Associated Press
An emergency room nurse dons her face protectors after taking a break in a driveway for ambulances and emergency medical services vehicles outside Brooklyn Hospital Center's emergency room, Sunday, April 5, 2020, in New York, during the coronavirus crisis. (AP Photo/Kathy Willens)
- Hospitals around the US faced significant challenges as they ramped up their response to the coronavirus pandemic.
- A lack of testing, insufficient protective gear, and shortages of supplies from thermometers to hand sanitizer plagued their responses, according to a report released Monday by the inspector general of the US Department of Health and Human Services.
- The inspector general surveyed more than 300 hospitals across the US and Puerto Rico between March 23-27 to get a sense of where the shortcomings were as the coronavirus spread in the US, hitting places like NYC particularly hard.
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At one hospital, a supply of N95 masks for staff arrived from a state strategic reserve with dry-rotted elastic bands that rendered the equipment useless.
Another received supplies that expired in 2010.
One hospital couldn't screen everyone who came through its doors because it didn't have enough contactless thermometers, so it decided to screen at random.
One hospital is working with a local distillery to combine 100 liters of ultrasound gel with alcohol to make hand sanitizer. Others still are accepting handmade mask and gown donations, construction masks, and protective gear made out of office supplies.
As the coronavirus pandemic spreads across the US, hospitals have found themselves plagued with shortages of gear, combined with a lack of testing capacity, according to a survey of 323 hospitals conducted by the inspector general for the Department of Health and Human Services. The hospitals were based in 46 states and Puerto Rico, and roughly a third had treated COVID-19-positive patients, while another third had patients suspected of being positive.
The accounts from the hospitals' administrators show pressures to have enough of virtually everything needed in the wake of the pandemic, from testing, to protective gear, to staff, to capacity. Some hospitals even ran short on basic supplies like food and toilet paper as case counts in the US skyrocketed.
The hospitals in turn asked the government for guaranteed access to supplies, flexibility to use healthcare workers credentialed in other states, authorization to increase bed capacity in their facilities, as well as financial assistance, particularly for rural hospitals. As hospitals confront the pandemic, they're faced with higher costs of taking care of their patients while having diminished revenue streams from everyday procedures that have been canceled.
Ventilators, the hospitals noted, are likely to run short, with some hospitals converting anesthesia machines and others hooking up two patients to one machine.
Testing shortcomings are hitting hospitals hard
As hospitals look to treat patients who have the symptoms of COVID-19 - shortness of breath, fever, cough, among others - the issues surrounding testing for the virus has hindered how they're able to respond.
The report found that hospitals were having a hard time knowing if patients were positive, which could determine their treatment course, how staff protect themselves around the patient, and timing for when they might be discharged. Some hospitals said it could take up to a week to get coronavirus test results.
Read more: The upstart biotech Moderna is hoping to have its coronavirus vaccine ready for emergency use in the fall. Here's how it plans to execute in record time.
Strains on protective gear
Because hospitals don't know which patients have the coronavirus, they're using up a lot of personal protective equipment, or PPE, worsening shortages.
"The testing turnaround presents a challenge, especially for our 'rule-out' patients…we have to use a lot of PPE on those rule-outs," one hospital administrator told the administration. "And especially when it's a negative, we basically used all that PPE for nothing."
One hospital said that in the course of a normal day, it might use 200 masks. As of the end of March, that's up to 2,000 masks a day.
Hospitals told the administration that to make up for the lack of gear, they began reusing single-use PPE, using UV light to sterilize mask or putting surgical masks over N95 masks. It's a major departure to how the usually disposable gear is treated.
"We are throwing all of our PPE best practices out the window," one hospital administrator said. "That one will come back and bite us. It will take a long time for people to get back to doing best practices."
Read more: A leaked presentation reveals the document US hospitals are using to prepare for a major coronavirus outbreak. It estimates 96 million US coronavirus cases and 480,000 deaths.
A toll on healthcare workers
The changes in guidelines, especially with regard to protective gear, is taking a toll on the staff working in the hospitals as well.
"Health care workers feel like they're at war right now…[they] are seeing people in their 30s, 40s, 50s dying…This takes a large emotional toll," one administrator said in the survey.
The hospitals noted that they got mixed signals from different public health agencies on local and national levels about how to best protect staff.
"[The inconsistency] makes everyone nervous," one hospital said. "It would have been better if there was coordination and consistency in guidance among the different levels of government."
The report noted that at one hospital, a staff member who tested positive had exposed other staff. But the hospital didn't have enough testing kits to test the staff who had been exposed.
Discharging patients has presented its own challenges. Hospitals looking to free up beds and move patients who are recovering to other healthcare institutions are facing pushback and requests for a weeks' worth of protective equipment for staff charged with taking care of the coronavirus-positive patients.
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