Three months ago, the country witnessed COVID-19 patients flooding the New York City intensive care unit, forcing some of its hospitals to turn cafeterias into wards and tents in parking lots.

Hospitals elsewhere are preparing for similar surges: They clean beds, hoard scarce protective equipment, and – voluntarily or under government orders – temporarily cancel non-emergency operations to save space and supplies for coronavirus patients.

In most places, a surge of patients never occurs.

Now, corona virus cases are rocketing nationally and hospitalizations are increasing at an alarming rate. But the response from the hospital is very different.

Most hospitals throughout the country did not cancel elective surgery – nor did government officials request it.

Instead, hospitals say that they are better equipped to deal with crush patients because they have enough protective equipment for their workers and know how to treat coronavirus patients better. They said it would close procedures not important in hospitals based on local risk assessments, but not throughout the system or the state.

Several hospitals have done so, including facilities in South Florida, Phoenix, and Central Valley of California. And in some cases, like in Texas and Mississippi, government officials have ordered hospitals to delay elective surgery.

The hospital’s decision to keep the operating room still partly guided by money. Elective surgery account for most of the hospital income; and American Hospital Assn. estimate that the hospital and the country’s health system lost $ 202.6 billion between March 1 and June 30.

“What we now realize is that shutting down the entire health care system in anticipation of a surge is not the best choice,” said Carmela Coyle, president of the California Hospital Assn. “This will make the health delivery system go bankrupt.”

Association estimate that California hospitals will lose $ 14.6 billion this year, of which $ 4.6 billion has so far been replaced by the federal government.

But some health workers worry that continuing elective surgery amid surges puts them and their patients at risk. For example, some nurses are still being asked to reuse protective devices such as masks and N95 gowns, even though hospitals say they have enough equipment to carry out elective surgery, said Zenei Cortez, president of the United National Nurses union.

“They continue to put us at risk,” Cortez said. “They continue to look at us as if we are disposable materials.”

Elective surgery, in general, is a procedure that can be postponed without endangering the patient, such as knee replacement and cataract surgery.

Least 33 states and the District of Columbia temporarily banned elective surgery this spring, and most hospitals in states that do not, such as Georgia and California, voluntarily suspend them to ensure they have a bed to accommodate surges of coronavirus patients. U.S. general surgeons, Centers for Disease Control and Prevention and the American College of Surgeons also recommend health facilities to delay non-emergency operations.

The suspension is always meant to be temporary, said Dr. David Hoyt, executive director of the American College of Surgeons. “When this all started, it was just a matter of flooding the system,” he said.

Today, the number of cases has soared after many states have eased orders to stay home and Americans flocked to restaurants, bars and backyards and met with friends and family for graduation parties and Memorial Day celebrations.

Nationally, confirmed COVID-19 cases have reached their peak 3 million. In California, there were many cases, with a 52% jump in the average number of daily cases over the past 14 days, compared to the previous two weeks. Inpatient care has gone up 44%.

Governors, district overseers and city councils have responded by requiring people to wear masks, close bars and restaurants – again – and close the beach on the Fourth July holiday weekend.

But in general, government leaders do not ask hospitals to proactively reduce elective surgery in preparation for surges.

“Our hospital tells us that they feel very strong and competent that they can manage their resources,” said Holly Ward, director of marketing and communications at Arizona Hospital and Healthcare Assn. If they feel the situation guarantees that, “they themselves will delay the operation.”

In some countries, such as Colorado, public health orders that allow hospitals to continue non-emergency operations in the spring require hospitals to have a protective supply of equipment and extra beds that can be used to treat the influx of COVID-19 patients.

Countries also arrange overflow sites if hospitals run out of rooms. In Maryland, for example, the state uses the Baltimore Convention Center as a field hospital. California last week reactivated four “alternative care site“- including hospitals that are on the verge of closing in the San Francisco Bay Area – to bring COVID-19 patients if the hospital is filled.

But the decision to reduce elective operations in California will not come from the state. This will be made by the district in consultation with the hospital, said Rodger Butler, a spokesman for the California Agency for Health and Human Services.

The question is whether the hospital has a system to meet the surge in COVID-19 patients when it happens, said Glenn Melnick, a professor of health economics at USC.

“To some extent, elective care is good care,” Melnick said, “They provide the services needed. They keep the system running. They provide employment and income.”

In Los Angeles County, more than 2,000 COVID patients are currently hospitalized, according to county data. While that number is projected to rise by several hundred people over the next few weeks, hospitals believe they can accommodate them, said county health services director Christina Ghaly. Meanwhile, the hospital is preparing to bring in additional staff members if needed and inform patients who have scheduled operations that they can be postponed.

“There are more patients with COVID in hospitals than ever before in Los Angeles County during a pandemic,” Ghaly said. “Hospitals are better equipped now to handle the patient’s volume than before.”

Although hospitals do not stop elective surgery, many have not ramped up the full schedule they had before COVID-19. And they say they pick and choose operations based on what happens in their area.

“We were all COVIDs when we were just starting,” said Joshua Adler, executive vice president for doctor services at UCSF Health. based in UC San Francisco. “We don’t know what we’re dealing with.”

But after a few months treating patients, the hospital has learned how to supply units, how to transfer patients, how to treat other patients simultaneously and how to improve testing, Adler said.

At Scripps Health in San Diego, which has brought more than 230 patients from Imperial County who were hit to the east, the hospital has resumed how many transfers they will receive when confirmed COVID-19 cases increase in their own communities, said Chris Van Gorder, president and CEO of Scripps Health.

A command center established by the hospital system reviews the number of patients and medical supplies and coordinates with regional health officials to learn how the virus spreads. Only patients who need urgent surgery are scheduled, Van Gorder said.

“We only allow our doctors to schedule cases in the next two weeks,” Van Gorder said. “If we see a sudden spike, we have to delay.”

In Central Valley California and in Phoenix, where cases and hospitalizations are soaring, Mercy’s hospital has suspended elective surgery to focus resources on COVID-19 patients.

But other hospitals in the CommonSpirit Health system, which has 137 hospitals in 21 states, did not end elective surgery – as they did in the spring – and treat patients with needs other than COVID, said Marvin O’Quinn, system president. and chief operating officer.

“In many cases their health has deteriorated because they did not get the care they need,” said O ‘Quinn, whose hospital lost nearly $ 1 billion in two months. “It’s not only detrimental to the hospital for not doing such cases; it harms the community. “

This story was produced by Kaiser Health News, which publishes California Healthline, an editorial service that is independent of California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.