Hospitals are struggling to find enough doctors, nurses and other health care workers to care for mounting numbers of critically ill coronavirus patients.
The staffing problems are on top of the equipment problems — the lack of ICU beds, ventilators, and masks and other protective equipment needed to prevent the healers from becoming patients.
Hospitals are taking extraordinary measures to bulk up the workforce, from calling on retirees for help to assigning medical students to answer the phones.
The Trump administration on Wednesday announced new rules that would let doctors practice across state lines, without going through layers of recertification and licensing. And CMS is releasing recommendations on limiting non-essential elective procedures, which will also free up personnel and resources — although hospitals, which rely on some revenue-producing elective procedures, raised alarms over the weekend over how to define “elective care.”
“They will not only preserve equipment, but it also allows doctors and nurses to help those that are on the front lines,” said CMS Administrator Seema Verma at a White House press briefing Wednesday.
The VA is also preparing to help bolster the civilian health care system.
But the numbers of physicians is finite — and older ones, as well as those with their own health conditions, are at risk from Covid-19. The problem is compounded by the infectious nature of the disease, which is exposing dozens of frontline workers who need to self quarantine if they have the virus. Some have already fallen ill.
“Dozens of frontline caregivers in the United States have been exposed,” wrote two Harvard University medical students Adam Beckman and Suhas Gondi and Yale University health policy expert Howard Forman on the Health Affairs blog Wednesday. “This trend will accelerate in the coming weeks and months, as health care workers increasingly come into contact with patients with Covid-19 and shortages of masks and other personal protective equipment (PPE) worsen.”
Hospitals will have to figure out how to steer any surging workforce, who should concentrate on coronavirus patients and who should take care of people who still come in with other serious diseases and injuries. And some community physicians, who may not have been in an ICU since their training but want to lend a hand, say they haven’t gotten a lot of guidance.
Hospitals are taking a sweeping look at how they can boost their staff — and already retired doctors have offered step up if they can easily renew their licenses and admitting privileges.
“It’s all hands on deck — especially well-educated clinical hands,” said Nancy Foster, the American Hospital Association’s vice president for quality and patient safety policy. She said some hospitals have reached out to medical and nursing schools asking who can “offer extra hands.”
Widespread school closures have also created problems for medical workers — as well as other hospital personnel including food service and the crews who more than ever who have to clean and disinfect — with kids now at home with no one else to take care of them. Some facilities are creating on-site child care facilities and also subsidizing these services, as the AHA and America’s Essential Hospitals call on more dollars from Congress to help.
“As they start closing schools down … it creates downward pressure on the availability of staff,” said Alan Levine, CEO of Ballad Health, which has more than 20 hospitals serving rural Tennessee and Virginia. “We lose some of our nurses and health care manpower.”
The Association of American Medical Colleges called on med schools to bar students from their clinical work with patients for two weeks — and some students are instead performing telehealth screenings or babysitting the children of doctors and nurses, so they can go to work.
Meanwhile, New York Gov. Andrew Cuomo is asking medical, nursing and public health schools for detailed information on how many students and staff could pitch in, and what their specialties are.
At Zuckerberg San Francisco General Hospital, staffing is the primary concern. They have two coronavirus teams of six staff each — and contingency plans for freeing up more staff, while also working with the other hospitals in the city on how to manage an influx of patients.
Some doctors say they are ready to help — even if they aren’t pulmonologists or ICU doctors, they can still care for patients, freeing up colleagues to concentrate on the pandemic. But it’s not at all clear that hospitals have figured out how exactly to pull these levers.
The American Nurses Association suggested that nurses with inactive licenses, school nurses and senior nursing students can take on roles like helping out at drive-thru testing sites or long-term care facilities.
Rural areas haven’t been hit as hard yet as their urban counterparts in places like New York, the Seattle area, and parts of California. But they already are seeing boosts in patients and workforce shortages. Their hospitals are already very lean, and a lot of the physicians are older, meaning they have their own coronavirus risks. And 48 percent of rural hospitals operate on a loss, according to the National Rural Health Association, making any surge in patients particularly difficult.
“In a small rural hospital, each employee wears several different hats, and if you lose just one of those, it’s like you’re losing a couple different employees, and soon the facility will be unable to function,” said Maggie Elehwany, the association’s government affairs and policy vice president.
For instance: In Indiana, one rural health member relayed to the national association thattwo staff members are quarantined, while the hospital is running low on money. They have four EMS personnel on staff, and are unsure how they would make up for the staffing loss if those front line workers have to self isolate.
But worries over the fast-moving coronavirus don’t stop at staffing shortages.
“We’re actually rather desperate for help right now,” said Cassie Sauer, president and CEO of the Washington State Hospital Association, where one of the most severe outbreaks is taking place. “We’re asking the navy to send a Navy Ship up here from San Diego — a medical ship — we’re asking for field hospitals, we’re asking for the National Guard, we’re asking for a release of the national strategic stockpile for PPE.” President Donald Trump did deploy two hospital ships on Wednesday though not necessarily to Seattle.
Shortages of personal protective equipment, bed capacity and key lifesaving equipment are mounting as more and more confirmed coronavirus cases crop up around the country.
Washington State Hospital Association is calling on other industries, such as dentists, veterinarians and even automakers, to share their supplies of personal protective equipment.
Levine said Ballad Health ordered more ventilators, but estimates they will take eight to 10 weeks to arrive. “Italy bought them up,” he said. He’s considering reopening one shuttered hospital as a Covid-19 hub — but will have to staff it.
The Ohio Hospital Association is talking to local nursing homes about using an empty wing or a building to treat non-coronavirus patients safely, freeing up hospital rooms for Covid-19 patients. They may even turn to floors of hotels for the less seriously ill patients.
University of California San Francisco has converted a floor of its largest facility, which has 600 beds, to an environment that can house coronavirus patients. The hospital has about two weeks of personal masks, gowns and gloves on hand, and is treating about 40 per day – and testing about 100 more.
Trump on Wednesday invoked the Defense Production Act, which puts the economy on a wartime footing against the virus. The VA is also preparing to share both medical personnel and equipment to shore up a civilian health care system about to face unprecedented demands.
But there’s still uncertainty for how much further the health care system will be pushed — and if it’ll reach a breaking point.
“I think there’s a lot we don’t know and I know that there are folks out there modeling scenarios,” Beth Feldpush, the senior vice president of policy and advocacy at America’s Essential Hospitals.