12:00 PM on April 24, 2020 by Christopher Kerns and Andrea Martin
The
Covid-19 pandemic continues to spread across the United States. To help
navigate the developments, we have compiled a list of 10 key takeaways on
Covid-19, consolidated from our webinar on April 23.
Join us Thursday, April 30, for
an update on where things stand.
1.
US case count tops 800K
The number of Covid-19 cases in the United States is now over 800,000, but there are signs that the number of deaths may be starting to plateau. Daily deaths in New York and California have both declined for several days in a row, while other states like Michigan and Florida are still seeing spikes in mortality. The next week will determine if this plateau is the top of the peak or if it a temporary leveling before another rise in deaths.
The number of Covid-19 cases in the United States is now over 800,000, but there are signs that the number of deaths may be starting to plateau. Daily deaths in New York and California have both declined for several days in a row, while other states like Michigan and Florida are still seeing spikes in mortality. The next week will determine if this plateau is the top of the peak or if it a temporary leveling before another rise in deaths.
2.
Some states projected to
see capacity shortages
With the exception of Covid-19 hotspots like New York, Michigan, and Louisiana, the majority of the country has the capacity to handle a surge of Covid-19 patients in the ICU. However in this week's projections there is a new alarming trend. Wyoming is now predicated to be short 105 ICU beds at its peak when previously the state was not projected to have capacity shortages. Experts have warned that rural America is not immune to Covid-19, but it would take time for the virus to make its way from urban hotspots to rural towns, which is exactly what this week’s models portray. The most rural states are predicted to be the last to hit their peak of the curve.
With the exception of Covid-19 hotspots like New York, Michigan, and Louisiana, the majority of the country has the capacity to handle a surge of Covid-19 patients in the ICU. However in this week's projections there is a new alarming trend. Wyoming is now predicated to be short 105 ICU beds at its peak when previously the state was not projected to have capacity shortages. Experts have warned that rural America is not immune to Covid-19, but it would take time for the virus to make its way from urban hotspots to rural towns, which is exactly what this week’s models portray. The most rural states are predicted to be the last to hit their peak of the curve.
3.
Rural America acutely
vulnerable to outbreaks
Despite less density, rural America is particularly vulnerable to viral outbreaks. The average population of rural parts of the country is made up of older individuals who have higher rates of chronic disease. The majority of jobs in rural towns do not allow people to work from home, preventing social distancing measures from blocking the spread of the virus. When outbreaks occur, there are few health care resources to care for very sick patients. Many critical access hospitals struggle financially to keep the doors open and are not staffed to care for more than a handful of patients.
Despite less density, rural America is particularly vulnerable to viral outbreaks. The average population of rural parts of the country is made up of older individuals who have higher rates of chronic disease. The majority of jobs in rural towns do not allow people to work from home, preventing social distancing measures from blocking the spread of the virus. When outbreaks occur, there are few health care resources to care for very sick patients. Many critical access hospitals struggle financially to keep the doors open and are not staffed to care for more than a handful of patients.
4.
States try to control
coronavirus spread as they seek to restart local economies
Although many states are moving forward with lifting stay-at-home restrictions, they continue to face a tension between restarting the economy and controlling the spread of the Covid-19. The Trump administration issued clear re-opening guidelines, but many governors express that they're unable to move forward with the White House plan until they have the resources and supplies required to complete widespread testing. The vast majority of states have not been able to increase testing rates, and although it is not clear how many tests are needed to contain future Covid-19 outbreaks, states will need to drive testing numbers higher than they are today.
Although many states are moving forward with lifting stay-at-home restrictions, they continue to face a tension between restarting the economy and controlling the spread of the Covid-19. The Trump administration issued clear re-opening guidelines, but many governors express that they're unable to move forward with the White House plan until they have the resources and supplies required to complete widespread testing. The vast majority of states have not been able to increase testing rates, and although it is not clear how many tests are needed to contain future Covid-19 outbreaks, states will need to drive testing numbers higher than they are today.
5.
Clinical trials show
promising results
On a more positive note, there are two promising Covid-19 treatments in development. Patients with severe Covid-19 were given Remdesivir at the University of Chicago demonstrated improvements in fever and respiratory symptoms, lowering the average length of stay to under a week. A second trial at Mayo Clinic using convalescent plasma (transferring antibodies from a recovered Covid-19 patient to an infected patient) is improving Covid-19 symptoms. While both of these studies still need to complete widespread trials to evaluate efficacy, they demonstrate that we are moving closer to securing treatments.
On a more positive note, there are two promising Covid-19 treatments in development. Patients with severe Covid-19 were given Remdesivir at the University of Chicago demonstrated improvements in fever and respiratory symptoms, lowering the average length of stay to under a week. A second trial at Mayo Clinic using convalescent plasma (transferring antibodies from a recovered Covid-19 patient to an infected patient) is improving Covid-19 symptoms. While both of these studies still need to complete widespread trials to evaluate efficacy, they demonstrate that we are moving closer to securing treatments.
6.
Some hospitals to resume
elective procedures
Hospitals that have a sufficient supply of PPE, testing, beds, and staff are preparing to resume elective procedures. Organizations must have enough excess resources on-hand for future Covid-19 outbreaks in addition to what is needed to complete routine care, meaning initially organizations will only be able to offer a portion of their original volumes. Leaders are carefully balancing clinically urgent procedures with high throughput, low resource intensity procedures in the initial opening phases.
Hospitals that have a sufficient supply of PPE, testing, beds, and staff are preparing to resume elective procedures. Organizations must have enough excess resources on-hand for future Covid-19 outbreaks in addition to what is needed to complete routine care, meaning initially organizations will only be able to offer a portion of their original volumes. Leaders are carefully balancing clinically urgent procedures with high throughput, low resource intensity procedures in the initial opening phases.
7.
Most health systems face
cash flow problem
The overwhelming majority of health systems are facing an immediate cash flow problem. Although Congress allocated additional funding to support hospitals, organizations will likely see continued downward pressure on margins. Future financial health will heavily depend on two main variables. First, how much will it cost organizations to care for Covid-19 patients? While payments for treating Covid-19 patients are likely to have a positive effect on revenue, it may not be enough to offset other factors like surge capacity costs and lost productivity. Second, what percentage of volumes will organizations be able to recover? Economic challenges are likely to depress original demand and demand going forward.
The overwhelming majority of health systems are facing an immediate cash flow problem. Although Congress allocated additional funding to support hospitals, organizations will likely see continued downward pressure on margins. Future financial health will heavily depend on two main variables. First, how much will it cost organizations to care for Covid-19 patients? While payments for treating Covid-19 patients are likely to have a positive effect on revenue, it may not be enough to offset other factors like surge capacity costs and lost productivity. Second, what percentage of volumes will organizations be able to recover? Economic challenges are likely to depress original demand and demand going forward.
8.
Frontline providers grow
frustrated over hospital practice environments
As the pandemic continues, there is growing frontline frustration with hospital practice environments. Nursing organizations are upset with the lack of PPE and resources to protect workers from contracting Covid-19, which could only be the beginning of a larger divide between frontline workers and health care executives. If hospital finances continue to decline, leaders will be tasked with finding savings across the organization, likely including some cuts to the labor budget. Now is the time for organizations to plan for a labor contingency plan to avoid further tensions with frontline staff.
As the pandemic continues, there is growing frontline frustration with hospital practice environments. Nursing organizations are upset with the lack of PPE and resources to protect workers from contracting Covid-19, which could only be the beginning of a larger divide between frontline workers and health care executives. If hospital finances continue to decline, leaders will be tasked with finding savings across the organization, likely including some cuts to the labor budget. Now is the time for organizations to plan for a labor contingency plan to avoid further tensions with frontline staff.
9.
Covid-19 is teaching the
industry some important lessons about the country's supply chain
In an attempt to improve the efficiencies, organizations have removed waste and streamlined supply chains, unintentionally creating inflexibilities that prevent the mobilization required during a crisis. The lack of supplies—like masks, PPE, ventilators, testing swabs—have severely limited how the United States is able to handle a massive surge of Covid-19 patients. A future more-resilient supply chain will require industry-wide changes from providers, the government, and suppliers.
In an attempt to improve the efficiencies, organizations have removed waste and streamlined supply chains, unintentionally creating inflexibilities that prevent the mobilization required during a crisis. The lack of supplies—like masks, PPE, ventilators, testing swabs—have severely limited how the United States is able to handle a massive surge of Covid-19 patients. A future more-resilient supply chain will require industry-wide changes from providers, the government, and suppliers.
10.
Post-Covid, some patients
may need intensive interventions
At the start of this pandemic, it appeared that large percentages of the senior population could die and providers would experience a shift in utilization patterns. The good news is that at this point, the death toll from Covid-19 will likely not be as severe as originally projected and only the hardest hit portions of the country may notice a decline in Medicare utilization. But it is more probable that providers across the country will experience different demand from the Covid-19 shutdown. For example, surviving Covid-19 patients may need ongoing care, and patients who delayed hospital visits during the pandemic will likely require more intensive interventions.
At the start of this pandemic, it appeared that large percentages of the senior population could die and providers would experience a shift in utilization patterns. The good news is that at this point, the death toll from Covid-19 will likely not be as severe as originally projected and only the hardest hit portions of the country may notice a decline in Medicare utilization. But it is more probable that providers across the country will experience different demand from the Covid-19 shutdown. For example, surviving Covid-19 patients may need ongoing care, and patients who delayed hospital visits during the pandemic will likely require more intensive interventions.
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