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‘I’m kind of scared’: Surgery for cancer patients and others cancelled as hospitals brace for possible COVID-19 wave


Janice Ense never actually got to talk to her doctor, or anyone else for that matter.

While she was out on Monday, an assistant left Ense a voicemail message announcing that the unfolding COVID-19 crisis had forced the postponement of her kidney cancer surgery.

The operation was supposed to take place next Thursday at Toronto’s St. Michael’s Hospital. Now the 47-year-old from Manitoulin Island, an eight-hour drive north, has no idea when the tumour will be removed. As the pain from it continues unabated.

“I’m kind of scared, because I don’t know if it’s going to metastasize … It has grown substantially in the past year,” Ense said in an interview Wednesday. “I was really disappointed. I was psyched physically and mentally to have major surgery and then, boom, it’s delayed.”

She is not alone.

Relatively few Canadians have contracted the novel coronavirus and fewer still have died from it. But COVID-19 is already having a tangible impact on thousands of the ill in Canada as hospitals postpone elective surgeries and transplants and clear out clinics and wards to ready for a possible wave of infected patients.

The moves — many announced in just the last few days — are designed partly to prevent sick and immune-compromised patients from being infected by COVID-19, but mostly to free up critical-care space and equipment should the pandemic suddenly spike.

The rationale is that even if a surgery is not urgent, those patients often spend time in the intensive-care unit and occupy a ward bed, resources that would be desperately needed if Canada experiences an Italy-like surge in COVID-19 cases.

“This is a big deal, we are doing a lot less,” said Vancouver cardiologist Dr. Andrew Krahn, a spokesman for the Heart and Stroke Foundation and president of the Canadian Cardiovascular Society.


Toronto General Hospital. COVID-19 is already having a tangible impact on thousands of the ill in Canada as hospitals postpone elective surgeries.

Dave Thomas/Postmedia/File

The cardiac care system has years of experience managing wait lists and ensuring the most urgent cases get looked after quickly, but there is always a concern with delaying treatment, especially if the coronavirus disruptions last for more than a few weeks, said Krahn.

“Of course there’s worry,” he said. “There’s no question indefinite delays will lead to people having bad things happen while they are waiting.”

With some variations from province to province, hospitals across the country are postponing all elective cardiac procedures, resulting in a reduction in bypass, stent and other operations of 50 to 75 per cent, said Krahn. The society is also recommending that clincs and diagnostic services essentially be closed, “except for very ill people.”

That means, for instance, that a patient who fainted because of a heart condition would be treated immediately. But those who have a routine stress test that indicates they have a borderline need for a stent will have to wait, he said.

This is a big deal, we are doing a lot less

Toronto’s University Health Network, which encompasses four major hospitals, tends to care for “the most acute patients in the country.” But it is delaying most elective surgeries — from non-urgent gall bladder and hernia operations to hip replacements — a reduction of 25 to 40 per cent, said CEO Dr. Kevin Smith.

Also postponed are kidney transplants except those involving dead donors and recipients who are “highly sensitized or quickly deteriorating,” and lung transplants for any patient who is not declining rapidly.

Smith said the process is being carried out with care, each potentially postponed case reviewed by a panel of doctors. Some cancer surgeries, such as those involving slow-developing tumours, can be delayed safely, he noted.

Smith said there’s been relatively little pushback from patients — some have even asked for a delay to lessen their potential exposure to COVID-19 — but acknowledged it can be difficult.

“No patient wants to hear ‘You’ve got a malignancy and I’m going to wait to take it out,’ ” said the CEO. “But we’re trying to balance that against the risk and needs of other patients we anticipate coming to the hospital.”

Still, a study of the spillover effects of the 2003 SARS outbreak in the Toronto area — relatively small compared to the scope of the COVID-19 changes — found that efforts to reduce the demand on hospital services had some unintended, and troubling, consequences.

There were actually reductions in high-acuity visits to Toronto emergency departments and of hospital admissions for heart attacks, gastrointestinal bleeding and pulmonary embolisms — blood clots in the lung.

Emergency physician Dr. Michael Schull, who headed the research, said some emergency departments are now also seeing significantly reduced patient volumes. Public health authorities should remind Canadians they can still go to the hospital if they have a serious problem, said the CEO of the Institute for Clinical Evaluative Sciences.

“As much as we’re telling patients ‘Stay home, don’t go out unless you have to’ … we should also be telling people: ‘If you need the health system, it’s there for you and make use of it.”





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Freddie Ljungberg accuses Arsenal players of being ‘scared’



Arsenal’s interim manager Freddie Ljungberg (Adam Davy/PA)
Arsenal’s interim manager Freddie Ljungberg (Adam Davy/PA)

Freddie Ljungberg accused his Arsenal players of being “scared” as defeat at home to Brighton condemned the Gunners to their worst run of form in over 42 years.

A 2-1 reverse at the Emirates Stadium means Arsenal have gone nine games without a win, a streak not matched since 1977.

Neal Maupay’s late header sealed a deserved victory for the Seagulls, who had led through Adam Webster’s first-half effort as Alexandre Lacazette temporarily levelled for the beleaguered hosts.

Ljungberg replaced Unai Emery on an interim basis after the Spaniard was sacked last week, but has so far been unable to address an alarming slide in form.

Arsenal have not won since October 24 and Ljungberg admits confidence is rock bottom as he looks to turn things around heading into the packed Christmas schedule.

“They look very short on confidence,” he said.

“In the first half they were scared to get the ball and a bit scored to move, they were just standing still.

“That’s something we need to talk about. They need to have a win, we need to dig out a win and get them some confidence.

“They can do it because they showed it in the beginning of the second half and they did it really well for 20 minutes.

Thursday nights at Arsenal are great
Graham Potter

“It’s hard to say that when you lose at home, but they were very good in that little spell.”

For Brighton, this was a first-ever victory away to Arsenal and a maiden win on the road against an established “top six” opponent.

It also meant boss Graham Potter was able to repeat his Europa League triumph over the same opposition at the Emirates with Swedish minnows Ostersunds in February last year.

“Thursday nights at Arsenal are great!” smiled Potter.

“Hopefully the Premier League will arrange more games on a Thursday.”

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Arsenal’s Granit Xhaka (centre) battles for the ball with Brighton and Hove Albion’s Aaron Mooy (left) and Leandro Trossard (Adam Davy/PA)

Brighton’s second away win of the season lifted them above Aston Villa, West Ham and Bournemouth into 13th.

Potter added: “We showed great quality and great courage, so overall I’m delighted with the players. It’s fantastic to get three points and play like we did.

“Given the quality up front they have, everything can change, but credit to the players, they managed the situation well, and there was a bit of quality from us as well.

“We’ve had a tough batch of games so it’s nice to come away from home, win, and play well. It gives us a bit more confidence on the path to going somewhere.”

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