- Covid-19's 'exponential growth' continues
The exponential growth of COVID-19 in the United States continues, from 60,000 cases one week ago to almost 200,000 confirmed cases as of April 1. In addition to the tremendous burden in human suffering, the rapid increase in case load is overwhelming the capacity of the U.S. health system in many markets and causing economic turmoil.
- Domestic death rate continues to climb
In what remains a very troubling trend beyond the raw numbers of cases, the domestic death rate from COVID-19 continues to climb, with the U.S. picture now looking very similar to Spain, Italy, and the United Kingdom. The most conservative current projections forecast at least 100,000 deaths in the United States in the weeks ahead, under the assumption of continued aggressive compliance with social distancing measures. Absent continued aggressive compliance with social distancing measures, some models forecast close to half a million deaths.
- Following New York, states hurtle toward peak demand
New York remains the epicenter for the disease's impact, but other locations are rapidly approaching peak forecasted demand. In areas that have not yet been overwhelmed by the virus, health systems must take action now to prepare. Lessons from health systems hit early by the disease underscore the need to anticipate shortages of beds, staff, testing supplies, ventilators, and personal protective equipment (PPE).
- Hospitals need contingency plans for looming ICU bed shortage
The most obvious and immediate issue in many markets is a significant projected shortage of ICU beds. With continued loosening of regulations, health systems are advised to develop contingency plans for radically increasing their critical care capacity: offloading non-COVID patients to lower acuity sites of care, repurposing as many beds as possible into ICU beds, and exploring new locations for treatment. Early adopters have implemented a diverse range of strategies to take advantage of every available location.
- Amid PPE shortages and test backlog, hospitals have to get creative
Shortages of equipment and supplies remain acute, particularly for ventilators and PPE. Existing vendors are expanding production capacity, and new vendors are entering the market to help address the shortage—but in the interim, health systems will need to explore very creative methods to reuse and replace PPE. Testing is finally ramping up around the country, although highly variable by state, and the increase in test volumes has exposed a bottleneck in lab processing. Some reports have suggested tens of thousands of test samples are backlogged and waiting to be processed.
- States poised to face a shortage of critical care physicians
In addition to beds and equipment, health systems should anticipate a significant shortage of clinical staff. For example, virtually every state is forecasted to have a shortage of critical care physicians. Efforts to expand supply by loosening restrictions on the practice of critical care medicine may help address the problem, but the hardest-hit areas can expect to see shortages across the spectrum of clinical staff. And while some states are implementing creative measures to meet demand—such as New York State's recent executive order opening the doors for many new sources of labor supply, with more than 70,000 clinical professionals answering the call for help—such heroic examples are not likely to be easily replicated elsewhere.
- Social distancing is paying off—but it's too early to tell if it's enough
While the nation's hospitals struggle to prepare for the coming onslaught of cases, there is evidence that an early and aggressive commitment to social distancing is paying off. California and Washington state have been able to significantly "flatten the curves." However, other states delayed in enacting their measures—data from Michigan suggests even a week's delay is significant—and still other states have yet to take drastic action at all. Further, it currently appears unlikely that the government will consider more extreme measures, such as contact tracing. All told, it is too early to tell if the United States as a whole has taken the necessary steps to control the epidemic.
- 'Stark' economic effects
What is clear, however, is that the economic impact is stark and getting worse. Initial concerns about financial market selloffs have been augmented the past two weeks by record numbers of job losses (6.6 million claims last week, up from 3.3 million the week before). The U.S. GDP is expected to drop dramatically in the second quarter, with estimates ranging from a 12-24% reduction.
- The CARES Act aims to support providers
The CARES Act, a $2 trillion stimulus package, aims to provide some direct support to health care providers. In addition to funding, the act provides for significant regulatory relief, although many of the details are left to be worked out by HHS. Among the most promising provisions are significant efforts to increase access to telehealth, funding to compensate for both increased Covid-19 expenses and lost revenue, and incentives for increased production of supplies and potential therapies.(A comprehensive analysis of the CARES Act can be found here.)
- Health systems taking 'radical measures' to field the impact
Health system finances are already feeling the cumulative effects of the costs of Covid-19 care, coupled with dramatic reductions in traditional sources of inpatient and outpatient revenue across service lines. For most hospitals and health systems, the revenue shortfalls from the cancellation of elective procedures are likely to outweigh Covid-19 revenue, except in markets with patient surges at the top end of most estimates (and even for them, margins will be razor thin, if not negative).
Faced with an immediate cash-flow problem, systems around the country are considering, and in some cases implementing, radical measures such as furloughing staff or cutting compensation and benefits. Health systems are advised to develop contingency plans for three "waves" of impact: immediate cash flow needs, due to foregone revenue from elective procedures; margin management across the balance of 2020, due to deteriorating case mix and the expenses associated with building surge capacity of beds, labor, and equipment; and longer-term competitive repositioning to capture growth once the crisis subsides.
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.