April 7, 2020

The 'most significant challenges' for hospitals fighting Covid-19, according to HHS

Daily Briefing

    As the death toll from the new coronavirus in the United States topped 10,000 on Monday, a new survey from HHS' Office of Inspector General (OIG) sheds light on hospitals' "most significant challenges" in fighting the epidemic.

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    US Covid-19 death toll tops 10K, but data offers hope in some hard-hit states

    As of Tuesday morning, U.S. officials had reported 366,238 cases of Covid-19, the disease caused by the new coronavirus—up from 336,776 cases as of Monday morning.

    U.S. officials have said there are signs the Covid-19 outbreak is plateauing in some of the hardest-hit states thus far. The governors of Louisiana, New Jersey, and New York on Monday separately said recent data on Covid-19 cases, hospitalizations, and ICU admissions suggests the rates of new Covid-19 cases appear to be leveling off in the states. However, the governors said a potential plateau does not mean state residents should stop following social distancing and handwashing guidelines, because the number of newly reported cases in the states remains high. The governors stressed that continuing to follow the guidelines is key to flattening of the curve of new infections in the states.

    Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said there are "good signs" of Covid-19 cases beginning to level off in the hardest-hit states thus far, but he warned against "claiming victory prematurely." Still, Fauci said he is "optimistic—always cautiously optimistic—that if" Americans continue to follow social distancing guidelines, the number of newly confirmed cases of Covid-19 in the country will "go down."

    As of Tuesday morning, U.S. officials had reported 10,959 U.S. deaths linked to the virus—up from 9,655 deaths reported as of Monday morning.

    HHS survey finds hospitals are facing 'severe' shortages

    While the number of U.S. Covid-19 cases and deaths continues to rise across the country, a report released Friday by HHS' OIG highlighted the biggest issues hospitals are facing as they work to combat the epidemic.

    Ann Maxwell—HHS' assistant inspector general for evaluation and inspections, who oversaw the report—said the report is "the first objective, independent, national look at how hospitals are addressing the Covid-19 response."

    The report is based on a survey conducted between March 23 and March 27. HHS' OIG surveyed 323 hospitals—including special pathogen centers and critical access hospitals—across 46 states, the District of Columbia, and Puerto Rico. Among the respondents, 117 reported providing care to patients with confirmed cases of Covid-19 and 130 reported providing care to patients with suspected cases of Covid-19. Another 32 hospitals reported having no patients with confirmed or suspected cases of Covid-19, and 44 hospitals did not respond to questions about their caseloads.

    According to the report, the main challenges hospitals reported facing included "severe shortages" of testing kits for the new coronavirus, delays in test results, "widespread shortages" in personal protective equipment, and "difficulty" maintaining adequate staffing levels, which has taken an "emotional toll" on providers.

    HHS' OIG found that the shortages have led some hospitals to take drastic measures. For example, some hospitals reported turning to auto-body shops and nail salons for protective masks, and at least one hospital reported mixing ultrasound gel with alcohol from a nearby distillery to make hand sanitizer.

    Hospitals also reported problems with shipments of face masks they received from the federal government, with one hospital saying the masks in its shipment had expired 10 years ago and another saying many of the masks it received were dry-rotted. In addition, one hospital said face masks that it used to purchase for about 50 cents were now priced at $6. Hospitals also reported shortages of ventilators, "intravenous therapy poles, medical gas, linens, and food," as well as toilet paper, the report stated.

    According to Maxwell, hospitals said "they felt there could be more of a role for the federal government to help intervene and coordinate the supplies that they needed and the distribution of those supplies."

    HHS OIG' also found that hospitals reported receiving inconsistent government guidance related to Covid-19. The report stated, "Some hospitals reported that … multiple changes in guidance contributed to a greater sense of confusion, fear, and distrust among staff that they can rely on hospital procedures to protect them."

    Trump pushes back

    According to the Washington Post, the findings underscore recent reports from hospitals that they're still grappling with testing limitations, supply shortages, and strained capacity.

    Maxwell said the federal government has acted to address many of the issues raised in the report, but noted that when HHS' OIG "talked to hospitals [in late March], they were still reporting that this was a serious challenge."

    President Trump on Monday challenged the report's findings, calling them "wrong." For instance, he said, "We are doing a better job [at testing] than anybody else in the world."

    HHS Assistant Secretary for Health Brett Giroir noted that the report is based on data from a few weeks ago, when the United States was ramping up its testing capacity and hospitals might have been experiencing more severe shortages than they are currently (Calfas et al., Wall Street Journal, 4/6; Layne/Szekely, Reuters, 4/6; Culver, USA Today, 4/7; Simmons-Duffin, "Shots," NPR, 4/6; Goldstein, Washington Post, 4/6; Strickler, NBC News, 4/6; Sullivan, The Hill, 4/6; Ehley/Ollstein, Politico, 4/6; New York Times, 4/7).

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