A new study conducted via the U.S. Premier Healthcare Database revealed nearly one in every four COVID-19 deaths may be attributed to hospital strain related to case overload. The results exposed staggering mortality rates suggesting that, despite improvements in COVID-19 survival between March and August 2020, surges in hospital COVID-19 caseload remain detrimental to survival and potentially erode benefits gained from emerging treatments. The lack of preparation from hospitals experiencing high surges and even higher mortality rates is devastating and, furthermore, reveals an opportunity for the United States to take steps forward to prevent this from happening again.
Hospitals around the globe have contended with large surges in COVID-19 patients throughout the pandemic. The U.S., in particular, has been met with a rapidly escalating demand due to staff availability and burnout, limited space and supplies, and a decrease in personal protective equipment (PPE) to effectively treat patients. Insufficient intensive care unit (ICU) bed availability and increasing community case burden have also been implicated as risk factors for poor COVID-19 patient outcomes.
Prior to the pandemic, hospitals were already met with a shortage of supply, limiting their ability to provide proper care for patients. A study published in April of 2021 suggested that sixty-three percent of intensive care unit (ICU) beds in U.S. hospitals were occupied prior to the pandemic, leaving the health system with approximately 32,000 unoccupied intensive care unit beds at baseline. Now, with the COVID-19 virus spreading exponentially, healthcare systems are left with an even heavier burden and consequences at a much higher cost.
The challenge moving forward is to make sure these hospitals are not only properly equipped and staffed in normal times, but also that they have the ability to manage a surge in cases by providing the necessary staff, personal protective equipment, and beds to deliver quality care in the midst of a national health crisis. If done properly, many COVID-19 deaths may be preventable and public healthcare organizational interventions will minimize the effect of surges on individual patients nationwide.
Some counties, however, had already taken these steps leading to the successful prevention and management of surges during the COVID-19 pandemic. Perhaps the most sophisticated of these is China. The Chinese approach included strategies such as proper management of human resources, communication, security, hygiene, and planning. Their hospitals also provided specific COVID-19 training for staff, focused on the well-being of healthcare workers, implemented sophisticated technologies, and involved various government healthcare organizations while handling the first wave of the COVID-19 crisis. E-health, telemedicine, and internet hospital interventions also made healthcare more approachable and affordable for many vulnerable groups across the country.
One of China’s most impressive approaches to handling the COVID-19 pandemic included building prefabricated and fully equipped hospitals, in the span of nearly two weeks, to halt the virus from spreading throughout Wuhan and other local districts. The purpose of these facilities was two-fold: to keep infectious patients isolated and to allow routine hospitals to continue caring for other patients. While other countries, such as Japan, were quick to follow this approach, the United States lacked the planning and resources to undergo such a judicious task.
In another example, Taiwan implemented a series of procedures to follow in response to surges in their emergency departments. During early stages of the pandemic, their hospital systems designed an indoor infection isolation area for each department, including two negative-pressure isolation rooms and two isolation areas with an independent ventilation system and four beds each. In accordance with incoming surges, however, they advanced their system by adding ten well-ventilated single-room tents at outdoor parking lots immediately outside emergency department entrances. They also transformed an outdoor concrete chemical decontamination area into a radiograph room, personal protective equipment removal corridor, and shower service. High-risk patients with oxygen demand or critical conditions were transported to indoor infection isolation areas for any resuscitation support.
While other countries such as China and Taiwan have added proper preventative measures to ensure bespoke service amid the pandemic, the U.S. is falling significantly behind. The treatment paradigm for COVID-19 is rapidly evolving and hospitals have grown situational awareness, but more lead time for planning and federal and state support must be gained over time. Countries where a substantial portion of the population has been vaccinated show new surges in rapid variants highlighting the continuous need for improved emergency response systems.
Although we can learn from other hospital systems, the U.S. certainly has the capability to manage COVID-19 as well or better than any country in the world. A coordinated effort must be implemented across all states to ensure that hospitals have the capacity to deliver high quality care even in the midst of a crisis. Such a systematic rethink also requires long-term planning as COVID-19 will not be the last pandemic this generation of Americans will experience.
Plans must consist of fundamental training so that every county is prepared for surge capacity, necessary equipment and instruction provided by state and federal governments, routine audit spot checks to ensure hospitals have supplies on hand to protect healthcare workers and patients, and proper education for local hospital employees to handle distressed systems. Other options for future surges also include building advanced temporary hospitals as seen in China and Japan. These changes will allow for improved care in COVID-19 facilities and normal medical procedures including serious surgeries and elective procedures which should not be interrupted by case surges. Unless we learn from the past, we are doomed to repeat the tragedies of the last year and a half. Altogether, it is time for our hospitals to learn from the best, so that all patients, no matter where they are treated and no matter what current state, are given the best chance medicine can offer.