A report expected Monday from a federal surveillance agency warns that various widely reported problems feed into each other in a vicious circle. These problems include insufficient testing, slow results, scarcity of protective equipment, shortage of breathing apparatus for critically ill patients and exhausted personnel concerned about their own safety.
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“There is this kind of domino effect,” said Ann Maxwell, deputy inspector general at the Department of Health and Human Services. “These challenges play on each other and make the situation worse. There is a cascading effect. “
The Inspector General’s report is based on a telephone survey of 323 hospitals across the country from March 23 to 27. With hundreds of new cases of coronavirus a day, the situation is getting worse for many 6,000 hospitals across the country. Others may still struggle to prepare. A copy of the report was provided to the Associated Press.
“Hospitals have indicated that their greatest challenges have centered on testing and caring for patients with known or suspected COVID-19, and on the safety of staff,” concludes the report.
“It is likely that every hospital in America will face this,” said Maxwell.
In most people, the coronavirus causes mild to moderate symptoms. Others, especially the elderly and those with underlying health conditions, can develop life-threatening respiratory problems. The United States has more cases diagnosed in the global pandemic than any other country, according to figures compiled by Johns Hopkins University. Projections show the nation will see the maximum impact later this month.
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Maxwell said that the purpose of the report was to describe the plight of the hospitals. She said the key idea is that different problems – usually dealt with individually – build on each other to confuse the whole system.
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For example, a lack of tests and slow results mean that hospitals must keep unconfirmed coronavirus patients longer.
This takes up valuable beds and uses protective equipment such as gowns, masks and face shields, as doctors and nurses must assume that patients with symptoms of respiratory distress may be positive.
The increased workload increases the stress levels of nurses, doctors and respiratory therapists, who also fear that they will not be able to protect themselves properly.
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“Health care workers feel like they are at war right now,” a New York hospital administrator told investigators by the Inspector General. They “see people in their thirties, forties and fifties dying. ? It takes a heavy emotional toll. The office of the Inspector General did not identify survey respondents due to privacy concerns.
Overtime and increased use of supplies are increasing costs while many hospitals are experiencing revenue squeezes because elective surgeries have been canceled. The recently passed federal stimulus bill injects money into hospitals.
“This is actually a national challenge, not just of the hot spots, but of the whole country,” said Maxwell. Rural hospitals are vulnerable due to a limited number of beds and smaller staff.
Of the 323 hospitals in the survey, 117 said they were treating one or more patients with confirmed COVID-19, while 130 said they were treating one or more patients suspected of having the disease. Suspected infections are treated the same way, due to the uncertainties surrounding the tests. Only 32 hospitals reported that they did not treat any patient with confirmed or suspected COVID-19. 44 other hospitals did not provide this information.
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“Hospitals were planning to be overwhelmed by an increase in the number of COVID-19 patients who would need specialized beds and isolation areas for effective treatment,” said the report.
Parts of Europe give a glimpse of what hospitals here are trying to avoid. The AP reported last week that some European countries are gathering makeshift hospitals and shipping coronavirus patients out of submerged cities via high-speed trains and military jets. In Spain, doctors have to make scary decisions about who gets the best care. In the United States, two Navy hospital ships have been deployed and field hospitals have been built.
One of the most pressing questions is how to prioritize the use of ventilators, life-supporting breathing apparatus. Louisiana hospitals in New York and Michigan are already facing predicted shortages, the AP reported last week.
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“The government must provide ethics guidelines if health resources are limited and decisions have to be made about the patients to be treated,” an office official with the Broward County Hospital in Florida told the office. of the Inspector General. “Are doctors accountable for their decisions if this happens? “
Many hospitals respond by improvising their own solutions. Some have considered purchasing face masks at nail salons due to the shortage of personal protective equipment or PPE. Others have tried making their own hand sanitizer by mixing ultrasound gel with alcohol from local distilleries.
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“We are throwing all of our best PPE best practices out the window,” said a west Texas hospital administrator at the office of the Inspector General. “This one will come back and bite us. “
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