National action plan addresses healthcare system’s expansion and change for remainder of COVID-19 pandemic
A new report from experts at Johns Hopkins University Center for Health Security offers a plan for expanding and adapting the US healthcare system for the duration of the COVID-19 pandemic.
The COVID-19 pandemic has led to unprecedented action and innovation in the US healthcare system; at the same time, it has presented extraordinary challenges and risks, addresses the report.
Through dramatic augmentation of surge capacity, deferral of other services and implementation of crisis standards of care, hospitals in many locations have been able to absorb the blow of the first peak of COVID-19 cases and continue to provide lifesaving care to both COVID-19 patients and others with life-threatening emergencies. But many communities are just beginning to experience the full force of the pandemic, and in every location, the healthcare response to COVID-19 has come at a very dear price. Healthcare facilities have sustained huge financial losses, and healthcare workers’ health and well-being have been put at high risk. New standard operating procedures and work processes have been improvised, and many old lessons have had to be relearned.
There is an urgent near-term need to address key challenges faced now by healthcare facilities and healthcare workers in the pandemic, and this current crisis also has made painfully apparent the many vulnerabilities of our healthcare system and the longer-term structural reforms that are necessary to sustain it. This report offers answers and recommendations related to the following problems, for which there are tractable solutions:
• How can we improve infection prevention in hospitals and maintain a robust supply chain for personal protective equipment (PPE)?
• What approach should we take to restarting deferred healthcare services?
• What financial support is needed for hospitals and healthcare providers?
• How should the healthcare workforce be sustained and augmented?
• How can we provide mental health support for healthcare workers in this crisis?
• How can we provide medical care and sick leave for all people in the United States?
• How can we make telemedicine a new normal?
• How can we reduce the number of undiagnosed infectious diseases in our hospitals?
• How can we better protect emergency medical services (EMS) personnel from infectious diseases?
• How can we better coordinate the healthcare response to COVID-19 and the next pandemic?
For example the section on how can we improve infection prevention in hospitals and maintain a robust supply chain for PPE offers guidance on the opportunities for nosocomial COVID-19 transmission in the healthcare system are numerous, particularly during aerosol-creating procedures such as intubation or manual ventilation.
To prevent transmission in hospitals, infection prevention and control measures must be improved and maintained. The US Centers for Disease Prevention and Control (CDC) has provided and regularly updates guidelines on their website for infection prevention and control in healthcare settings. These recommendations, which cover topics such as ways to reduce exposure opportunities, patient isolation, staff training, infection prevention and control precautions, and environmental infection control, should be reviewed and implemented by all healthcare facilities.
Importantly, to properly operationalize these guidelines, facilities need consistent access to sufficient levels of proper PPE and other materials necessary to prevent transmission, such as hospital-grade disinfectants and hand sanitizer. Unfortunately, shortages of these resources, particularly PPE, have been widespread during the pandemic due to high demand, fragile supply chains, and limited stockpiles.
This has greatly hindered infection prevention and control efforts. Whereas the national need for PPE during this first wave of the pandemic has been estimated, there is no publicly available information on the supply. Although PPE from the federal Strategic National Stockpile (SNS) has been distributed, for the most part healthcare facilities and states have had to source their own limited supplies of PPE, often in competition with each other. There are several critical elements of the supply and use of PPE that must be considered at the state and federal levels in order to ensure ongoing healthcare operations.
At each of the federal, state, and healthcare facility levels, PPE supplies and needs should be systematically and continually assessed. Supply chain issues are typically part of the incident command structure at each level. However, there is no preexisting mechanism for providing needed situational awareness regarding the availability of supplies. No agency of government is responsible for tracking supply or manufacturing capacity for PPE, and manufacturers are not required to report this information.
To determine near-term PPE needs, forecasting scenarios should be used at all levels (including alternative PPE supplier options) to get ahead of possible absolute shortages. If PPE supplies are not adequate to permit their use under conventional standards, back-up options should be identified in line with crisis standards of care guidelines to use PPE in ways that diverge from normal practices. It is critical to implement a strategy to monitor PPE use and distribution and to centralize visibility of orders placed at every level. This improves purchasing power and allows for strategic realignment of supplies to match needs and fill gaps in coverage. It also allows for the identification of potential failure points and bottlenecks. These areas can then be targeted for rapid intervention and mitigation strategies.
