Is U.S. health system ready for increase in COVID-19 cases?

Bara Vaida

About Bara Vaida

Bara Vaida (@barav) is AHCJ's core topic leader on infectious diseases. An independent journalist, she has written extensively about health policy and infectious diseases. Her work has appeared in outlets that include the National Journal, Agence France-Presse, Bloomberg News, McClatchy News Service, MSNBC, NPR, Politico and The Washington Post.

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Photo: Defence Images via Flickr

As expectations grow that many more cases of COVID-19 coronavirus may be identified in the U.S. in the coming weeks, public health officials have headlined media and congressional briefings to discuss the readiness of the nation’s health system’s to respond to a surge in affected hospital patients.

In general, there is agreement that while the U.S health system is better prepared than 20 years ago, it cannot handle a sudden surge in sick patients, largely because of insufficient staff, clinical space, medical equipment and treatments.

“We don’t have the surge capacity to manage that in our health care system,” Julie Gerberding, former Centers for Disease Control and Prevention director, told the U.S. Senate Committee on Homeland Security & Governmental Affairs on Feb. 12.

In New York City, for example, hospitals already are stretched thin because it is flu season, Dr. Syra Madad, senior director of system-wide special pathogens at New York City Health and Hospitals, told an audience at the Center for Global Development in Washington, DC on Feb 13.

“If you put on top of that potential [coronavirus] cases, that would tax any health system in New York City, or any health system, so it is important to prepare,” Madad said.

N.Y. hospitals, for example, are working on understanding their inventory of medical supplies, but fears about the coronavirus, plus manufacturing disruptions in China, have meant that the city’s hospitals may not have enough equipment and medicine to handle a surge, she said. “We are still looking for guidance on surge strategies” from state and federal public health officials.

The health system still has some time to prepare, said former U.S. Food and Drug Administration Commissioner Scott Gottlieb, who testified to the Senate (at the same hearing as Gerberding) that “statistically, it is quite probable that we are going to see those outbreaks emerge sometime in the next two to four weeks.”

President Trump released a national biodefense strategy in 2018 aimed at preparing for a pandemic, but implementation of the plan wasn’t completed, Luciana Borio, a former director for medical and biodefense preparedness on the White House National Security Council, told the Senate.

“We have fallen short in key areas” of preparation, Borio said.

On Jan. 29, the administration created a Coronavirus Task Force to coordinate federal and state efforts to contain the virus’s spread in the U.S. Health and Human Services Secretary Alex Azar is leading the group, which includes officials from multiple federal agencies including the Centers for Disease Control and Prevention, National Institutes of Health, the Department of Defense and the Department of Homeland Scrutiny.

For more government resources, check out a transcript from the HHS’s office of the assistant secretary for preparedness and response. The transcript describes a recent meeting with health care system stakeholders to outline the government’s strategy for hospital preparation and developing vaccines and medical countermeasures. The agency also launched a website focused on medical countermeasures.

Among the challenges for hospital readiness has long been lack of financial support from the federal government to help health systems maintain readiness for responding to a contagious respiratory virus, Nicki Clowers, managing director of the health care team at the U.S. Government Accountability Office, told the Senate.

Since 2003, there has been a significant cut in federal funding on preparedness and even as the coronavirus threat has grown. The Trump administration’s just released 2021 budget proposal calls for further cuts in funding to hospital preparedness for health emergencies. See the Health and Human Services budget summary here. (Look on pages 43 and 176 for specific information on funding for the CDC and emergency preparedness.)

This lack of funding is especially worrisome because there is a growing amount of data showing that health care workers in China treating patients in the epicenter of the outbreak have gotten sick, indicating they weren’t protected adequately against transmission.

“We are no more prepared to deal with the rapid increases in coronavirus patients needing hospitalization in the United States than in China,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy. “If doctors, nurses and first responders are faced with coming to work without such equipment as respirators, gloves, eye protection and disposable suits will they? And if hospitals become places where coronavirus is spread more than contained, will the public panic?”

A key story in the coming days, therefore, will be whether your local health system can handle an outbreak. For resources to help with your coverage:

We welcome members’ feedback and comments and any resources that we may have missed. Please send them to bara@healthjournalism.org.

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