The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) has issued a report concluding that U.S. hospitals remain unprepared to meet the COVID-19 pandemic, when it comes to personal protective equipment (PPE), ventilators, and other key issues.
The report, entitled “Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Survey March 23-27,” was based on a nationwide survey of hospital leaders conducted online on March 23 through 27. It was posted to the HHS website on Friday.
The Washington Post’s Amy Goldstein wrote about the report in an article on Monday, April 6, stating that “A federal watchdog is corroborating warnings by governors and front-line health-care workers that hospitals’ ability to combat the coronavirus pandemic is being impeded by shortages of tests, protective gear, staff and space, as well as inconsistent government advice. Some hospitals are so desperate for protective masks that they are scrounging them from auto-body shops and nail salons,” Goldstein wrote, “according to a report by the Inspector General of the Department of Health and Human Services. At least one hospital is making its own hand sanitizer by mixing gel used for ultrasounds with alcohol from a nearby distillery, the report said.”
As Goldstein noted in her article, “The report is the first public federal critique of the capacity of the nation’s hospitals to cope with the flood of infected patients in coronavirus hot spots — an inundation likely to arrive elsewhere soon. In substantiating complaints about inadequate equipment, it essentially counters assertions by President Trump that hospitals and state officials advocating for them are being greedy.” And she quoted the report directly, as it noted that “Hospitals across the country reported facing similar challenges, regardless of which stage of the process they were in — treating patients with [the virus], testing patients who were potentially infected, or preparing to treat covid-19 patients in the near future.” Executives from 343 hospitals in 46 states responded to the survey.
Among the survey’s key findings, stated verbatim in the report:
Ø Hospitals reported that their most significant challenges centered on testing and caring for patients with COVID-19 and keeping staff safe.
Ø Hospitals across the country reported facing similar challenges, regardless of which stage of the process they were in—treating patients with coronavirus 2019 (COVID-19), testing patients who were potentially infected, or preparing to treat COVID-19 patients in the near future. The most commonly reported challenges centered on hospitals’ efforts to confirm cases of COVID-19, to keep health care staff safe, and to provide needed services to patients requiring hospital care for a wide array of medical reasons, including COVID-19. Challenges included difficulties related to testing, lack of personal protectiveequipment (PPE), and staffing, including specialized staffing.
Ø Hospitals reported that severe shortages of testing supplies and extended waits for test results limited hospitals’ ability to monitor the health of patients and staff.
Ø 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. 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." 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.
Ø Hospitals described extended waits for COVID-19 test results. Hospitals reported frequently waiting 7 days or longer for test results. According to one hospital, 24 hours would typically be considered a long turnaround time for virus testing. Hospitals’ reliance on external laboratories contributed to delays, particularly as these laboratories became overwhelmed with tests to process from around the State or country. Hospitals also reported delays related to infrequent specimen pickups, mailing delays, and labs’ restrictive business hours. Some hospitals described success getting results more quickly by using commercial labs, whereas others received more timely results from public sources. Still others experienced inconsistent turnaround times, leaving them unable to predict when results would arrive or advise patients on how long they should self-quarantine or undertake other measures while awaiting results.
Ø Testing challenges exacerbated other challenges, including bed availability, PPE supplies, and staffing shortages. 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 (i.e., an individual with symptoms that strongly indicate COVID-19 and tests have ruled out similar conditions, but without a positive COVID-19 test result). 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 supplies, and staffing, as noted in Exhibit 1.
The same types of scarcity issues are true right now around ventilators:
Ø Anticipated shortages of ventilators were identified as a big challenge for hospitals. Hospitals reported an uncertain supply of standard, full-feature ventilators and in some cases used alternatives to support patients, including adapting anesthesia machines and using single-use emergency transport ventilators. 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 also referenced increasing financial distress among U.S. hospitals, including:
Ø Hospitals described increasing costs and decreasing revenues as a threat to their financial viability. Hospitals reported that ceasing elective procedures and other services decreased revenues at the same time that their costs have increased as they prepare for a potential surge of patients. Many hospitals reported that their cash reserves were quickly depleting, which could disrupt ongoing hospital operations.
Ø
Released Friday, the report says the findings are “not a review of HHS response to the covid-19 pandemic” but are intended “as an aid to HHS as it continues to lead efforts to address the public health emergency.”
In the Monday White House COVID-19 press briefing, President Donald Trump expressed considerable agitation at being asked about the report’s citing testing difficulties. “We are doing an incredible job on testing,” Trump said. “We’re the federal government. We’re not supposed to stand on street corners doing testing.”
Vox’s Aaron Rupar reported in his account on Monday night that, when asked about the HHS IG’s report, Trump said, “It’s just wrong. Did I hear the word ‘inspector general?’ Could politics be entered into that?”
Rupar wrote that, “When he was asked about the report for a second time, Trump suggested it couldn’t be trusted because he wasn’t sure whether the HHS official who put it together — Principal Deputy Inspector General Christi Grimm — was appointed by him. Grimm, however, has experience in the federal government under both Republican and Democratic presidents dating back to the Clinton administration. Moreover, the IG report is based on direct conversations with hospital administrators. Later, when Fox News reporter Kristin Fisher attempted to ask Trump specifically about the report’s finding that hospitals are working with a ‘severe shortage’ of testing materials, Trump unloaded on her. ‘You should say ‘congratulations, great job,’ instead of being so horrid in the way you ask a question,’ he said.”
In a statement released Monday evening by the Charlotte-based Premier Inc. health alliance, Blair Childs, the organization’s senior vice president of public affairs, stated that “Today’s HHS OIG report exemplifies the dire situation in hospitals that Premier has been highlighting for several weeks. It is imperative that this information be used by the government to take every action it can to increase access to and manufacturing of critical medical supplies. In addition,” Childs said, “all parties in the supply chain must be transparent and collaborate as never before. Finally, the report underscores that we must leverage early learnings from this pandemic and take immediate steps to build the necessary healthcare infrastructure and data and analytic systems to predict, plan for and prevent these catastrophic events prior to further disease progression in additional hot spots.”
