Hospitals grapple with staff shortages as federal Covid funds run low

“We had to ramp up power during surges and then try to figure out, ‘Are we keeping people or letting them go when we don’t have surges?’” said Julie Hirschhorn, director of the Division of Molecular Pathology at the Medical University of South Carolina. in Charleston. “Bursts tend to be far enough apart 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 risen by more than 40 percent Last month also creates new strain on agencies as federal funding for the pandemic response runs out, leaving some with less ability to hire more staff if they need to.

In March, a deal was signed to finance part of White House request for $22.5 billion fell apart because Democrats in Congress object to reallocation of unspent funds promised states earlier during the pandemic, while Republicans said they need accounting of the $6 trillion allocated by Congress to fight the pandemic in past funding bills, before new money is approved.

“There is growing concern that this money has run out,” said Nancy Foster, vice president of quality policy and patient safety for the American Hospital Association. “It’s not really getting enough attention.”

As of July 22, hospitals in nearly 40 states have reported acute staffing shortagewhile hospitals in all 50 states have said they expect it within a week.

Several states where Covid-19 cases are on the rise have large and growing problems, even though they involve non-Covid factors.

In California, for example, only eight hospitals cited the staff shortage as critical as of July 22, but 118 expect it to be within a week. In Louisiana, only one hospital reported a critical shortage last week, but it is expected to be in 46 hospitals by this week. Other hospitals also anticipated shortages in Alabama, Florida, Kentucky, New Mexico, Tennessee and West Virginia – all states with rising numbers of cases.

“While we have experienced shortages in the past, we are acutely aware of the shortages in almost every position in the hospital right now.” Foster said. “If we have a large influx of Covid patients, it will be much more difficult to meet these needs than ever before.”

Chronic understaffing in hospitals will remain a long-term problem, administrators say, because even vaccines that have been shown to be highly effective in preventing serious illness are not keeping everyone away from the hospital. There has also been a growing resistance by Americans to mitigation measures such as social distancing and mask-wearing, and officials’ unwillingness sound the alarm during a wave, when fewer people become seriously ill and die than during previous waves.

Hospital intensive care units are not overcrowded with Covid-19 patients as they were in previous waves, and average daily mortality fluctuates around 350far below the thousands of Americans who die each day in past peaks, according to the Centers for Disease Control and Prevention.

But a serious strain on the health care system persists without these grim losses.

“I don’t think people realize the implications that we can transmit the virus almost unwittingly right now,” said David Wohl, an infectious disease expert who leads the Covid-19 response at UNC Health in North Carolina. “If there are supply chain issues, if there are service delays, or if people say, ‘Well, I don’t have enough staff, I can’t do this,’ it’s because of the pandemic.”

“Rob Peter to pay Paul”

A shortage of hospital staff — from nurses to doctors to medical lab technicians — existed prior to SARS-CoV-2, a result of both an aging healthcare worker and an aging population as a whole, increasing the demand for medical care.

The pandemic has created a kind of domino effect in the medical community, said Sherry Polhill, associate vice president of hospital laboratories, respiratory care and lung services at UAB Medicine in Birmingham, Alabama.

This prompted older workers to leave early and sparked a boom in the lucrative traveling healthcare industry, which poached people away from their jobs in the state.

“You have this vacuum of vacancies that you need to fill and you can’t do it easily,” Polhill said, adding that it can take years to fill vacancies in her labs.

The deficiency hits hospitals and their patients in different ways as BA.5 has proven its ability to evade immunity and has become the dominant strain in the country.

In North Carolina, where cases almost 20 percent Over the past two weeks, UNC Health has been struggling to meet the growing demand from patients for monoclonal antibody treatments.

Hospitals are still providing antibody treatment for those taking medications that may interact negatively with the simpler therapeutic agent, Paxlovid.. Unlike Paxlovid, a tablet that can be taken anywhere, monoclonal antibodies are administered by infusion, which is a time-consuming process that requires careful infection control to treat patients in infusion centers that also treat immunocompromised people.

For this to work, the hospital has to borrow staff from other departments, Wohl says.

“We have to rob Peter to pay Paul,” he said. “If you have people working in an infusion center doing this, what was their day job like before Covid? Some of them worked in intensive care. Some of them worked in the operating room. You just can’t take people away from these other important features and have them always work elsewhere.”

Next door in South Carolina, staffing shortages at the Medical University of South Carolina have already prompted the hospital to stop testing all inpatients for Covid-19, as it did earlier during the pandemic.

The facility received money from Congress through the March 2020 Covid-19 Relief Act to ramp up its testing capacity with new equipment and staff.

Now that money began to dry up, and Hirschhorn had to cut shifts and staff. Her laboratory, one of a chain of hospitals, had 44 full-time and part-time employees at the peak of the pandemic, and today only 10 full-time employees. His Covid-19 testing capacity has dropped from about 3,500 a day to 1,500.

The decision to stop routine testing for Covid helped prevent the lab from being overwhelmed. even though the number of people hospitalized with Covid has risen 34 percent in South Carolina in the last two weeks. But Hirshhorn said she’s uncomfortable knowing she no longer has the resources to return if she needs to.

“We’re all trying to figure out what our lab looks like right now and what we can do to help ourselves prepare for the next surge, knowing we won’t have the same staff as during other surges,” she said. . “We’re flying blind.”

pandemic fatigue

This concern is widespread in hospitals, where the pandemic has exacerbated the shortages that preceded it.

“Medical lab technicians are unhappy right now,” said Susan Harrington, a microbiologist at the Cleveland Clinic and chairman of the American Society of Clinical Pathology’s laboratory manpower steering committee. “They work too hard and they’ve worked too hard for too long.”

“How did it end?” she asked. “I really don’t quite know the answer.”

While hospital labs are generally much better prepared to handle this wave of cases than they were in 2020, Jonathan Miles said, the Medical University of South Carolina is not alone in ending testing all inpatients for Covid-19 due to staffing shortages. Chairman of the College of American Pathologists Board of Public and Professional Affairs.

The lack of local testing options poses a great danger to patients and society, especially in rural facilities operating in economically disadvantaged areas, he said. “They are working on a tight budget,” he said. “If you limit testing to rural areas, you are exacerbating disparities in care.”

Large urban hospitals can better handle times of high transmission, but as more staff call in sick and more patients test positive, they too are under pressure.

In Los Angeles County, where the number patients hospitalized with Covid-19 has risen sharply since May, despite high vaccination rateHarbor-UCLA Medical Center had to find ways to manage.

“People are getting infected with Covid right and left,” said Anish Mahajan, CEO and chief medical officer of the facility.

So far, the hospital has dealt with this spike in cases by increasing waiting times in the emergency department due to staffing shortages and increasing patient numbers, he said. The hospital may have to re-prioritize emergency cases if the situation worsens.

The only real way to end the uncertainty, he said, is to stop the virus through vaccination and taking measures to stop it from spreading, such as re-wearing masks when transmission is high.

“The more the virus is transmitted in our world, the more likely we are to see a generation of future variants,” Mahajan said. “Perhaps this option does not lead to the fact that many people end up sick in the hospital. But we don’t know what the next options might do.”