WASHINGTON -- Hospital administrators expressed concerns about the federal government's inadequate response to the COVID-19 pandemic when contacted late in March by the Office of Inspector General (OIG) at the Department of Health and Human Services.
"Hospitals reported that their most significant challenges centered on testing and caring for patients with known or suspected COVID-19 and keeping staff safe," a indicated. "Hospitals also reported substantial challenges maintaining or expanding their facilities' capacity to treat patients with COVID-19."
For the report, OIG investigators conducted brief telephone interviews March 23-27 with a random sample of hospital administrators from 323 hospitals across 46 states, the District of Columbia, and Puerto Rico; the response rate was 85%. Types of hospitals contacted included special pathogen centers, critical access hospitals, and "a range of hospitals nation-wide of various sizes and characteristics," the authors noted.
The interviews focused on three key questions:
- What are your most difficult challenges in responding to COVID-19?
- What strategies is your hospital using to address or mitigate these challenges?
- How could government best support hospitals responding to COVID-19?
Testing Demands Are Overwhelming
Testing was a big problem area for hospitals. "Hospitals explained that they were unable to keep up with testing demands because they lacked complete kits and/or the individual components and supplies needed to complete tests, such as nasal swabs, viral transfer media, and reagents used to detect the virus," the report said. "These shortages left hospitals unable to effectively test staff, patients, and others in the community who reported that they were concerned about possible exposure."
One hospital administrator said that across the industry, 'millions [of tests] are needed, and we only have hundreds.' Because of the shortage, "some hospitals described dividing the media in COVID-19 kits in half to double their capacity and resorting to using the transfer media in flu and strep kits to provide testing," the authors noted.
Getting test results was another problem, with hospitals reporting they are frequently waiting 7 days or longer for test results. "Hospitals' reliance on external laboratories contributed to delays, particularly as these laboratories became overwhelmed with tests to process from around the state or country," the report found. "Hospitals also reported delays related to infrequent specimen pickups, mailing delays, and labs' restrictive business hours."
These testing delays led to other problems. "Hospitals reported that to prevent the spread of the virus in the hospital and community, they were treating symptomatic patients as presumptive positive cases of COVID-19," the report said. "The scarcity of COVID-19 tests and length of time it took to get test results back meant presumptive positive patients greatly strained bed availability, PPE [personal protective equipment] supplies, and staffing. Hospitals reported that some presumptive positive patients remained in the hospital for days while awaiting test results, which reduced the hospitals' availability of beds for other patients."
PPE Also at Issue
Shortages of PPE were another big problem for the report's respondents. "Hospitals across the country reported that a shortage of PPE was threatening their ability to keep staff safe while they worked to treat patients with COVID-19," the authors wrote. "The most commonly needed PPE items reported were masks (including N95 masks, surgical masks, and face shields), followed by gowns and gloves. Hospitals reported that heavier than normal use of PPE contributed to shortages. The administrator of one hospital stated that before COVID-19, the hospital's medical center used around 200 masks per day and that it was now using 2,000 per day."
In terms of replenishing their stock, "one hospital administrator reported that some supply distributors limited the quantity of supplies that any one hospital could order, which meant that even with no COVID-19 patients, the hospital was depleting PPE faster than it could restock." At another hospital, an administrator said that with its current high "burn" rate, its PPE inventory would last only 3 more days.
Part of the problem was the lack of a robust supply chain, respondents indicated. "Hospitals reported that the supply chain for medical equipment had been disrupted because of increased demand for PPE from healthcare providers and others around the country," OIG said. "Another administrator stated that their hospital's purchaser was reporting delays of 3-6 months in being able to replenish key supplies, including surgical and N95 masks." And it's not just other hospitals that are competing for supplies, the report said, noting that one hospital administrator "reported apprehending a person trying to steal face masks from the hospital lobby."
Hospital administrators were uncertain about getting PPE from federal and state governments, with some noting that "they had not received supplies from the Strategic National Stockpile, or that the supplies that they had received were not sufficient in quantity or quality." One hospital said that the 2,300 N95 masks it had received from its state's strategic reserve were unusable because the elastic bands had dry-rotted, while another said that 500 of the 1,000 masks it had received from federal and state governments "were for children and therefore unusable for the health system's adult staff."
Ventilators -- and Their Components -- Are Wanting
Ventilators were another big supply issue. "Many hospitals reported concerns that they would not have enough ventilators if faced with a surge of COVID-19 patients," the report found. "One administrator explained the difficulty of predicting whether a surge would come and how many ventilators would be needed, '[We] just don't know two weeks down the road what we will need.' Hospitals pointed to overall supply shortages and the unavailability of ventilators in other facilities, as well as the scarcity of ventilator components such as tubes."
The OIG's findings are not very surprising, Nick Diamond, a consultant with Avalere, a healthcare consulting firm here, said in a phone interview. Although there is somewhat of a disconnect between the report's conclusions and the rosy picture that Trump administration officials are painting regarding the federal government's help with the supply chain, "we have been hearing from the folks at the CDC talking about the importance of ramping up capacity in some resource allocation considerations the report seems to mention," Diamond said. One thing the report will be good for, he added, is "to serve as a guidepost later on to think about lessons learned to take to future pandemics and epidemics, for thinking about what we know at a given moment in time and relative to the steps taken afterwards."
The American Hospital Association (AHA) praised the report, calling it "timely" and "important." In addition, "while not in the OIG report, there are also shortages of critical drugs for patient care that must be addressed," AHA president and CEO Rick Pollack said in a statement. "The OIG report also highlights the tremendous strain -- both physical and emotional -- that this pandemic is putting on the shoulders of heroic physicians, nurses and other caregivers and their families, and why they need our support during this critical time."
Janis Orlowski, MD, chief healthcare officer at the Association of American Medical Colleges, pointed out another issue clarified in the report, which is that "at some point the OIG is going to need to have a report on the relief funds" provided to hospitals through the stimulus bill, she said. As an organization that represents teaching hospitals, "we understand there needs to be an OIG audit for the stimulus money, and we're comfortable with that."