by Dr. J. Craig Morrison, Southern Joint Replacement Institute

Limiting elective surgery in Nashville was important for three reasons: preserving PPE (Personal Protective Equipment), protecting staff, and protecting patients. Thankfully, the anticipated surge in COVID 19 cases has not overwhelmed our community. Social distancing and other measures have worked and our hospitals have capacity to begin taking care of less urgent medical issues including elective surgical procedures. Do not be fooled by the term "elective". Most of these surgeries are medically necessary. They were not urgent, but are certainly time sensitive. Joint replacement surgery, coronary artery bypass surgery, and some cancer surgeries are just a few examples of procedures that have been put off. Now that the curve has been flattened, our medical community will and should take care of the patients that have made a sacrifice to delay.

Centennial Medical Center, like all area hospitals, has a plan to keep patients and health care staff safe. Initially, consistent with the Governor and Mayor's executive orders, only patients under the age of 70 with few medical comorbidities and considered low risk will be scheduled. This will protect the most vulnerable patients. For higher risk procedures, the judicious use of COVID 19 testing may be applied. In a perfect world, all patients would be tested for COVID 19 the day of surgery with a rapid turnaround time for results. This is not the current reality anywhere in the country, so patients will be screened by phone for common COVID 19 symptoms or exposure.

Patients will have to be without symptoms for more than 3 days before surgery. Additionally, patients that have been exposed to someone that is COVID 19 positive will have to wait 14 days from the time of exposure until surgery. On the day of surgery, screening questions and a temperature check will be performed as a final screen before admitting to the hospital. Visitors and staff will also be screened and have their temperature checked daily. Visitors will be limited to one per patient only on the day of surgery and masking will be required for all patients, patient visitors, and staff. Although Centennial has cared for many COVID 19 positive patients they have always been quarantined to one specific areas of the hospital, vastly reducing exposure risk from a current COVID patient. is not possible.

For the protection of our staff, PPE will be required as if all patients are infected. For your protection, our staff will maintain enhanced PPE precautions. These "universal protections" for the respiratory transmission of COVID 19 will include appropriate masking and face shields where appropriate for the type of procedure being performed. The PPE supply is sufficient to meet this demand, but hospitals and their staff will continue to be good stewards of this equipment to prevent waste.

It is great news for our community that we can now safely proceed with this plan for elective surgery. Over the next few weeks, hospitals and public health officials will monitor the number of new cases in the setting of relaxing social distancing restrictions. If the hospital capacity remains acceptable, then patients at higher risk may be scheduled and more visitors may be allowed. If we handle this ramp up period as responsibly as our community handled the surge prevention, we will successfully return to treating all patients needing "elective" surgery and quality of life improving surgical procedures before the end of June.