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US hospitals don’t have what they need to fight off COVID-19

A report from the HHS oversight office shows how unprepared the health system is

US-HEALTH-VIRUS Photo by BRYAN R. SMITH/AFP via Getty Images

Hospitals in Cincinnati are furloughing and cutting hours for nurses and other health care workers. Nurses at a New York City hospital struggled to get tested for COVID-19. A Minnesota health center considered closing because it didn’t have enough face masks.

A new report from the Office of Inspector General (OIG) at the Department of Health and Human Services, which is tasked with overseeing the agency, makes it clear that those reports aren’t just anecdotes, but consistent problems faced by hospitals all over the country as they struggle to respond to the COVID-19 pandemic.

The OIG interviewed administrators at 323 hospitals around the country between March 23rd and March 27th, and found that they faced severe shortages of testing supplies, ventilators, and protective equipment. They struggled to keep up with federal and state guidance and, despite projected and active surges in COVID-19 patients, have seen revenue decline.

Many of the challenges cascaded from the limited number of tests available for patients. The US struggled to scale up testing for the novel coronavirus, and it’s still hard for people who feel sick to access tests. Even health care workers, who interact closely with sick patients, are finding it difficult to get tested to see if they can keep working or need to isolate. Hospitals told the OIG that they don’t have the supplies they need to conduct tests, and that it can take days for test results to come back.

Doctors and nurses treat patients who are still waiting for test results as if they have the virus and use personal protective equipment (PPE) when interacting with them. The longer it takes for a test result to come back, the more PPE they have to use. “The testing turnaround presents a challenge, especially for our ‘rule-out’ patients … we have to use a lot of PPE on those rule-outs. And especially when it’s a negative, we basically used all that PPE for nothing,” one administrator said.

In addition, without negative tests, some hospitals couldn’t discharge patients to long-term care centers or other facilities where they could get less-specialized, but still necessary, care. Patients had to stay in the hospital longer, filling beds unnecessarily.

It takes an equally long time to get test results back for nurses and doctors, hospitals said — and every day those providers waited was a day they weren’t able to provide care for patients.

Inconsistent and sometimes conflicting advice from federal, state, and local authorities — around when to test patients, for example, and what types of PPE doctors and nurses should use — make decision-making difficult. “It’s difficult when a doctor or nurse shows you legitimate information from legitimate sources and they’re contradictory,” one administrator told the OIG.

Hospitals around the country are canceling elective procedures in order to free up beds and space for COVID-19 patients. Those procedures are major sources of revenue for these facilities, and in the US, hospitals operate on thin margins. At the same time, costs for things like PPE are up. So at a time when they’re critically important, many hospitals said that they were in a precarious financial position. That’s reflected in layoffs and furloughs of health care workers around the country.

To keep up with the pace of the pandemic, hospital administrators said they needed the federal government to help provide supplies and equipment for testing and to help funnel PPE to facilities that need it. Medical supplies from the Strategic National Stockpile are supposed to be a backstop for states — but most hospitals said they hadn’t received enough equipment from the stockpile, or that when they did, it wasn’t what they’d asked for. Some federally provided PPE was expired, rotted, or didn’t meet standards, they said.

Rather than helping secure PPE for health care facilities, the federal government has spent the last few weeks outbidding states for supplies or seizing their orders.

Hospitals also asked that the federal government provide financial assistance, relax rules around where health care workers can practice medicine, and help offer treatment in nontraditional settings.

They also wanted the government to provide consistent information to help them navigate the crisis. So far, the federal response has been characterized by inconsistent, sometimes misleading, and unpredictably changing information on testing and masks, as well as in other areas.

The US health care system — which has too few doctors and too few beds per capita, is inefficient, and too expensive — is ill equipped to deal with a pandemic of this magnitude. Experts have stressed for years that America wasn’t ready for the next great medical disaster. And now, with surges of COVID-19 patients arriving at their doors each day, hospitals are struggling under the weight of those problems.