Your top questions about COVID-19, answered

1. This week has seen a 'dramatic, exponential' surge of COVID-19
   
   As predicted by epidemiologists and consistent with the experience of other countries, the past week has seen a dramatic, exponential rise in the number of COVID-19 cases in the United States, with 60,000 cases confirmed as of March 25, and at least 800 deaths. Troublingly, the rate of deaths from COVID-19 has not yet slowed down in the United States. In the United States the cumulative number of deaths from COVID-19 is currently doubling every three days, compared with every week in South Korea.
   
   
2. New York City is the new epicenter of the pandemic
   
   New York City remains the area of greatest incidence, and approximately half of all confirmed COVID-19 cases in the United States are in New York State. New York City's challenges in being one of the first municipalities hit by the virus have been compounded by population density and an already-high level of bed occupancy prior to the outbreak.
   
   
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3. The economic damage is piling up (and leading to huge pushback)
   
   The second major development in the United States over the past week has been the shift in narrative from containing the spread of the virus to limiting the economic damage caused by it. It is now possible that many of the measures taken to date (school and business closures, adoption of widespread social distancing), may be lifted within the next few weeks, even in advance of clear evidence that the spread of disease has been controlled to a manageable level. Such action will be especially concerning if widespread testing is not yet available. Provider organizations need to be prepared for a world in which transmission of the virus remains at high rates.
   
   
4. The pandemic is on track to overwhelm the US' inpatient and ICU capacity
   
   While the United States has the greatest number of critical care beds per-capita in the world, the current rates of increase in incidence of the disease are still projected to overwhelm hospital inpatient and ICU capacity across the next six weeks. While the timing and magnitude of the surge will vary by location, all acute care facilities should be prepared to increase their effective capacity, especially in their critical care units. In addition to beds, provider organizations need to have plans for accessing ventilators, personal protective equipment (PPE), and essential medications. Lastly, and perhaps most importantly, all provider organizations need to have emergency plans for staffing, both to handle the anticipated surge of demand and to account for the likelihood that some percentage of clinical staff will themselves contract the virus.
   
   
5. It's unclear if social distancing will be enough
   
   Countries around the world have enacted a range of strategies to "flatten the curve" and slow the spread of the virus. While China and South Korea have been successful in these efforts, to date the United States has been unwilling to adopt China's extreme lockdown measures and unable to deploy South Korea’s model of widespread testing. Instead, the United States has relied on voluntary adoption of social distancing, with other measures varying by state. Rates of adoption of various social distancing practices have increased significantly across the United States in the past two weeks, but it remains to be seen whether this will be sufficient, especially in a world where these restrictions may be eased in the near future.
   
   
6. The US takes two big steps
   
   Although slow to act compared to other countries, the federal government has initiated two major steps in addressing the pandemic. The Trump administration's declaration of a national emergency on March 13 included waivers allowing providers increased flexibility in the use of beds, facilities, labor, and care models. The CARES Act, passed by the Senate on March 25, increases funding for COVID-19 care and attempted to reduce roadblocks in the deployment of tests, supplies, and potential therapies.
   
   
7. States are adopting a variety of responses
   
   Individual states are enacting their own policies to respond to the pandemic. These range from more extreme restrictions on trade, commerce, and mobility to more aggressive approaches to increasing the supply of labor and equipment. New York State has implemented a number of measures intended to dramatically increase the clinical labor supply.
   
   
8. The US needs aggressive plans for supply and testing
   
   Although a number of public and private efforts are underway to increase the supply of ventilators and PPE, these will likely not have a significant impact in the immediate term (i.e. the next month). Likewise, a number of organizations are moving quickly to develop rapid point-of-care testing solutions. Widespread testing, already necessary, will be absolutely essential if social distancing efforts are relaxed. Provider organizations will need to have aggressive plans for sourcing, repurposing, and—where possible—reusing essential equipment and supplies. The supply of PPE is particularly important, as a shortage of PPE will likely restrict the deployment of broad-based testing even if more testing supplies and methodologies become available.
   
   
9. Providers need to combat medical misinformation
   
   One of the most concerning consequences of the COVID-19 outbreak has been the increase in use of medicines that are not yet proven to be clinically effective. Misinformation around the use and efficacy of drugs like chloroquine, hydroxychloroquine, and remdesivir has led to unintended (potentially contraindicated) usage as well as supply shortages. Provider organizations should be taking steps now to secure supplies and combat misinformation in the public domain.
   
   
10. What are the financial implications for health systems?
    
    While it is not yet the paramount concern of most health systems, early modeling suggests that the financial impact of COVID-19 could be significant, due to the direct costs of care and the anticipated loss of revenue from deferred or cancelled procedures. Longer-term impacts to health system financial performance include a likely shift in payer mix with anticipated job loss in the commercial sector, as well as deteriorating performance of the investment portfolio in a bear market.

Your top resources for COVID-19 readiness

You're no doubt being inundated with a ton of information on how to prepare for possible patients with the 2019 coronavirus (COVID-19). To help you ensure the safety of your staff and patients, we pulled together the available resources on how to safely manage and prevent the spread of COVID-19.

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