2 Year

The COVID-19 pandemic has severely taxed every single component of the healthcare system in the United States. None, however, has been more stretched and stressed than medical facilities of all sizes.

In many locations, the unthinkable became routine: patients waiting in ambulances for three hours due to a lack of emergency room space; elective surgeries postponed; patients delaying treatment for other diseases due to COVID-19 fears, sometimes with serious — even fatal — consequences.

As elective surgeries and procedures generate more revenue than emergency care, it’s understandable that many medical facilities are struggling financially. Add to that the fact that obtaining the specialized equipment and supplies to treat COVID-19 patients has also been costly, especially in a seller’s market. A study conducted by Texas A&M University estimated that hospitals lost between $1,000 and $3,000 per COVID-19 patient.

Hospitals also incurred extra personnel costs to maintain adequate treatment staff over the past year. A nationwide nursing shortage during pandemic peaks forced facilities to provide higher pay and sometimes bonuses to attract sufficient qualified staff; some even provided housing or childcare, further adding to their costs. At the same time, staff from other areas of treatment were furloughed or released as demand for their services fell.

The human toll on the doctors and nurses has been particularly severe. The Centers for Disease Control and Prevention (CDC) released figures at the end of February 2021 indicating that more than 412,000 medical workers had contracted COVID-19, and nearly 1,500 had died from the disease — data that the CDC believes is actually a very conservative estimate.

There have also been serious mental health impacts on medical workers. In addition to watching countless patients die under particularly difficult circumstances, many doctors and nurses have had to quarantine away from their families, work highly extended hours, and sometimes work outside their areas of specialty. The result has been fatigue, anxiety, depression, PTSD; in one extreme case, a top emergency room physician in New York City committed suicide due to being overwhelmed by the situation.

In response to personnel issues, some hospitals have brought retired doctors and nurses back on staff. North Dakota even allowed COVID-19-positive nurses to keep working. Needless to say, this has not helped the quality of patient care.

And because too much is never enough, IBM estimates that cyberattacks against hospitals have doubled since the start of the pandemic. These have often been ransomware attacks, as criminals surmise that hospitals cannot afford down time and are more likely to pay.

A Steep Learning Curve
Local facilities never reached the dire situation of patient overflow; for example, at its peak, University Medical Center in New Orleans gave 59% of its patient beds to COVID-19 cases. Nonetheless, non-emergency procedures were postponed, the hospital had to make adjustments like converting post-operation recovery rooms into extra ICUs, and staffing concerns were frequent.

Moreover, the disease itself, as a new virus, created its own set of issues.

“Our biggest challenge was probably understanding the modalities of the disease, because that has been changing and evolving,” said Michael Griffin, president and CEO of DePaul Community Health Centers. DePaul has 10 community health centers throughout the Greater New Orleans region, as well as mobile units, and also has a presence in 23 area schools, which meant their 325 staff members saw and treated a wide variety of patients.

DePaul responded by mobilizing quickly to provide virtual care via telehealth processes, but Griffin noted that “it was difficult to provide the same level of treatment, especially for patients with chronic diseases like diabetes or hypertension. It was very disruptive.”

DePaul’s health centers also had to reduce services such as dentistry and optometry to emergency care only, as in-person visits to the facilities were kept to a minimum. At the same time, the centers had to make the switch to providing COVID-19 testing safely and efficiently; to date, the DePaul facilities have tested some 10,000 patients.

All these changes required establishing a new level of communications with patients.

“We worked really hard to communicate to patients how they could continue to have access to our services,” Griffin reported. “I’m really proud of the speed and flexibility of our team to adjust and continue serving patients.”

DePaul did experience a high level of turnover among support staff. Some were a result of having children suddenly out of school, while others left the healthcare field entirely, concerned about exposing themselves or family members to the coronavirus. All struggled with the new demands placed on them by the pandemic.
“Taking care of our own team quickly became a top priority, as well as a major challenge,” said Griffin.

From HIV to Covid-19
Similar challenges have confronted CrescentCare, another federally qualified health center. Founded in New Orleans in 2013, with two locations in the city and one in Houma, CrescentCare’s origins with the NO/AIDS Task Force gave it a different viewpoint on the pandemic — as well as a different set of challenges in caring for its patient base.

“Our HIV experience gave us some expertise and perspective on the pandemic,” said Dr. Jason Halperin, HIV/infectious disease clinician lead for CrescentCare. “Our DNA is caring for people with HIV, ending that pandemic. Those same lessons came back, especially relating to managing fear in patients.”

CrescentCare’s facilities are intentionally located in underserved areas, which means caring for populations that typically struggle to access quality healthcare. However, like DePaul, they too had to minimize in-person visits; by the end of March 2020, they had converted to almost 100% telehealth. Internet access tends to be lower in these communities, however, so CrescentCare’s patient base frequently encountered difficulties responding to this transition. And, as Halperin observed, “How do you provide care to someone without a phone when you aren’t having clinic visits?” Many patients lost their jobs and were simply struggling to survive, let alone manage their health and face increased challenges navigating the health insurance maze.

In response, CrescentCare cautiously increased their number of home healthcare visits. They expanded their food pantry, and established a 24-hour call center staffed by nurses and providers. Ultimately, they became what Halperin described as a “COVID-19 clinic.”

“We began offering COVID-19 testing on March 14 [2020], and at this point we’ve tested over 15,000 people,” he said. “We provided walk-in testing, and people didn’t have to be previous patients. We saw a lot of very sick people, and in April we were seeing a 45% positive test rate. We tried to provide the best answers we could for these patients, based on the best science available at the time.”

CrescentCare also had to focus on keeping its own employees cared for and safe, essentially creating their own employee health structure and doing their own internal contact tracing.

Larger facilities, like area hospitals, faced similar issues, but in some ways their size provided certain advantages. The LCMC system, with its six hospitals and more than 12,300-member staff, used this strength effectively during the worst of the pandemic.

“At the highest peak, we were able to redeploy teams, mostly nurses, from less busy units and hospitals to the units with the high demand in order to ease the load and have more staff to help care for patients,” said Mary Beth Haskins, director of public relations for LCMC. “We have not had any staff furloughs.”

At the same time, Haskins said the biggest challenge for the system was “the emotional and physical toll this past year has taken on hospital teams, and not just physicians and nurses, but the entire staff.”

Vaccines: Good News Came With Its Own Challenges
Fortunately, the arrival of vaccines has improved the outlook of facilities and their personnel throughout the greater New Orleans region, but it has also created a new set of logistical problems.

“The vaccination process has had its struggles from the start,” said Mike McKendall, director of Pharmacy Services at East Jefferson General Hospital. “We had to create an entirely new process for this.”

East Jefferson and the other LCMC hospitals conducted some vaccine planning exercises earlier in 2020, but those did not anticipate that the first vaccines available would require multiple doses, nor the extreme refrigeration requirements, particularly for the Pfizer vaccine.

“We had to obtain the 80-below freezers, and as a hub for distribution, we had to be sure we had enough capacity to store whatever supply we received,” McKendall said. “We had to deal with the transportation issue. We had to deal with scheduling, especially when supply levels were uncertain, and the reminders for the second appointments, without overcommitting ourselves. We really had to reinvent the wheel.”

Like other medical facilities, East Jefferson was eager to get its own staff vaccinated, but McKendall noted that even that required planning. “We had to stagger employee vaccinations in anticipation of potential side effects,” he said. “We couldn’t have our entire staff out for a day dealing with the side effects.”

Managing vaccination logistics has been a challenge for the community health clinics as well. At DePaul, issues such as hours of availability for people working regular jobs, transit accessibility, and even parking availability at vaccination sites have posed problems. In response, DePaul is vaccinating teachers in their schools and establishing vaccination clinics at community sites. Being flexible in these ways had enabled them to provide 6,500 vaccinations by the beginning of March, with Griffin and his team ramping up to reach 1,000 shots per day within a few weeks.

CrescentCare was fortunate enough to begin receiving vaccines early on, starting with giving 60 shots per day and climbing to 180 per day by early March, at which point 88% of its staff had been vaccinated. Supply was still well short of demand, however. Halperin said the clinic received 200 to 300 calls per day from people requesting the vaccine.

CrescentCare also struggled with the complicated vaccine process — the storage requirements, the paperwork, the two-dose process — and the situation was compounded by financial issues. The pandemic had already stressed the clinic’s finances, as regular revenue streams were shut down, along with access to the facilities, and according to Halperin, “There is simply no money in this. We receive better reimbursement for testing than for the vaccines.”

The arrival of the single-dose Johnson and Johnson vaccine is “a game-changer,” in the words of East Jefferson’s McKendall. “We can vaccinate people at a much better rate, and this will help us bring the pandemic to an end much sooner.”

The single-dose vaccine is also key to the mass vaccination site opened at the New Orleans convention center in early March. According to Allison Guste, vice president of clinical affairs for LCMC, the site can administer more than 1,000 shots per day, though uncertainties over the number of available doses have lingered as a problem.

Guste was also pleased to see community participation rates going up as the vaccination process continued. “We are working now with community groups to get the word out about vaccine safety and efficacy, and to debunk the social media myths.”

In fact, Guste and her team heard “some really great stories from people wanting the vaccine before they were eligible for it,” though nothing as crazy as the two Florida women who tried to pose as seniors in order to get their shots.

Another positive result from increasing vaccine availability is that facilities are hiring more staff to manage the vaccination process. Guste reported that LCMC is re-employing Convention Center staff that had been laid off when business there dried up, and is also hiring out-of-work people from the hospitality industry. East Jefferson is bringing on data entry people and rehiring retired nurses, while DePaul is drawing on its partnership with the local academic medical facilities to create a pipeline to fill its staff needs.

Working in the healthcare field requires a certain innate optimism, a fervent hope that one can make things better for individuals and entire communities. On that note, Griffin said he sees a possible silver lining of the events over the past year.

“I hope this will help us prepare for other biological threats that we know are out there,” he said, “that this will add to our understanding of epidemics and diseases. We can learn from what went wrong and adjust how we treat them in the future.

Filling the Healthcare Workforce Pipeline

Both locally and nationally, the COVID-19 pandemic has created staffing issues across the healthcare spectrum, exacerbating a problem that had already existed, and will likely linger well past the pandemic’s end.

“Even before the pandemic, the Department of Labor listed healthcare as the fastest growing job sector,” said Sandy Mead, national director of workforce development at MedCerts, an online career training and certification firm based out of Michigan. “The need for allied health professionals has never been higher, due to the number of Americans now using our healthcare system.”

In February, MedCerts announced it was teaming up with Equus Workforce Solutions, a national provider of workforce development services, to address these problems. According to a statement from MedCerts, the firms will “work with local hospitals to build apprenticeship programs. This approach is used for doctors when they get their internship and residencies, but in jobs like medical assistants and phlebotomists, this approach isn’t common.”

New Orleans is one of 10 target cities for this partnership, which hopes to “train dozens of apprenticeships” in the next few months.

Ochsner Health System also just announced in March that it will partner with Delgado Community College to develop new medical worker training. If these two programs are successful, a permanent solution to medical staffing issues could be another positive outcome from the tragedy of COVID-19.