Major League Baseball, like many sports leagues around the world, has been shut down indefinitely because of the growing threat that is the novel coronavirus (COVID-19). Spring training has been suspended and Opening Day has been pushed back to at least mid-May, and that remains subject to change as the situation develops.

Several states and counties have banned elective surgeries on a temporary basis to lessen the burden on our health care system during the pandemic. As a result, famed surgeon Dr. James Andrews announced his facility, the Andrews Institute for Orthopaedics & Sports Medicine in Pensacola, Florida, has temporarily stopped performing Tommy John surgeries.

Alex Speier of the Boston Globe passes on the news:

"We are not performing any non-urgent or non-emergent procedures, including Tommy John surgery, in compliance with the governor's executive order," the spokesperson wrote. "We are adhering to these restrictions and all such cases are suspended at this time."

On March 20, Florida governor Ron DeSantis issued an executive order banning "any medically unnecessary, non-urgent or non-emergency procedure or surgery which, if delayed, does not place a patient's immediate health, safety or wellbeing at risk, or will, if delayed, not contribute to the worsening of a serious or life-threatening medical condition."

Tommy John surgery is still being performed at other facilities, however. Red Sox lefty Chris Sale had his elbow rebuilt Monday by Dr. Neal ElAttrache at the Kerlan-Jobe Institute in Los Angeles. Los Angeles County has issued a recommendation against elective surgeries but has not yet banned them outright.

Red Sox chief baseball officer Chaim Bloom told reporters, including MassLive.com's Chris Cotillo, the club received assurances Sale's surgery would not interfere with the fight against COVID-19. From Cotillo:

"It was important to all of us to do this in a way that would not place any undue burden on anyone suffering due to coronavirus," said Red Sox chief baseball officer Chaim Bloom. "I spoke to Dr. ElAttrache personally to make sure that was the case here and he is just as mindful of the considerations that go along with surgery at a time like this. We are obviously appreciative that he was able to the procedure but also that he took the time to discuss those considerations with us." ... "We know this is not life and death and that there are people who are suffering in situations that are life and death," Bloom said. "That's why it's important to us to make sure that we weren't putting any burden on the health system that would be a negative for people who are battling the coronavirus or any other ailment. It certainly is something we all know is necessary for his livelihood but we're aware it's apples and oranges when you talk about this versus something that is life-threatening."

Mets righty Noah Syndergaard had his Tommy John surgery on March 26. It was performed by Dr. David Altchek, the team's medical director, at the Hospital for Special Surgery in West Palm Beach after Florida issued its ban on elective surgeries. The doctor determines what is an elective surgery, however, and Dr. Altchek declared Syndergaard's procedure essential.

In an interview with Henry Schulman of the San Francisco Chronicle, Dr. ElAttrache defended performing Tommy John surgery during the pandemic, saying it is essential to the player's career and livelihood. Here's what Dr. ElAttrache told Schulman:

"I know that I'm going to get criticized for taking care of these kinds of guys, but it's essential to their livelihoods," ElAttrache said. "If you have somebody's career at stake and they lose two seasons instead of one, I would say that is not a nonessential or unimportant elective procedure." ... "We're trying to select players so we don't overtax the system," ElAttrache said. "We have to have some criteria. We don't want it to be arbitrary. We want the public to trust what we're doing. If we didn't have some criteria for selecting patients, we easily could be accused of bias for non-medical reasons and lose the public trust."

Dr. ElAttrache told Schulman the Kerlan-Jobe Institute is performing approximately 90 percent fewer Tommy John surgeries during the pandemic and all potential surgeries must be approved by an internal panel, with the most time-sensitive procedures given the most consideration.

Sale is in the first year of a five-year, $145 million contract signed last spring. He could have delayed his surgery a few weeks and not been hurt financially, though it would have made him less likely to pitch next season. Syndergaard, meanwhile, is on a one-year contract worth $9.7 million. He will not be eligible for free agency until after 2021. His huge payday hasn't arrived yet.

Tommy John surgery typically peaks in spring training as players increase their throwing following the offseason. Fourteen players had Tommy John surgery in February and March this year, including big names like Sale, Syndergaard, and Luis Severino. Last year 11 players had Tommy John surgery in February and March, and the year before it was 22.