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Government watchdog warns hospitals face severe supply shortages

As the U.S. entered “peak death week” in the coronavirus outbreak, an internal government watchdog reported Monday that hospitals are in dangerously short supply of not only protective gear and testing kits, but basic materials like thermometers, toilet paper and disinfectants, putting health care workers at risk.

The Health and Human Services Office of Inspector General report flags challenges hospitals are facing — most already widely reported by health care workers on the front lines of the outbreak — that paint an alarming picture of a system struggling to keep pace with the highly contagious virus. 

In a survey of 410 hospitals across 47 states, the government health investigators confirmed reports that hospitals are making do without proper personal protective equipment, or PPE, like masks and face shields due to the lack of a robust supply chain delaying or preventing restocking.

As the U.S. death toll topped 10,000 on Monday, the publicly released report further verified severe concerns that as hospital shelves emptied, doctors and nurses have been forced to protect themselves with “new, sometimes un-vetted, and non-traditional sources of supplies and medical equipment.” This includes reusing single-use masks, exploring methods to sterilize disposable masks and turning to non-medical-grade equipment like handmade face shields and gowns. 

But the inspector general also found hospitals are short on basic supplies to keep patient rooms functioning, including medical gas, linens, toilet paper, no-touch infrared thermometers and cleaning supplies.

“Isolated and smaller hospitals faced special challenges maintaining the supplies they needed and restocking quickly when they ran out of supplies,” the report states. 

The unorthodox moves to keep afloat also extend to staffing procedures: “To ensure adequate staffing to treat patients with COVID-19, hospitals were training medical staff such as anesthesiologists, hospitalists, and nursing staff to help care for patients on ventilators,” the report found. 

John Romley, a professor at the University of Southern California and expert on the hospital industry, said in an interview Monday that the ad hoc strategy was a good call. 

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“Operating a ventilator takes some expertise,” Romley said. “But it’s also not something that you have to spend years getting board certified for, and someone who is 80% trained up on it is better than not having anyone at all.” 

While President Donald Trump has questioned the need to rapidly supply hospitals with thousands of new ventilators, governors in hard hit states criticized the federal government’s failure to shore up the supply chain as medical staff scrambled to respond to spikes in positive tests for Covid-19. 

Backing the state-raised alarm, the report concluded that ventilator shortages are a major concern. Reports have already begun to surface that doctors in New York are deciding who to save by weighing which patients to hook up to ventilators based on an individual’s chance of survival. 

“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 states, grazing the highly controversial issue that is already a stark reality in some European countries. 

Romley said doctors in the U.S. will likely continue to have to make tough calls on who to save. 

“There’s a good probability that we just can’t turn away from making those decisions…We are going to see some heart-wrenching stuff here too,” the professor said.  

The inspector general findings also support concerns raised by state authorities across the country calling out the federal government for failing to provide critical equipment, as prices have spiked across supply chains. 

“Many hospitals noted that they were competing with other providers for limited supplies, and that government intervention and coordination could help reconcile this problem nationally,” the report found, adding that hospitals want the government to ensure they have access to test kits, swabs, protective supplies and ventilators.

Hospitals that have shifted their normal operations to respond full force to the outbreak may soon run short on revenue. 

“Many hospitals reported that their cash reserves were quickly depleting, which could disrupt ongoing hospital operations,” the report warned. 

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From USC, Romley likewise linked the bidding wars between governors for protective equipment to the federal government’s failed response to the outbreak.

“People are doing heroic things under the circumstances,” the professor said, arguing many lives could be saved by a stronger response from Washington. “What troubles me is that we’re not seeing stronger leadership at the federal level across the board.”

The strain on medical staff has been further exacerbated by slowdowns in testing as hospitals wait on results, hindered by incomplete test kits. While beds fill up, medical staff have been forced to hold out a week or longer for confirmation that a patient has contracted Covid-19. 

Health and Human Services Secretary Alex Azar, while seemingly sidelined from the federal response to the outbreak, has at times praised the bravery of American health care workers in press conferences from the White House. 

But the agency’s inspector general reported the alarming toll the virus is taking on the nation’s medical workforce. 

“Hospitals reported a shortage of specialized providers needed to meet the anticipated patient surge and raised concerns that staff exposure to the virus may exacerbate staffing shortages and overwork,” the report states. “Hospital administrators also expressed concern that fear and uncertainty were taking an emotional toll on staff, both professionally and personally.”

Continuing to contradict medical experts, Trump on Monday tweeted “USA STRONG!” and “LIGHT AT THE END OF THE TUNNEL!”

Meanwhile, Admiral Brett Giroir, a physician and member of the White House coronavirus task force, warned on ABC’s “Good Morning America” that “it’s going to be the peak hospitalization, peak ICU week and unfortunately, peak death week.” 

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