An Urgent Need To Reopen Medical Care For All

A shorter version of this article was originally published in The Hill.

Each day in America and in most countries around the world brings with it a new story of crowded hospitals packed with panicked patients and exhausted health workers. But there is another story, equally tragic, unfolding in the privacy of our homes, with countless numbers of Americans with chronic conditions and other serious illnesses languishing in isolation without access to care. While hospitals have of course remained open throughout the Covid-19 crisis, only the most urgent cases pass through the doors. Less critical patients are offered virtual visits instead, despite the fact that many are managing equally serious and life-threatening conditions.

A close friend of mind was recently diagnosed with colon cancer at one of the top hospitals here in New York. While the treatment for his condition is clear, the timeline to be treated is not. He was told via a virtual visit that he would have to wait for surgery to remove the growth, since his condition was not yet urgent enough to warrant immediate care. My friend is better off than many others. The New York Times recently wrote about a blood cancer patient in Philadelphia in need of chemotherapy. Unfortunately, blood supplies were rationed across the city and the patient couldn’t get enough transfusions to allow his chemotherapy to begin. His clinic visits were canceled, his condition worsened, and by the middle of April, he had passed away, a death expedited by Covid-19.

Stories like these are just the tip of the iceberg. Doctors across the country have been reporting concerning trends among patients, with many delaying much needed care because of concerns about contracting Covid during an emergency room visit. A survey of nine major hospitals published earlier this month in the Journal of the American College of Cardiology found that the number of patients presenting with severe heart attacks had dropped by nearly forty percent since March. Vaccinations and well-child visits have seen a similar deterioration, with millions of children now at greater risk of infection of other preventable diseases due to the stark decline.

All this reinforces the undeniable fact that the first facilities to reopen in our communities must be our hospitals. The Centers for Medicare & Medicaid Services (CMS) recently released guidance for reopening healthcare facilities for non-emergent cases, but the advice included is vague at best. While the guidance includes recommendations for screening patients and staff and creating non-Covid care zones to provide safe care to patients who test negative, it offers no advice on when to screen patients or how to set up non-Covid care zones.

Though perhaps counterintuitive, the first step to reopen our hospitals is to assume everyone is infected and infectious. Working under this assumption, patients, providers and hospital administrators alike will behave with the necessary caution to keep people safe. Screening and testing of providers and patients is critical, as is the need for a plan for what should be done if someone tests positive, especially staff members who risk spreading the infection to other patients.

Unfortunately, state guidance on this front is woefully inadequate and, in some cases, downright dangerous. State departments of health in even the hardest hit areas suggest that healthcare professionals can return to work after testing positive for Covid-19, assuming they have been symptom free for just three days and seven days have passed since their symptoms first developed. This despite the fact that studies have shown that some people may be infectious for up to ten days after obvious symptoms have resolved.

In the absence of more careful guidance, many medical centers have developed more stringent guidelines for their healthcare professionals, providing greater protection for them and their patients than the current guidance requires. Some hospitals are already facing lawsuits from staff who claim that hospitals have not done enough to protect healthcare workers from home, alleging shortcomings ranging from a lack of personal protective equipment to inadequate training for staff redeployed to Covid wards. Their concerns are not unfounded — one in five people in the United States with Covid-19 are healthcare professionals.

In addition to designing their own strategies to protect healthcare workers, hospitals are also crafting their own plans to protect patients. Some hospital systems have created broad networks of ambulatory care centers that operate as outpatient facilities. These clinics are far more robust than your average walk in clinic, with some health systems providing up to eighty percent of all surgeries — including complex neurosurgery and total hip replacements — in ambulatory care settings. Some hospital administrators think their best bet may be to funnel patients suspected of Covid-19 to the hospitals while maintaining a steady supply of high quality services for non Covid patients through the ambulatory care centers. This would keep hospital beds free for the worst Covid patients and still provide high quality care to other patients in need. To ensure that the non Covid facilities remain Covid free, patients and providers might be screened in the days leading up to appointments, as well as on the appointment day itself.

All of this extra effort will require additional resources, something that is becoming a pivotal challenge for all hospitals large and small. A substantial portion of a hospital’s income comes from elective surgeries. Ever since facilities were forced to cancel these procedures to ramp up Covid care, they have been hemorrhaging cash in extraordinary amounts. In New York State alone, one of the Buffalo region’s smallest hospitals has said they are losing roughly $1 million each month. In New York City, some of the major medical centers are losing as much as $450 million.

The same is happening in hospitals throughout the country. A USA Today investigation found that almost half of all counties with coronavirus cases are served by a hospital that reported a net loss in 2017. Their analysis predicts that, because of the Covid crisis, more than one hundred hospitals could shutter within a year. Many of these hospitals are in rural communities it means that when these hospitals close, there will be no other medical facility able to step in. Tens of thousands of Americans will be left without hospital care.

The only way these hospitals can survive is with an immediate infusion of money. True, there are some large hospitals with generous endowment funds that may be able to make it through the crisis without outside support. But smaller hospitals in rural communities and many safety net hospitals in larger cities are running out of cash already. We cannot charge patients more for the care they are receiving. A recent poll suggests that one in seven Americans avoid seeking care because of the financial burden and potential cost. The onus is on our government to step in and support our hospitals as they reopen fully. It is quite simply a matter of life and death, not convenience or economic recovery.