Dan Cunningham’s right hip has been worsening for months, and he doesn’t know yet when he will be able to have the hip replacement surgery that was postponed in March when the coronavirus pandemic hit Maine.

But the Brunswick resident might be able to reschedule his surgery soon, as health services unrelated to the pandemic start to return Friday in the first phase of Gov. Janet Mills’ reopening plan. That means delayed services such as elective surgeries, colonoscopies, mammograms, physicals, cataract surgeries, cancer biopsies, rehabilitation and others will resume.

The pent-up demand will be enormous. For example, Maine doctors perform more than 4,000 hip and knee replacement surgeries per year just for Medicare patients age 65 or older, according to federal data.

The reopening will be gradual, state and hospital officials have cautioned, so patients should not expect that everything will be up and running immediately. Priorities will be given to patients with the most acute needs.

“We need to first take care of people who have more urgent needs that affect their day-to-day health,” said Dr. James Jarvis, medical specialist for Northern Light Health’s incident command. Northern Light is the parent company of Northern Light Eastern Maine Medical Center in Bangor and Northern Light Mercy Hospital in Portland, as well as other hospitals in Maine. “There won’t be an announcement we are just doing (certain health services) today and anybody who needs them can come in today.”

For instance, some joint replacements, among the most common elective surgeries across the country and in Maine, could still be postponed. Age and health of patient, how much pain the patient is in, and how well the patient can move will be considered.

Cunningham, 68, of Brunswick, said he will be calling his MaineHealth doctor’s office on Friday, but his case could fall into a gray area. Cunningham said his condition has deteriorated over the past month to where he now has to use a cane to move around. He also wakes up frequently during the night because of pain. He will find out soon whether his case is severe enough, compared to other patients, to put him at the front of the line.

“It’s frustrating, but I don’t blame anyone. Everyone is sacrificing, and I’m willing to do my part,” said Cunningham, a retired finance director who has hiked all the 4,000-foot mountains in New England.

Dr. Herb Cushing, chief medical officer at South Portland’s Spectrum Healthcare Partners, which does many joint replacement surgeries in southern Maine, said resuming surgeries won’t be like flipping a switch. Some patients are almost bedridden, and in elderly people such reduced movement could cause death, so those patients will be rushed to the front of the line, Cushing said.

“What was maybe an elective surgery in February probably isn’t anymore,” Cushing said.

John Porter, spokesman for MaineHealth, parent company of Maine Medical Center in Portland and eight other Maine hospitals, said the system “expects to resume operations in a phased approach.”

“In the coming days, MaineHealth will evaluate which doctor visits, procedures and surgeries are most urgent and can safely be undertaken even as we maintain readiness in the event of a surge in new COVID-19 patients,” Porter said in a statement.

Hospitals and health care systems across Maine postponed nonessential health care services starting in March to save capacity for a surge in COVID-19 cases. Now that cases have flattened, and current hospitalizations have declined from 87 on April 7 to 32 on Wednesday, health care services can start to re-open.

In Maine, because COVID-19 hasn’t spiked to a crisis point and now appears to be on a slow downward slope, hospitals have the capacity to care for COVID-19 patients and can start returning to doing other services. Other restrictions will remain, though, such as strict limits on visitation and keeping COVID-19 patients separated from other patients.

Steven Michaud, president of the Maine Hospital Association, said patients will benefit from the gradual reopening. But for hospitals, especially rural, independent facilities, it will be a needed financial lifeline.

Two hospitals, Calais Regional Hospital and Penobscot Valley Hospital in Maine, are now in bankruptcy. Several hospitals in Maine – including Central Maine Healthcare in Lewiston and St. Joseph Hospital in Bangor – have announced furloughs or layoffs as many services were sidelined and revenue fell. Michaud said hospital rescue packages approved by Congress totaling $175 billion nationally helped but were not sufficient.

“It was nowhere near enough,” Michaud said “The only answer is to get up and running.”

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