US hospitals are being stretched to the limit as they struggle to respond to the coronavirus outbreak, suffering from a lack of government co-ordination on supplies, staffing and funding.
A new report from the US health and human services department’s inspector-general painted a chaotic picture of hospitals bidding against each other for essential personal protective equipment (PPE) and facing price gouging. Some warned that their cash piles could run out in weeks.
The survey of 323 hospitals across 46 states included testimony from administrators worried about shortages of everything from thermometers to toilet paper, adapting anaesthesia machines to act as ventilators and creating face shields from office supplies.
“Hospitals reported that their most significant challenges centred on testing and caring for patients with known or suspected Covid-19 and keeping staff safe,” the report said. It added that the situation might have changed since the survey was completed between March 23 and 27.
In the Balkanised US healthcare system, where many hospitals are operated privately, often by non-profit institutions, the providers called on the federal government to do more to help co-ordinate the chaos.
They wanted help with testing, including securing more ingredients for the tests; obtaining supplies of PPE; and relaxing licensing rules so they could be more flexible with how they used their medical staff.
Hospitals also pointed to confusing or contradictory messages from local, state and federal authorities on subjects such as who should be tested and what PPE to use, and called on the federal government to take the lead in co-ordinating communication.
For instance, one hospital administrator said that the state and federal authorities had given conflicting guidance on what kind of masks that staff treating coronavirus patients should wear.
““[The inconsistency] makes everyone nervous. It would have been better if there was co-ordination and consistency in guidance among the different levels of government”, the administrator said.
Some smaller hospitals, which were already under financial pressure, were also concerned the outbreak could lead them to cease operations — and some had already laid off staff, the report revealed. The cancellation of elective procedures had significantly cut revenue for hospitals, while treating or preparing to treat Covid-19 patients had increased costs.
The US government’s stimulus package included $100bn for hospitals but few knew when it would reach them or how it would be distributed. Hospitals were asking for faster and higher payments from the government-backed Medicare insurance for seniors and loans and grants.
One administrator said it had been, “an absolute financial nightmare for hospitals”.
Shortages of key equipment were hampering patient care and staff safety. Hospitals said they had seen “sharp increases” in the prices of PPE from some sellers, including one reporting that a mask that used to cost 50 cents was now $6.
“We are all competing for the same items and there are only so many people on the other end of the supply chain,” one hospital administrator noted. Another said everyone was “trying to pull [PPE] from the same small bucket”.
Many were worried about the quality of the masks being sent from federal and state stockpiles, with some reporting masks with dry rot, or masks that expired 10 years ago. Others were turning to unconventional sources for supplies — including beauty salons and car repair garages — but were concerned about the quality of masks from private suppliers.
As well as PPE, hospitals were short of many ordinary supplies, including cleaning fluids and food. Many were resorting to DIY-approaches, including creating their own disinfectants, 3D-printing their own protective masks, and adapting ventilators and anaesthesia machines to serve many more patients each.
The US — like the UK — has been struggling with testing enough patients. Hospitals reported it was taking up to seven days for a test result to be returned, during which time patients often took up valuable bed space, and staff might be quarantined even if they did not have the virus.
Without staff, no amount of extra beds and equipment would help patients, the hospitals warned. One administrator said: “You can build thousands of ventilators, but you need an army to manage that equipment and care for those patients.”
Another reported from the front lines: “Healthcare workers feel like they’re at war right now . . . seeing people in their thirties, forties, fifties dying . . . This takes a large emotional toll.”