Kokua Line: Why should ‘elective’ procedures be delayed to make room for unvaccinated COVID-19 patients?

Question: I understand why insurance covers people with COVID-19 even if they chose not to get vaccinated; we don’t deny care to car-crash victims who weren’t wearing their seat belts, or diabetics who eat ice cream all day. What I don’t understand is why hospitals prioritize unvaccinated COVID-19 patients over other people needing hospital care.

Already, the Healthcare Association of Hawaii is warning that if COVID-19 hospitalizations rise much more, “elective” procedures may be canceled because the hospitals won’t have enough beds to serve everybody who needs care. But a lot of those supposedly “elective” procedures are not really optional. Someone who has to delay a knee replacement surgery, for example, will be forced to live in pain for longer than necessary.

Also, if so much of the virus is circulating that they start postponing screening tests, like they did early in the pandemic, diseases like breast cancer and colon cancer might not be caught early enough to save the patient. I hope that you can get an answer from the health authorities about why COVID-19 patients still take priority in the hospital, even though most of the adults who are hospitalized for COVID-19 now could have avoided catching a serious case of the disease by getting vaccinated. Shouldn’t they be the ones who are told that the hospital is full?

Answer: No, because doing so would violate a principle of health care. Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, explains: “Medical personnel triage patients in hospitals and healthcare settings. Those who are most sick or most in need of critical care receive care first. Medical personnel do not make moral or value judgments about negligence, ignorance or stupidity, that may result in injury or even death. It is possible that someone may have to experience pain from a joint degeneration for a longer period of time, or that a screening may have to be delayed, because of inadequate healthcare resources resulting from a significant increase in COVID- 19 hospitalizations. We only have a finite number of healthcare personnel, drugs and equipment, and triaging patients based on immediate need is a basic tenet of healthcare.”

Other readers have expressed opinions or questions similar to yours, reflecting frustration over what Lt. Gov. Josh Green describes as a “preventable pandemic,” since the vast majority of people now hospitalized with COVID-19 chose not to be vaccinated (vaccination is freely available to people ages 12 and up).

As of Wednesday, 111 patients were hospitalized with COVID-19 in Hawaii, a number that is rising but far below the peak of 315 patients in September, before the vaccines were available. Some hospitals did postpone elective procedures then.

Seventy percent of Hawaii’s eligible population had completed COVID-19 vaccination as of Thursday, and 78% had received at least one dose, according to the state’s COVID-19 portal.

Health officials say the highly transmissible delta variant can infect vaccinated people, but those cases tend to be mild. Most new cases are among the unvaccinated, as are the vast majority of hospitalizations and deaths, according to the U.S. Centers for Disease Control and Prevention.

The state Department of Health’s most recent report about clusters of cases, issued July 22, said, “COVID-19 is spreading in the community almost entirely among unvaccinated residents,” exacerbated by people failing to isolate when sick, failing to get tested when they have symptoms, failing to quarantine or monitor for symptoms when they are exposed to COVID-19 and failing to consistently use prevention measures, such as wearing a face mask. Read the report at 808ne.ws/cluster.

Write to Kokua Line at Honolulu Star-Advertiser, 7 Waterfront Plaza, Suite 210, 500 Ala Moana Blvd., Honolulu 96813; call 529-4773; fax 529-4750; or email kokualine@staradvertiser.com.