its curtailed elective procedures, UIHC surgeries have been down about 75 percent since the COVID-19 outbreak began, according to hospital Chief Executive Officer Suresh Gunasekaran. Face-to-face visits, he said, have plummeted 80 percent — although some have been replaced by those virtual appointments.

“If you net out the video visits,” Gunasekaran said, “it’s probably about a 65- to 70-percent reduction, versus an 80 percent reduction.”

In Cedar Rapids, similarly, Mercy Medical Center, UnityPoint Health-St. Luke’s Hospital, Surgery Center Cedar Rapids and PCI on March 17 announced they were postponing non-life threatening and non-urgent surgeries and procedures to focus on the COVID-19 response.

Almost all knee replacement surgeries, for example, were delayed.

Since the announcement, total surgical volumes at St. Luke’s Hospital have dropped more than 70 percent, officials said. Surgery Center Cedar Rapids ceased operations.

Among the main drivers for clinical and surgical cancellations across Eastern Iowa is preservation of personal protective equipment for medical staff caring for coronavirus patients.

“I think as COVID-19 has increased in all communities, I worry less about exposure, … It’s more an issue of making sure we have (personal protective equipment) for those taking care of patients,” said Tim Quinn, executive vice president and chief of clinical operations at Mercy Medical Center in Cedar Rapids.

For gray areas — like when surgery isn’t urgent but a patient’s long-term outcome could change without the procedure — medical professionals are converging remotely to consider the case and how to proceed.

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“Shockingly, there’s only been a few of these cases,” Quinn said. “In the overwhelming majority, it’s been really clear whether it needs to be done urgently or whether it can wait.”

As for the potential to miss a more serious health condition — like a lump in the breast, for example — UIHC’s Brennan said those patients still can get in to be seen “as quickly as they did before.”

“Actually, maybe even quicker because we’re postponing the non-urgent or elective patients,” she said. “The places where I worry that we may miss things, in general, would be someone who’s afraid of coming to a hospital or afraid of calling in because they’re afraid of this virus and so they postpone things electively themselves.”

She raised the potential for a screening to miss a health concern — like a worrying lump.

“But that’s where it’s really important that individuals follow those guidelines — probably now more than ever — for their routine self-exams,” she said.

Although other hospital departments and services continue to function and are just as busy as before — like labor and delivery — some unit operations look different due to a variety of changes, like visitor restrictions.

“It’s a complete redefinition of how we do our work and how much work we do,” Quinn, with Mercy Medical Center, said.

Officials with St. Luke’s said patients and families have been “very understanding” during the pandemic.

The Mahnckes in Cedar Falls said they recognize the need for all the precautions — as David is among those at highest risk from the virus.

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But when last month they learned UIHC wouldn’t be scheduling any new evaluations until June or July, they still felt disheartened.

“I was discouraged when we found out he’s not even going to get evaluated,” Mandy said. “It’s disheartening to me because in July it’ll be like eight months since he lost his original transplant. He could have been on the list waiting for another one. Or people who have offered to get tested for him could have been tested and we could be trying to get something scheduled. It just adds eight months on to his wait time.”

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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Our most important Coronavirus coverage is free to the public.

If you believe local news is essential, especially during this crisis, please donate. Your contribution will support news resources to cover the impact of the pandemic on our local communities.

All donations are tax-deductible.