As nearly six months have now passed since the World Health Organization (WHO) declared a global pandemic, it is starting to become possible to study the effects of health policies that were put into place as a result of Covid-19. A recent study by Wang and colleagues in the Canadian Medical Association Journal (CMAJ) quantified the surgical backlog in Ontario, a province of Canada, as well as the estimated time required to clear the backlog.
Ontario, like much of the world, began ramping down elective surgical procedures mid-March and gradually began ramping them back up near the end of May. According to Wang and colleagues, in April, there were 42% fewer cardiac surgeries and 73% fewer vascular surgeries compared to April 2019. The study reported an incremental backlog of 148,364 surgeries province-wide (referring to total surgeries, including cardiovascular and any other type of surgery). Furthermore, the study reported that, for all surgeries, it will take the province approximately 84 weeks to clear the total backlog, while it will take approximately 14 weeks to clear the backlog of time-sensitive surgeries. This assumes a certain level of hospital resources, as well as complete prioritisation of time-sensitive surgeries.
A subset of cardiovascular procedures would fall into the category of ‘time-sensitive’, including (but not limited to) percutaneous coronary intervention (PCI) in acute myocardial infarction cases, valve replacement or repair in patients with severe, symptomatic valve disease, electrophysiology ablation in patients with certain conditions such as drug-refractory ventricular tachycardia, and more. Given the relatively short window of 14 weeks predicted for the surgical backlog to be cleared for these types of procedures, it could potentially be expected that device markets, operating in these areas, would make a full recovery to pre-pandemic revenue levels by the end of 2020, assuming the backlog clearance process starts now. This includes devices such as coronary stents, prosthetic heart valves, electrophysiology ablation catheters, and others.
However, given that these same devices are also used to treat patients in less urgent conditions, it is likely that these device markets will not actually see a full recovery until the backlog is completely cleared: that is, the predicted 84 weeks in Ontario. According to this timeline, it would be early 2022 before there was a complete return to normalcy. Markets for devices that are more often used to treat critical patients will see a faster recovery in this scenario, while markets for devices that are more often used for less urgent conditions will see a slower recovery.
As more reports of this type are released, we will get a better and better idea of the global surgical backlog and continue to have a clearer picture of the timelines for market recovery for devices associated with those surgeries.