Patients delaying colonoscopies resulting in cancer diagnoses that could have been caught weeks earlier. Someone with a burst appendix, a result of delayed treatment for appendicitis. People with strokes and heart attacks not coming to the emergency room, causing more severe side effects and potentially inoperable disabilities.

Doctors from hospitals throughout Washington rattled off all these cases and more, explaining the consequences of delaying urgent medical care at a virtual news briefing Thursday. Their main message: If it’s an emergency, the hospitals can handle it.

Washington residents have been delaying medical care in emergency situations due to fears of safety from COVID-19, and providers stressed that while the system has been working to care for patients with the virus, that system has also developed ways to keep all patients safe.

“We’ve heard alarming stories and experienced patients delaying their care because of the fear of contracting COVID,” said Dr. Sam Hsieh, chief medical officer at Coulee Medical Center in Grand Coulee. “We have heard beliefs that we don’t have the time to attend to others. I want to bust that myth and say that’s simply not true.”

On March 19, Gov. Jay Inslee issued a proclamation halting all nonemergency medical procedures in the state, an effort to conserve personal protective equipment and make sure hospitals had the capacity necessary to treat a surge of COVID-19 patients. That proclamation expires Sunday, and stakeholders are working to determine what the next phase for hospitals looks like.

“We are working with a large group of stakeholders in the medical and dental communities to reach an agreement on a replacement for the nonemergent procedures ban in the existing proclamation that expires on Sunday,” the governor’s senior policy adviser for health, Molly Voris, said in a statement. “We sincerely hope to have an agreed-upon plan to announce on Monday.”

Beth Zborowski, senior vice president of membership engagement at the Washington State Hospital Association, said it may be a phased approach and not necessarily “business as usual.” She said there is particular guidance out that clarified which procedures count as “nonemergent” that health care providers can use to determine whether to conduct a surgery or procedure.

“There’s a lot of care currently being delayed by people themselves that can be given under the current proclamation,” she said.

Some hospitals are preparing for Monday by ensuring they have enough testing supplies and setting up procedures to protect both health care workers and patients coming in for surgeries. In Newport, the critical access hospital is planning to test all patients getting surgery for COVID-19 prior to their procedure. Surgeons would order tests for the patients, and they could get them done at the hospital’s lab.

Patients would need to provide a negative laboratory test for COVID-19 no less than three days and no more than seven days before their procedure. Newport hospital officials made preparations based on Monday’s start date for nonemergency procedures but are prepared to pivot depending on what happens Monday.

Rural and urban hospitals have struggled to access the necessary supplies as well as ensure they have enough funding to keep their doors open. Some rural hospitals have struggled to get access to the materials they need thus far in the pandemic. Balancing the possibility of a surge of COVID-19 patients, as counties reopen, with the need to begin other surgeries and procedures is on hospital officials’ minds.

“Preparation is the key. We discuss surges on a daily basis to see what we need to amp up on and see how we need to prepare,” Hsieh said.

Dr. Stuart Freed, chief medical officer at Confluence Health in Wenatchee, said that while their hospital capacity is currently good, he anticipates a surge with the counties they serve seeing increased case numbers.

“I don’t want to be pessimistic, and we have a fair amount of capacity in our ICU, but it will fill up like a narrow-neck bottle when this community opens back up, is my fear,” Freed said. “I am very fearful of what will happen if we prematurely open.”

In recent weeks, rural communities that previously struggled to get access to testing materials or personal protective equipment have been able to access more supplies, another necessary component to further opening the health care system. Freed said they just got enough testing supplies to test everyone they admit as of last week, not just those who were coming in for emergency procedures.

“It’s not the same across the state, which is somewhat frustrating. We’d like to have testing not be an issue,” he said.

Part of the governor’s reopening plan ensures that the state’s health care system has enough capacity and PPE necessary to care for both patients potentially coming in for non-emergency procedures (which contribute significantly to hospital revenues) but also to care for COVID-19 patients in the event of a surge of cases.

As of May 11, the state had ordered more than $400 million worth of PPE, but so far has received only a tiny fraction of those supplies. Hospitals have their own supply chains if they are connected to a larger health care system, which makes it easier than for independent or public hospitals.

Locally, hospitals have had capacity for weeks and never reached surge levels. MultiCare hospitals in Spokane County experienced a 35% dip in their overall census numbers in March and April. Compared with the 2019 March and April time frame, Providence hospital admissions locally were down 21%, and emergency department visits were down 27%.

“We are taking steps to ensure that we’re ready to restart surgeries and appointments that have been delayed due to the pandemic as soon as we have permission to do so. Safety is our top priority and we have protocols in place that help to keep patients safe including separating COVID-19 and non-COVID-19 patients, limiting visitation, universal masking policies and more,” a statement from Providence officials said. “While we wait for these surgeries and procedures to be rescheduled, we want to emphasize that our caregivers are here, virtually and in person, to address our patients’ medical needs. Our emergency departments and urgent cares are available and continuing to deliver high-quality care.”

Zborowski said the pandemic has taken a toll on hospital and health care system finances throughout the state. The Washington State Hospital Association estimates that March and April will amount to a $900 million loss to the system due to expenses for COVID-19 and canceled elective procedures and appointments. These losses are significant, especially in rural counties, and enabling health care systems to safely offer more care ideally will begin to ease some of that financial pain.

“It’s not a great financial situation right now but certainly not as dire as it was a few weeks ago when we had folks at risk for immediate closures,” Zborowski said.