Robert Nam is a professor of surgery at the University of Toronto who specializes in surgical treatment for patients with urologic cancers. He holds a masters degree in clinical epidemiology.
As a surgeon at a major cancer centre in Toronto, I have not been able to provide timely care to my patients. I’ve had to turn away referrals to help patients with cancer because of the provincial order to cancel all elective surgery. My hospital has allowed me to operate on people with the most urgent life-threatening diagnoses, but there are so many people in line. It’s all been gut-wrenching.
For cancer patients waiting for treatment – people who have been thrown into mental anguish knowing that their disease is a ticking time bomb – their hopes of being able to beat their disease have been severely harmed by the stroke of a pen. The directive to cancel all elective surgery from the province’s Chief Medical Officer, David Williams, is just another example of a pandemic response that harms Ontarians with its blanket, goalpost-moving approach.
The order appears intended to make room for COVID-19 patients in hospital and to clear the ICUs. But for decades, hospitals have developed efficiencies and surgical techniques for cancer operations that do not require a hospital bed or an ICU (called ambulatory surgery). It should also be said that while there are shortages of ICU nurses related to COVID-19 demands, their skillsets are not as easily interchangeable with nurses from other departments, particularly those most familiar with the operating room.
But this order may well be extended beyond May 20, as daily COVID-19 rates remain high – even though the lockdown is not achieving its goal. Numbers will eventually go down, but it will take months, not weeks. Some of my cancer patients can’t afford to wait that long. And so the surgery stop order has taken away our ability to treat those who do not need a hospital bed or ICU and, perhaps worst of all, it has taken away our ability to offer hope. One should not underestimate the power of hope in relation to major health conditions.
Dr. Williams and associate medical officer of health Barbara Yaffe continue to cite the reduction of mobility as the reason for the province-wide lockdown. But while mobility may be associated with COVID-19 infection rates, there is no clear proof that mobility alone causes the direct spread of COVID-19; there is a major difference. There are other factors at play, including essential workers going to work sick and indoor gatherings serving as sites of transmission. And while the science is clear that outdoor activities do not spread the virus – as opposed to indoor activities, which enhance viral spread and in which the lockdown actually forces Ontarians to engage – tennis, golf, basketball and baseball have all been prohibited. These kinds of activities are part of the solution – not the problem.
The novel coronavirus continues to spread, all while elective surgeries that could be done safely continue to be put on the shelf. How many lives have been lost or had their quality affected because of this ban on non-COVID-19 surgery and treatment?
There are lessons to be learned looking south of the border. Florida and Texas have long been open and allowed people to participate in outdoor activities. They both fared better than California, where a lockdown forced people indoors.
I do not mean to disparage the dedicated work of Dr. Williams and Dr. Yaffe. They have toiled tirelessly for months. But sooner or later, working at a breakneck pace, people burn out. The solutions are right in front of us, but we continue to ignore them. We need better vaccination supplies and strategies. We need better essential work support. We need to get outdoors, continue to wear masks and socially distance. And we need to allow hospitals to perform elective cancer surgery, now.
It’s time to get a second opinion, for the sake of so many Ontarians who are living with cancer.
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