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It's no surprise that William Prentice, CEO of the Ambulatory Surgery Center Association (ASCA), believes it's appropriate to keep ambulatory sur- gery centers open — even as COVID-19 cases are spiking in some states. However, he has data to back up his claim. He references a survey conducted by the ASC Quality Collaboration, which found that only 16 patients out of more than 84,000 who recently underwent surgery at 709 surgery centers reported being COVID-19 positive within 14 days of surgery. All patients were asymptomatic before and during their procedures, and none of the cases have been definitively linked to the episode of care provided at an ASC, according to Mr. Prentice. "The assumption at the beginning of this pan- demic was that everything had to be shut down, because nobody knew how safe it would be to per- form elective surgeries," says Mr. Prentice. "We can now show that we have the ability to keep people safe with the data from cases performed over the last four months at more than 700 facilities. Testing, screening, social distancing, masking and enhanced infection control measures such as increased termi- nal cleaning have worked." Cause for concern? When the number of positive COVID-19 cases started to decrease in May, healthcare workers around the nation breathed a collective sigh of relief. Hospitals and surgery centers cautiously began to reschedule surgeries that were paused when the pandemic hit and dig themselves out of financial distress. After months of sheltering in place, Americans felt it was finally safe to venture out to restaurants, bars and beaches. Within weeks, the virus reared its ugly head again, this time with even more vengeance in certain states, including Florida, California, Texas and Arizona. There were at least 148,692 cases of the coronavirus reported in Arizona as of July 20, according to the New York Times database. However, the number of positive cases was beginning to trend downward after peaking on July 6. Banner Health System, Arizona's largest health- care provider, operates a dozen outpatient surgery centers throughout the state. As of late July, the health system has proceeded with elective surgeries. However, Marjorie Bessel, MD, the system's chief clinical officer, says they are currently balancing the need to perform elective surgeries with the need to maintain bed capacities for COVID-19 patients and adequate PPE supplies. "We are postponing non- emergent procedures that require more than a four- hour stay in the post-anesthesia care unit and are likely to result in a hospitalization," she says. Dr. Bessel believes the risk of delaying elective surgeries is greater than performing them at this time. "It is safe, appropriate and important to con- tinue performing medically necessary elective sur- geries that, if delayed, could result in an emergency with far worse outcomes," she states. Banner Health currently has an adequate supply of PPE, which is monitored on a daily basis. The system is also prioritizing its staff's health and safe- ty by testing each patient before their procedures. When patients arrive for elective surgeries, they undergo a RT-PCR test and antibody testing. Ultimately, Dr. Bessel says Arizona will see more negative COVID-19 test results and elective cases will be allowed to proceed if the community does its part to flatten the curve. "We must all continue to frequently wash our hands, wear masks, social distance and stay home," she says. "All of these fac- tors help to reduce the spread of COVID-19 and will allow us to continue to provide necessary sur- gical care." When COVID-19 cases began spiking in Florida shortly after Memorial Day, facility leaders in the 2 2 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 2 0 "There are no good medical reasons to cancel elective procedures." — Richard Berger, MD