An urgent need to reopen medical care for all


Each day a new story of crowded hospital corridors and exhausted healthcare workers appears in our newspapers. But another story, equally tragic, is unfolding in the privacy of our homes. Countless Americans with chronic conditions and other serious illnesses languish in isolation without access to care. While hospitals have of course remained open for urgent care, patients with less critical needs have been relegated almost entirely to virtual visits.

Many without illness are able to cope, but countless families have been permanently broken by the hospital closures. Take, for example, the blood cancer patient in Philadelphia who was desperately in need of chemotherapy. Unfortunately, blood supplies had been rationed for Covid patients 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 this 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 it has recommendations for testing and screening of both patients and providers, it gives no concrete advice on how often to screen each group or what to do if a healthcare provider tests positive.

Guidance from state departments of health is equally inadequate and, in some cases, downright dangerous. Some in 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 their own more stringent guidelines. 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. Many 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.

All of this extra effort will require additional resources, something that is becoming a pivotal challenge for all hospitals large and small. 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 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.


This article originally appeared in The Hill (May 1, 2020)

© William A. Haseltine, PhD. All Rights Reserved.