January 27, 2023

“We had to ramp up during peaks and then try to figure out, ‘Are we keeping people on or are we letting them go if we don’t rise?’” said Julie Hirschhorn, director of molecular pathology at the Medical University of South Carolina in Charleston. “The peaks are usually just 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 being hospitalized with Covid-19 has more than increased 40 percent in the past month, also puts new pressure on facilities as federal funding for the pandemic response is running low, leaving some with less flexibility to hire more staff as needed.

In March a financing agreement to buy part of the The White House’s $22.5 Billion Request fell apart as Democrats in Congress objected to reusing unspent funds promised to states earlier in the pandemic, while Republicans said they needed accounts of the $6 trillion Congress earmarked for pandemic help in previous financing accounts before approving new money.

“There is a growing concern that this money is running out,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. “It doesn’t really get enough attention.”

On July 22, hospitals in nearly 40 states reported: critical staff shortageswhile hospitals in all 50 states said they expected within a week.

Several states where the number of Covid-19 cases is rising have major and growing problems, although factors besides Covid are also at play.

In California, for example, only eight hospitals described their July 22 staff shortage as critical, while 118 expected it within a week. In Louisiana, only one hospital reported a critical shortage last week, but 46 will have one this week. More hospitals also expected shortages in Alabama, Florida, Kentucky, New Mexico, Tennessee and West Virginia — all states with rising cases.

“While we have faced staff shortages in the past, we are now well aware of staff shortages in virtually every function within the hospital,” said Foster. “If we have a large influx of Covid patients, meeting those demands will be much more challenging than ever before.”

Chronic shortages of hospital staff will remain a long-term problem, administrators said, because even vaccines that have proven highly effective in preventing serious illnesses won’t keep everyone out of the hospital. There is also growing resistance from Americans to mitigating measures such as social distancing and masking, and the unwillingness of officials to sound the alarm during a wave in which fewer people are seriously ill and dying than during the previous one.

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Hospital ICUs are not overrun with Covid-19 patients as in previous waves, and the average daily deaths hover around 350according to the Centers for Disease Control and Prevention, far below the thousands of Americans who died each day in previous peaks.

But serious strains on the health care system continue without that grim toll.

“I don’t think people appreciate the consequences because we can now transmit the virus almost randomly,” said David Wohl, the infectious disease expert who leads the Covid-19 response at UNC Health in North Carolina. “If there are supply chain problems, if there are delays in getting services, or if people say, ‘Well, I’m understaffed, I can’t do it,’ it’s because of the pandemic.”

‘Robbing Peter to pay Paul’

Hospital staff shortages — from nurses to doctors to medical lab technicians — existed before SARS-CoV-2, the result of both the aging of the health care workforce and an aging population in general that is driving up the demand for care.

The pandemic created a kind of knock-on effect in the medical community, said Sherry Polhill, associate vice president of hospital labs, respiratory care and pulmonary function services at UAB Medicine in Birmingham, Ala.

It pushed older workers to leave their jobs early and sparked a boom in the lucrative traveling medical professional industry that lured people away from their staffing jobs.

“You have a void of vacancies to fill and that’s not easy,” Polhill said, adding that it can take years to fill the open positions in her labs.

The shortage affects hospitals – and their patients – in different ways, as BA.5 has been shown to be able to evade immunity and become the dominant strain in the country.

In North Carolina, where business is on the rise almost 20 percent For the past two weeks, UNC Health has struggled to meet increasing patient demand for monoclonal antibody treatments.

Hospitals still offer the antibody treatment to people taking medications that can interact negatively with a simpler therapeutic agent, Paxlovid. Unlike Paxlovid, a pill that can be taken anywhere, monoclonal antibodies are delivered through an IV, a labor-intensive process that requires careful infection control to treat patients in infusion centers that also treat immunocompromised individuals.

For that to work, Wohl said, the hospital needs to borrow staff from other departments.

“We have to rob Peter to pay Paul,” he said. “If you have people who work in an IV center, what was their day job before Covid? Some of them worked in the emergency room. Some of them were working in the operating room. You just can’t take people out of these other critical functions and always have them work elsewhere.”

Next door in South Carolina, staff shortages at the Medical University of South Carolina have already prompted the hospital to stop testing all admitted patients for Covid-19, as it did before in the pandemic.

The facility received funding from a Covid-19 relief law congress passed in March 2020 to build its testing capacity with new equipment and staff.

With that money starting to dry up, Hirschhorn has had to cut back on shifts and employees. Her lab, one in a network of them at the hospital, had 44 employees and contract workers at the height of the pandemic, but only 10 full-time employees today. To be Testing capacity for Covid-19 has fallen from about 3,500 per day to 1,500.

The decision to discontinue routine Covid testing has helped keep the lab from becoming overwhelmed, even though the number of people hospitalized with Covid has risen 34 percent in South Carolina in the past two weeks. But Hirschhorn said it makes her uncomfortable to know she no longer has the resources to back up when needed.

“We’re all trying to figure out what our lab looks like now and what we can do to prepare for another peak, knowing that we won’t have the same staffing levels as other peaks,” she said. . “We’re flying blind.”

Pandemic fatigue

That fear is widespread in hospitals, where the pandemic has exacerbated the pre-pandemic staff shortage.

“Medical lab scientists are unhappy right now,” said Susan Harrington, a microbiologist at the Cleveland Clinic and chair of the Laboratory Workforce Steering Committee of the American Society for Clinical Pathology. “They’re working too hard, and they’ve been working too hard for too long.”

“What’s the end of this?” she asked. “I don’t really know the answer.”

While hospital labs are generally much better prepared to handle this wave of cases than they are in 2020, the Medical University of South Carolina isn’t alone in stopping testing all hospitalized patients for Covid-19 due to staffing levels, Jonathan Myles said. president of the College of American Pathologists’ Council on Government and Professional Affairs.

A lack of local testing capabilities creates a greater danger to patients and the community, he said, especially in rural facilities operating in economically deprived areas. “They operate on a little bit,” he said. “If you limit testing in rural settings, you exacerbate inequalities in healthcare.”

Large urban hospitals may be better positioned to juggle during periods of high transmission, but with more workers calling in sick and more patients testing positive, they too are under pressure.

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

“People are getting Covid left and right,” said Anish Mahajan, CEO and Chief Medical Officer of the facility.

So far, the hospital has accommodated this rise in the number of cases, he said, with slightly longer wait times in the emergency room due to staff shortages and more patients. The hospital may need to re-prioritise emergency care if it gets worse.

The only real way to end the uncertainty is to stop the virus through vaccination and by taking measures to stop the spread, he said, such as putting masks back on when transmission is high.

“The more the virus transmits in our world, the more likely we will see the generation of future variants emerge,” Mahajan said. “Perhaps this variant will not ensure that so many people end up sick in hospital. But we don’t know what the next variants will do.”