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Our Take: Hospitals feel the strain of staff shortages with the omicron-fueled COVID-19 surge

Jan 17, 2022

Hospitals across the country are contending with a triple whammy: a record-setting surge in COVID-19 hospitalizations associated predominantly with the omicron variant, burnout among their staffs following wave after wave of COVID-19 hospitalizations for nearly two years, and now, significant staff shortages as more and more health care workers become infected or are quarantining following exposure to COVID-19.

Early last week, CNN reported that nearly a quarter of the nation’s hospitals were experiencing a “critical staffing shortage,” citing data from the Department of Health and Human Services (HHS). Specifically, of the 5,000 hospitals reporting the data to HHS on Jan. 8, nearly 1,200 indicated a critical staffing shortage, and more than 100 others anticipated a shortage within the ensuing week.

In states where crisis capacity strategies have been implemented, workers at hospitals and other health care facilities who have tested positive and are either asymptomatic or have only mild symptoms are continuing to work or returning after a five-day isolation period — with the blessing of the Centers for Disease Control and Prevention, the state health department and their employer. Some hospitals have said it’s the only way they can keep up with the demand, as caseloads continue to climb.

Last Monday, Reuters reported that hospitalizations in the U.S. had reached a new high since the start of the pandemic, with 132,646 hospitalized patients confirmed positive for COVID-19. On Friday, The New York Times reported the seven-day average at 151,329, a 73% increase in two weeks.

Those figures include patients with “incidental” COVID-19, meaning those hospitalized for other reasons who also have COVID-19. Many of these patients come to the hospital not knowing they are infected, placing hospital staff and other patients at risk. Some who require specialized care can’t be treated in a ward designated for COVID-19 patients, which means extra precautions must be taken to prevent the virus from spreading.

Governors in several states have deployed the National Guard to help alleviate worker shortages in hospitals, and on Thursday President Joe Biden said 1,000 military health personnel would be dispatched in phases to overwhelmed hospitals in six states, starting this week. The Federal Emergency Management Agency (FEMA) has also sent staff in response to states’ requests for support.

Staff shortages are not the only problem. The Guardian reported on Friday that hospitals are almost at capacity in 24 states, with at least 80% of staffed hospital beds occupied. In 18 states, at least 85% of adult ICU beds were occupied. Those figures are also based on HHS data.

The staff shortages, combined with the lack of hospital beds, are causing hospitals throughout the country to cancel elective and non-urgent procedures, including surgeries for patients with critical illnesses.

In Washington, Gov. Jay Inslee ordered a statewide halt of non-urgent procedures for four weeks. In New York, the state Department of Health told hospital-owned ambulatory surgery centers at 40 hospitals to stop non-urgent surgeries for at least two weeks in response to an executive order announced by Gov. Kathy Hochul.

State health officials, hospitals, and other health care facilities are also having to ration treatments that can help prevent milder cases of COVID-19 from progressing to severe disease, as only certain ones — namely Pfizer’s Paxlovid and GSK and Vir Biotechnology’s sotrovimab — appear to be effective against the omicron variant, and supplies are extremely limited.

Our Take: The pandemic continues to cast light on the shortcomings of our national health care system. We were not prepared in early 2020, and nearly three years later we still are not in a position to effectively deal with this no-longer-novel coronavirus.

Viruses mutate, so variants were anticipated. If more people had been vaccinated early on, could we have avoided variants like delta and omicron? We’ll never know, and at this point it doesn’t matter because here we are.

Fortunately, the groundwork for mRNA vaccines had already been laid long before SARS-CoV-2 came into existence, making it possible for drugmakers to develop effective vaccines in a matter of months. Imagine if we’d had to wait for several years for an effective vaccine.

Despite the widespread availability of the vaccines in this country, you can’t force people to get vaccinated if they don’t want to — and tens of millions of Americans don’t want to. Even though only a small percentage of that population is likely to become infected and require hospitalization, the nation’s hospitals simply are not prepared to treat an onslaught of hundreds of thousands of patients on top of those who require care for other illnesses and injuries.

COVID-19 treatments, including the monoclonal antibodies and antivirals, also were developed and authorized in an impressively short amount of time. But omicron has rendered several of those treatments ineffective, and those that are effective are largely unavailable right now. There’s really no equitable way to decide who should receive what limited supply there is, yet someone has to make that call.

And there have been substantial staff shortages for well over a year now, with many health care professionals leaving the field and others battling chronic exhaustion or mental health issues. Omicron has greatly exacerbated the problem, and even traveling nurses are in short supply. Federal funding has been earmarked to expand the health care workforce by providing scholarships and funds for loan repayment, but that could take years to have a noticeable effect.

For now, it looks as though the omicron surge may be starting to drop off in the areas where it first hit hard — at least in terms of case counts. But we all know by now that hospitalizations lag behind infections by a couple of weeks, so it could be early to mid February before many hospitals see some relief.

And then what? How do we better prepare for the next variant, or the next virus that could cause a pandemic? Let’s hope the wheels are already in motion, because surely there will be a next something.

What else you need to know

The vaccine mandate for health care workers can be enforced nationwide, following a 5-4 vote by the Supreme Court on Thursday. The mandate applies to all providers that receive federal Medicare or Medicaid funding, which includes approximately 76,000 health care facilities and most home health care providers. Altogether, the mandate, which allows for medical and religious exemptions, affects an estimated 10.4 million workers. In 25 states and Washington, D.C., workers must have received their first dose of a COVID-19 vaccine by Jan. 27 and the second dose (if receiving an mRNA vaccine) by Feb. 28. In the 24 states where the mandate had been blocked pending the Supreme Court’s decision, workers must be fully vaccinated by March 15. A preliminary injunction blocking the mandate in Texas is still in effect; Texas challenged the mandate in a lawsuit separate from the lawsuit brought by the other 24 states.

CMS proposed providing only limited coverage for Biogen’s Aduhelm (aducanumab). The agency said in a press release that its proposed National Coverage Determination (NCD) would only cover the drug — and other FDA-approved monoclonal antibodies that target amyloid for treating patients with Alzheimer’s disease — for Medicare beneficiaries who are enrolled in qualifying clinical trials. The proposed NCD is open for public comment for 30 days. Last month Biogen cut the list price for Aduhelm by nearly half, from $56,000 for a year of treatment to $28,200. HHS Secretary Xavier Becerra subsequently requested that CMS review its recent premium increase for Medicare Part B. When the agency announced the increase, which is the largest ever in terms of dollar amount, it said the sharp increase was due in part to the possibility that CMS would provide broader coverage for Aduhelm.

A new rule proposed by CMS could lower prescription drug costs for people enrolled in the Medicare Part D program. The proposed rule would require all Part D plans to apply the price concessions they receive from network pharmacies at the point of sale, which would lower beneficiaries’ out-of-pocket expenses. Moreover, the policy would redefine the negotiated price as the lowest possible payment to a pharmacy, effective Jan. 1, 2023. Public comments on the proposed rule must be submitted by March 7.

Pfizer will trim its U.S. sales force by “a few hundred,” Reuters reported Tuesday, citing a source familiar with the matter. The company said it is making the change based on expectations that health care providers will continue to want fewer in-person meetings with sales people after the pandemic ends. New positions will be added in other areas for roughly half of the jobs being eliminated, according to Reuters.

Owens & Minor signed a definitive agreement to acquire Apria, a home heath care equipment provider, in a cash transaction valued at approximately $1.45 billion. According to a press release, the boards of both companies have unanimously approved the acquisition, which is subject to regulatory approval and customary closing conditions. The transaction is expected to close in the first half of this year.

After nearly 10 years, Renton, Wash.-based Providence will end its affiliation with Orange County, California’s Hoag Memorial Hospital Presbyterian by the end of the month. Hoag filed a lawsuit in 2020 to end the affiliation, but Providence fought the lawsuit. A superior court judge overruled Providence’s objections last February. As part of their settlement agreement, Hoag said it would expand its reproductive and women’s health care services.

Hierarchical Payment Models—A Path for Coordinating Population- and Episode-Based Payment Models. JAMA Viewpoint, 1.14.22

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