Texas, Oklahoma and Alaska are among the first states to begin reopening their economies, including allowing elective surgeries to resume, following the release of new guidance from the White House this week.
Friday, Texas Gov. Greg Abbott issued three executive orders, including an order that loosens restrictions on surgeries put in place in March. From April 21 through May 8, the order says health providers should continue to postpone elective procedures with the exception of those procedures that would not be expected to deplete hospital capacity or personal protective equipment (PPE) needed to cope with COVID-19 or any procedure performed in a facility that has certified it will reserve at least 25% of its hospital capacity for COVID-19 patients and will not request PPE from any public source for the duration of the crisis.
Meanwhile, Oklahoma Gov. Kevin Stitt issued an amendment to his earlier executive orders in order to allow medical providers to determine which elective surgeries can resume April 24.
He also signed an order outlining an Elective Surgery Acuity Scale (ESAS) for medical providers to follow regarding when elective surgeries can be performed during the COVID-19 state of emergency.
“We initially suspended elective surgeries to preserve hospital bed capacity and PPE to handle a potential surge in COVID-19 patients,” Stitt said in a statement. “Since our data indicates we are in a good position regarding hospital capacity—and provided individual institutions can accommodate their internal demand for PPE—it is time to bring some of these procedures back to help our hospitals and the Oklahomans who need them.”
All minor medical procedures and nonemergency dental procedures such as outpatient surgeries or procedures for not life-threatening illnesses may resume May 1, the order says.
Meanwhile, Alaska Gov. Mike Dunleavy issued a mandate to allow (PDF) non-urgent or nonemergengy elective services that cannot be delayed beyond eight weeks without posing a significant risk to quality of life to resume May 4. The order additionally lays out a range of safety precautions that must be met in order for facilities, which explicitly include ambulatory surgical centers, to provide elective services.
The orders are the first to follow a phased-in approach to begin reopening the economy in the wake of the COVID-19 crisis announced by the White House Coroanavirus Task Force on Thursday evening. Those guidelines call for states to wait until they see data that show a sustained decline in influenza-like illness, as well as positive COVID-19 cases with persistent testing, for a minimum of 14 days.
During the first phase of reopening, the guidelines also call for vulnerable individuals to continue to shelter in place while those individuals that do begin going out in public continue practicing social distancing such as avoiding large gatherings and nonessential travel. Visits to senior living facilities and hospitals should also continue to be prohibited, they said.
Gyms can open if they can adhere to strict physical distancing. Employers should make special accommodations for vulnerable individuals and continue encouraging telework options. Employers should begin returning employees back to work in phases. Schools should remain closed. Large venues including sit-down dining can only be operated under strict physical distancing protocols and maintaining that six feet.
Provider groups have raised the alarm about attempting to reopen different segments of the economy or beginning elective surgeries prematurely.
A road map released Friday by the American Hospital Association and American College of Surgeons, among other groups, says resuming elective procedures should depend on whether a hospital can quickly test patients and show a steady two-week decline in COVID-19 cases. They should also have to ensure they have enough PPE and staff, the groups said.