|THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
Confronting a national emergency over coronavirus
President Trump declared a national emergency today, in response to the growing spread of coronavirus across the country. The administration had come under sharp criticism for its sluggish response to the coronavirus crisis, in particular the widespread shortage of tests. Dr. Antony Fauci, director of the National Institute of Health’s infectious disease branch, told Congress on Thursday that the government’s response on testing was “not really geared to what we need right now…That’s a failing. Let’s admit it.” In response, the administration today announced a series of emergency steps to increase testing capacity, turning to private labs to support the effort. The emergency status frees up $50B in federal emergency funding. Trump also announced that the Health and Human Services (HHS) Secretary will be able to waive regulations around telemedicine licensing, critical access hospital bed requirements and length of stay, and other measures to provide hospitals with added flexibility. House Speaker Nancy Pelosi and Treasury Secretary Steven Mnuchin have negotiated a sweeping aid package that would strengthen safety net programs, and offer sick leave for American workers affected by the virus.
Meanwhile, the American economy likely entered a recession, as consumers continued to pull back on spending on airline travel, entertainment, and other discretionary areas, while financial markets experienced the worst one-day drop in more than 30 years. Many school districts and universities shut down and announced plans to convert to online instruction for the foreseeable future. Employers imposed broad travel restrictions on their employees, moved to teleworking where possible, and even began to lay off workers as demand for services cratered. Shoppers stocked up on staples, cleaning supplies, and (inexplicably) toilet paper, as shelves ran bare in many stores. Epidemiologists and disease experts urged broad adoption of “social distancing”, restricting large gatherings and reducing the ability of the virus to spread person-to-person. The objective: “flattening the curve” of transmission, so that the healthcare delivery system does not become overwhelmed as the virus spreads exponentially.
“Beyond containment”: sobering predictions for coronavirus spread
As of today, over 132K cases of coronavirus, or COVID-19, have been diagnosed worldwide, with nearly 1,300 cases confirmed in the United States. As the number of American cases begins to grow, the New York Times detailed sobering “worst case” projections from the Centers of Disease Control (CDC). CDC scientists evaluated four different scenarios of how the virus could progress, based on virus characteristics, transmissibility and severity of illness, finding that between 160M and 214M Americans could be infected, and as many as 200K to 1.7M could die. The analysis also highlighted a potentially devastating gap in needed hospital capacity, estimating that 2.4M to 21M people could require hospitalization. If these patients were to surge into emergency departments over a short period of time, the nation’s hospitals, which operate only 925,000 staffed beds, could be overwhelmed.
News from Italy, now with over 15K coronavirus patients, shows that intensive care capacity is even more important than free hospital beds. Reports from the country’s epicenter in Milan and surrounding regions paint a picture of “wartime” medicine, with exhibition centers turned into ICUs and doctors, facing a shortage of ventilators, forced to decide who lives and who dies. (Read these two Twitter feeds from Italian clinicians to understand the dire situation and stress on providers in their hospitals.) As we show in the graphic below, while the US has more ICU beds per capita than Italy and many other countries, we still fall short of the number of ventilators that could be needed at peak coronavirus infection rates, or even a severe flu pandemic.