“We had to step up during the peaks and then try to figure out, ‘Are we keeping people or are we letting them go when we’re not peaking?'” said Julie Hirschhorn, director of pathology molecular at the Medical University of South Carolina. in Charleston. “Surges tend to be just far enough away that you don’t know what to do…It’s a tough new normal.”
The current wave, in which the new number of patients hospitalized with Covid-19 has increased by more than 40% in the past month, is also putting new pressure on facilities as federal funding for the pandemic response runs out. , leaving some with less flexibility to hire more staff if they need to.
In March, a funding deal to cover part of the White House’s $22.5 billion request fell apart because congressional Democrats objected to reallocating unspent funds pledged to states earlier. in the pandemic, while Republicans said they needed an accounting of the $6 trillion from Congress earmarked for pandemic relief in past funding bills before approving new funds.
“There is growing concern that that money is running out,” said Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association. “He doesn’t really get enough attention.”
As of July 22, hospitals in nearly 40 states reported severe staffing shortages, while hospitals in all 50 states said they expected to do so within a week.
Several states with increasing numbers of Covid-19 cases have significant and growing problems, although factors beyond Covid are involved.
In California, for example, only eight hospitals described their staffing shortages as critical as of July 22, but 118 are expected to do so within the week. In Louisiana, only one hospital reported a critical shortage last week, but 46 expected to have one this week. More hospitals were also expecting shortages in Alabama, Florida, Kentucky, New Mexico, Tennessee and West Virginia — all states with rising case counts.
“While we have experienced staffing shortages before, we are acutely aware of staffing shortages in virtually every type of position within the hospital at this time,” said Foster. “If we have a large influx of Covid patients, it will be much more difficult to meet these demands than ever before.”
Chronic hospital staffing shortages will continue to be a long-term problem, administrators said, as even vaccines that have been shown to be highly effective in preventing serious illnesses do not keep everyone from going to hospitals. . There’s also Americans’ growing resistance to mitigation measures like social distancing and masking, and public officials’ reluctance to sound the alarm during a wave in which fewer people are getting seriously ill and dying than during of the previous ones.
Hospital intensive care units are not inundated with Covid-19 patients as they were in previous waves, and the average daily death toll hovers around 350, the Centers for Disease Control and Prevention says, well below thousands of Americans dying each day during past peaks.
But severe strains on the healthcare system persist without these grim tolls.
“I don’t think people appreciate the ramifications for allowing us to transmit the virus almost willy-nilly now,” said David Wohl, the infectious disease expert who leads the Covid-19 response at UNC Health in Carolina. North. “If there are supply chain issues, if there are delays in getting services, or if people say, ‘Well, I’m understaffed, I can’t do, “it’s because of the pandemic.”
“Stealing Peter to Pay Paul”
Staffing shortages in hospitals – from nurses to doctors to medical laboratory technicians – existed before SARS-CoV-2, a result of both aging healthcare workers and an aging population as a whole that increases the demand for care.
The pandemic has created something of a domino effect in the medical community, said Sherry Polhill, associate vice president of hospital laboratories, respiratory care and pulmonary function services at UAB Medicine in Birmingham, Ala.
This prompted older workers to quit their jobs early and created a boom in the lucrative traveling health care professional industry that diverted people from their staff work.
“You have this void of vacancies that you need to fill and you can’t do it easily,” Polhill said, adding that it could take years to fill the vacancies she has in her labs.
The shortfall hits hospitals – and their patients – in different ways, as BA.5 has been shown to be able to evade immunity and become the dominant strain in the country.
In North Carolina, where cases have risen nearly 20% in the past two weeks, UNC Health is struggling to meet growing patient demand for monoclonal antibody treatments.
Hospitals are still providing the antibody treatment to those taking drugs that could negatively interact with a simpler treatment, Paxlovid. Unlike Paxlovid, a pill that can be taken anywhere, the monoclonal antibodies are given by infusion, a labor-intensive process that requires careful infection control to treat patients at infusion centers who also treat immunocompromised people.
For this to work, Wohl said, the hospital has to borrow staff from other departments.
“We have to rob Peter to pay Paul,” he said. “If you have people working in an infusion center who do this, what was their daily work before Covid? Some of them worked in the emergency room. Some of them worked in the operating room. You just can’t take people out of those other critical functions and still have them working somewhere else.
Next door in South Carolina, staffing shortages at the Medical University of South Carolina have already prompted the hospital to stop testing all hospitalized patients for Covid-19 as it did earlier in the pandemic.
The facility received money from a Covid-19 Relief Act Congress passed in March 2020 to bolster its testing capacity with new equipment and staff.
Now that money has started to dry up and Hirschhorn has had to downsize its teams and employees. His lab, part of a network of them at the hospital, had 44 staff and contractors at the height of the pandemic, but only 10 full-time staff today. His Covid-19 testing capacity has increased from around 3,500 a day to 1,500.
The decision to halt routine Covid testing helped prevent the lab from being overwhelmed, even as the number of people hospitalized with Covid has increased 34% in South Carolina in the past two weeks. But Hirschhorn said it made her uncomfortable knowing she no longer had the resources to get back up and running if she needed to.
“We’re all trying to figure out what our lab looks like now and what we can do to help prepare for another surge, knowing that we won’t have the same staff we had in other surges,” he said. she declared. . “We are flying blind.”
This anxiety is prevalent in hospitals, where the pandemic has exacerbated the staffing shortages that preceded it.
“Medical laboratory scientists are unhappy right now,” said Susan Harrington, a Cleveland Clinic microbiologist and chair of the American Society for Clinical Pathology’s laboratory workforce steering committee. “They work too hard, and they work too hard for too long.”
“What is the end?” she asked. “I don’t really know the answer.”
Although hospital labs are, generally speaking, much more prepared to handle this wave of cases than they were in 2020, the Medical University of South Carolina is not alone in ending the testing of all hospitalized patients for Covid-19 due to staffing, said Jonathan Myles, president of the College of American Pathologists’ Council on Government and Professional Affairs.
A lack of local testing options creates greater danger to patients and the community, he said, especially in rural facilities operating in economically disadvantaged areas. “They operate with little means,” he said. “If you limit rural testing, you exacerbate the inequity of care.”
Large, urban hospitals may be in a better position to juggle periods of high transmission, but with more staff calling in sick and more patients testing positive, they too are under pressure.
In Los Angeles County, where the number of patients hospitalized with Covid-19 has increased dramatically since May despite the region’s high vaccination rate, Harbor-UCLA Medical Center has had to find ways to manage.
“People are getting Covid left and right,” said Anish Mahajan, the facility’s CEO and chief medical officer.
The hospital has so far coped with this surge in cases, he said, with longer wait times in the emergency room due to staff shortages and a greater number of patients. The hospital may need to prioritize urgent care cases again if things get worse.
The only real way to end uncertainty is to stop the virus, through vaccination and taking steps that stop its spread, he said, such as putting on masks when transmission is high.
“The more the virus is transmitted in our world, the more we are going to see the generation of future variants taking hold,” Mahajan said. “Maybe this variant doesn’t cause a lot of people to get sick in the hospital. But we don’t know what the next variants might do.