Trump calls new hospital coronavirus report ‘another fake dossier.’ Here’s what it says
Hospitals around the country are facing widespread shortages in supplies as they face growing numbers of coronavirus patients, according to a new report from the U.S. Department of Health and Human Services’ Inspector General.
“Hospitals reported that changing and sometimes inconsistent guidance from Federal, State, and local authorities posed challenges and confused hospitals and the public,” according to the inspector general’s report released Monday.
A day after its release, President Donald Trump criticized the report as “another fake dossier,” alluding to the Steel Dossier, a private investigation into connections between Trump and Russia.
The report is based on telephone interviews with administrators from 323 hospitals across 46 states, Puerto Rico and the District of Columbia between March 23 and 27. Interviewers asked a standard set of questions to understand how hospitals are confronting the COVID-19 pandemic, looking at challenges, coping strategies and how government could help.
What are the biggest challenges facing hospitals?
Problems with testing for the coronavirus and shortages of personal protective equipment have drawn headlines around the world, and they present very real challenges for hospitals, the report says.
Here’s what hospital administrators said are the biggest challenges:
- “Severe shortages of testing supplies and extended waits for test results” make it hard for hospitals to monitor patients and staff. Testing delays means hospitals sometimes had to keep patients longer than necessary, taking up already strained resources.
- Well-documented ventilator shortages create a big challenge for hospitals. “Hospitals anticipated that ventilator shortages would pose difficult decisions about ethical allocation and liability, although at the time of our survey no hospital reported limiting ventilator use,” the report said.
- “Changing and sometimes inconsistent guidance from federal, state, and local authorities posed challenges and confused hospitals and the public,” the report said. “Hospitals also reported concerns that public misinformation has increased hospital workloads (e.g., patients showing up unnecessarily, hospitals needing to do public education) at a critical time.”
- The report describes “widespread shortages” of personal protective equipment like masks and gowns that put patients and staff at risk. “Hospitals also expressed uncertainty about availability of PPE from federal and state sources and noted sharp increases in prices for PPE from some vendors.
- Hospitals said they are having trouble maintaining staffing levels and planning for surges in COVID patients. “Hospital administrators also expressed concern that fear and uncertainty were taking an emotional toll on staff, both professionally and personally.”
- Administrators are also worried about being able to have enough capacity to handle a spike in the number of patients.
- Critical supply shortages: “Hospitals reported needing items that support a patient room, such as intravenous therapy (IV) poles, medical gas, linens, toilet paper, and food. Others reported shortages of no-touch infrared thermometers, disinfectants, and cleaning supplies.”
- Revenue is going down at many hospitals, but costs are going up as hospitals see more coronavirus cases. “Many hospitals reported that their cash reserves were quickly depleting, which could disrupt ongoing hospital operations,” the report said.
Hospital coping strategies
Hospital administrators said they have come up with strategies to face the hurdles of keeping up with the coronavirus pandemic.
Here are the top strategies, according to the inspector general:
Hospitals have turned to alternative sources to make sure their staffs have personal protective equipment. “To try to make existing supplies of PPE last, hospitals reported conserving and reusing single-use/disposable PPE, including using or exploring ultra-violet (UV) sterilization of masks or bypassing some sanitation processes by having staff place surgical masks over N95 masks. Hospitals also reported turning to non-medical-grade PPE, such as construction masks or handmade masks and gowns, which they worried may put staff at risk.“
With growing numbers of COVID patients, hospitals have trained other medical staff, including nurses, hospitalists and anesthesiologists, to help with patients on ventilators.
Some hospitals said they are helping their staff by providing child care, helping with basics like doing the laundry and grocery shopping, and giving some hotel rooms so they don’t have to be around older at-risk family members.
To face problems with capacity, some hospitals offer telehealth services so people don’t have to go to the hospital for minor issues. They’re also “setting up alternate facilities such as fairgrounds, vacant college dorms, and closed correctional facilities as additional spaces for patient care.”
Hospitals have been trying to face an expected shortage in ventilators in some parts of the country. “Hospitals tried to obtain additional machines by renting ventilators, buying single-use emergency transport ventilators, or getting ventilators through an affiliated facility. Some hospitals reported converting other equipment, such as anesthesia machines, to use as ventilators.”
What hospitals want
The inspector general’s report details ways hospital administrators say government could help respond. There has already been movement on some of these recommendations since the survey was conducted. Here’s what administrators told the inspector general:
- Hospitals are competing for needed supplies. “Government intervention and coordination could help reconcile this problem nationally. For example, hospitals wanted the government to ensure that they have access to test kits and swabs, make tests faster by allowing more entities to conduct and produce tests, and help hospitals obtain PPE supplies and other equipment such as ventilators.”
- Regulations could be loosened for hospital staffing. “Hospitals requested that government allow reassignment of licensed professionals and realignment of duties as needed, provide flexibility with respect to licensed professionals practicing across State lines, and provide relief from regulations that may restrict using contracted staff or physicians based on business relationships.”
- Changing facility rules would help add capacity. “Hospitals asked for relaxed rules around bed designations, the ability to establish surge facilities in non-traditional settings, and expanded flexibilities in telehealth, such as the types of services, caregivers, and modalities eligible to receive reimbursement.”
- Hospitals need financial help. “All types of hospitals, and especially small rural hospitals, requested financial assistance, including faster and increased Medicare payments, and loans and grants.”
- Hospitals want better communication and public information. That includes “evidence-based guidance, reliable data and predictive models, and a central repository for all COVID-19-related guidance, data, and information.”
