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Saskia v. Popescu, PhD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in Biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control and has worked in both pediatric and adult acute care facilities.

A National Survey Sheds Light on COVID-19 Health Care Response

APR 16, 2020 | SASKIA V. POPESCU
From New York to Washington State, hospitals have been faced with increased pressures and challenges when preparing for and responding to the coronavirus disease 2019 (COVID-19) pandemic. Stories are being shared by medical providers on news outlets and indicate just how severe the crisis is in New York City. From personal protective equipment (PPE) challenges to limited access to staff and ventilators, this is a situation few have ever faced.
 
A new report from the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) has shed some slight on what’s actually happening on the frontlines of health care across the United States. From March 23-27, they interviewed administrators from 323 hospitals across 46 states to learn more about the situation. The OIG set out to determine the most difficult elements of response, strategies being used to address or mitigate challenges, and how the government could best support hospitals responding to COVID-19.
 
There findings ultimately included several key challenges:
·      Severe shortages of testing supplies and extended wait times for results
·      Widespread shortages of PPE
·      Difficulty maintaining adequate staffing and supporting staff
·      Difficulty maintaining and expanding hospital capacity to treat patients
·      Shortage of critical supplies, materials, and logistic support?
·      Anticipated shortages of ventilators
·      Increased costs and decreased revenue
·      Changing and sometimes inconsistent guidance

Hospitals worked to combat these challenges through several strategies including conservation and disinfection of PPE for re-use, securing various medical supplies by renting, securing additional staffing needs by training medical staff to help care for patients on ventilators, etc. As the report notes, the testing limitations have been extremely stressful. “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.”

According to the report, these shortages affected the hospitals’ ability test patients and members of the community who may have been exposed to COVID-19.

“One hospital administrator said that across the industry, ‘millions [of tests] are needed, and we only have hundreds.’ Without access to needed testing materials, 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 report stated.
 
Those delays mean that patients are presumptive positive, which translates to them staying in a hospital bed, reducing not only availability of beds to other patients, but also the use of PPE.

The report further states that 1 hospital used an average of 307 masks per day for 23 patients with suspected cases of COVID-19.

From concerns regarding securing of critical supplies to shortages of no-touch, infrared thermometers, this report spells out issues many of us are living, but also pieces together a mosaic of what US health care is dealing with right now.

As hospitals reported to OIG officials in late March, there are considerable challenges in maintaining, let alone expanding their facilities’ capacity to treat patients with COVID-19. 
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