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3 of 4 US Hospitals Facing COVID-19    04/06 06:07

   Three out of four U.S. hospitals surveyed are already treating patients with 
confirmed or suspected COVID-19, according to a federal report that finds 
hospitals expect to be overwhelmed as cases rocket toward their projected peak.

   WASHINGTON (AP) -- Three out of four U.S. hospitals surveyed are already 
treating patients with confirmed or suspected COVID-19, according to a federal 
report that finds hospitals expect to be overwhelmed as cases rocket toward 
their projected peak.

   A report due out Monday from a federal watchdog agency warns that different, 
widely reported problems are feeding off each other in a vicious cycle. Such 
problems include insufficient tests, slow results, scarcity of protective gear, 
the shortage of breathing machines for seriously ill patients and burned-out 
staffs anxious for their own safety.

   "There's this sort of domino effect," said Ann Maxwell, an assistant 
inspector general at the Department of Health and Human Services. "These 
challenges play off each other and exacerbate the situation. There's a cascade 
effect."

   The inspector general's report is based on a telephone survey of 323 
hospitals around the country, from March 23-27. With hundreds of new 
coronavirus cases daily, the situation is becoming more dire for many the 
nation's 6,000 hospitals. Others can still scramble to prepare. A copy of the 
report was provided to The Associated Press. 

   "Hospitals reported that their most significant challenges centered on 
testing and caring for patients with known or suspected COVID-19, and keeping 
staff safe," the report concluded. 

   "It's likely that every hospital in America is going to have to deal with 
this," Maxwell said.

   In most people, the coronavirus causes mild to moderate symptoms. Others, 
particularly older people and those with underlying health issues, can develop 
life-threatening breathing problems. The U.S. has more diagnosed cases in the 
global pandemic than any other country, according to figures compiled by Johns 
Hopkins University. Projections show the nation will see the peak impact later 
this month.

   Maxwell said the goal of the report was to describe the predicament 
hospitals are facing. She said the key insight is that different problems --- 
usually addressed individually --- are building on each other to entangle the 
whole system. 

   For example, a lack of testing and slow results means hospitals must keep 
patients with unconfirmed coronavirus disease longer.

   That takes up precious beds and uses up protective equipment like gowns, 
masks and face shields, since doctors and nurses have to assume that patients 
with symptoms of respiratory distress may be positive.

   The increased workload raises the stress level for nurses, doctors and 
respiratory therapists, who are also concerned they may be unable to properly 
protect themselves.

   "Health care workers feel like they're at war right now," a hospital 
administrator in New York City told the inspector general's investigators. They 
"are seeing people in their 30s, 40s, 50s dying. ... This takes a large 
emotional toll." The inspector general's office did not identify survey 
respondents due to privacy concerns. 

   Overtime hours and increased use of supplies are raising costs at the same 
time that many hospitals experience a revenue crunch because elective surgeries 
have been canceled. The recently passed federal stimulus bill pumps money to 
hospitals.

   "It is in fact a national challenge, not just from the hot spots, but from 
all over the country," Maxwell said. Rural hospitals are vulnerable because of 
a limited number of beds and smaller staffs.

   Of the 323 hospitals in the survey, 117 reported they were treating one or 
more patients with confirmed COVID-19, while 130 said they were treating one or 
more patients suspected to have the disease. Suspected infections are treated 
similarly, because of the uncertainties around testing. Only 32 hospitals said 
they were not treating any patients with confirmed or suspected COVID-19. 
Another 44 hospitals did not provide that information. 

   "Hospitals anticipated being overwhelmed by a surge in COVID-19 patients, 
who would need specialty beds and isolation areas for effective treatment," the 
report said.

   Parts of Europe provide a glimpse of what hospitals here are trying to 
avoid. The AP reported last week that some European nations are throwing 
together makeshift hospitals and shipping coronavirus patients out of 
overwhelmed cities via high-speed trains and military jets. In Spain, doctors 
are having to make agonizing decisions about who gets the best care. In the 
U.S., two Navy hospital ships have been deployed and field hospitals erected.

   How to set priorities for the use of ventilators, breathing machines that 
can sustain life, is one of the most worrisome questions. Hospitals from 
Louisiana to New York and Michigan are already confronting projected shortages, 
the AP reported last week.

   "Government needs to provide guidelines on ethics if health resources are 
limited and decisions need to be made about which patients to treat," a 
hospital official in Broward County, Florida, told the inspector general's 
office. "Are physicians liable for their decisions if that happens?"

   Many hospitals are responding by improvising their own solutions. Some 
explored buying face masks from nail salons due to the shortage of personal 
protective equipment, or PPE. Others have been trying to make their own hand 
sanitizer by blending ultrasound gel with alcohol from local distilleries.

   Ingenuity can create its own worries.

   "We are throwing all of our PPE best practices out the window," a hospital 
administrator in West Texas told the inspector general's office. "That one will 
come back and bite us."


(KR)

 
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