The Devastating Impact of the COVID-19 Pandemic on Breast Cancer Care Among Medically Underserved Populations at Two New York City Public Hospitals.

Abstract

The COVID-19 pandemic has stretched hospitals to their capacities and has forced them to restructure and divert resources to accommodate the influx of critically ill patients. Surgical specialties are particularly vulnerable to restructuring given the need for highly trained personnel with intensive care unit (ICU) experience and procedural skills and need for ventilators and spaces that can function as ICUs. The diversion of hospital resources and redeployment of staff to the care of COVID patients has led to unintended consequences, including delays in care for patients with oncologic diagnoses, such as breast cancer. These unintended consequences are illustrated by the COVID-19 experiences of 2 New York City public hospitals: Bellevue Hospital and Elmhurst Hospital. The Breast Services of both hospitals treat the city's vulnerable, medically underserved breast cancer patients. Despite similar patient populations, Bellevue and Elmhurst had divergent COVID-19 experiences. With a larger surge capacity and an affiliation with New York University, the Breast Service at Bellevue Hospital was able to continue to offer essential breast operations, albeit at reduced volumes, whereas the Breast Service at Elmhurst Hospital was completely shut down. These experiences serve as a harbinger of the continually widening health care disparities and force hospital systems and policymakers to critically examine the impact of the COVID-19 pandemic on underserved patient populations that receive care at smaller public hospitals.