by James A. Bacon
Citing ample hospital capacity and the deferral of 15,000 medical procedures each week, the Virginia Hospital and Healthcare Association is calling upon Governor Ralph Northam to allow hospitals to resume non-emergency procedures across Virginia.
“Significant progress has been made in combating the COVID-19 pandemic and treating those afflicted with the virus,” wrote President Sean Connaughton to the governor in a letter written five days ago and released today.
Northam’s March 25 executive order prohibited inpatient and outpatient surgical hospitals from performing elective procedures in order to free up more hospital beds and personal protective equipment. That directive expires April 24, and Connaughton urged the Governor not to renew it. In place of that order, hospitals have agreed to abide by a “Framework for Reopening Virginia’s Hospitals.”
Northam’s emergency measures accomplished what they were meant to do, and now it is time to move to the next step, Connaughton said.
Working together, we have distributed personal protective equipment (PPE) to frontline health care workers, expanded the Commonwealth’s capacity for testing suspected COVID-19 patients, increased capacity to treat COVID-19 patients, and modeled projected surge at our hospitals. These efforts, combined with your administration’s directives on social distancing and Virginians’ commitment to staying home, have helped stem the impact COVID-19 has had on the Commonwealth.
While the crisis is far from over and COVID-10 will continue to be the primary focus of our hospitals and health care providers for the foreseeable future, we are mindful of the tens of thousands of Virginians who have deferred care for chronic conditions and other non-urgent medical needs. We are concerned that continuing to delay their care while we have available capacity to address and/or stabilize their condition will have long-term negative impacts on health across the Commonwealth.
The shutdown of elective procedures in Virginia also has contributed to the layoff of thousands of healthcare workers as well as a devastating loss of revenue for hospitals.
As of April 18, 1,301 COVID-19 patients (confirmed and pending test results) were being hospitalized. Only 21% of the ventilators were in use, Connaughton wrote. “Critically, these numbers have remained consistent since the end of March.” (As of this morning, Virginia hospitals were treating 1,379 COVID-19 patients, have 5,327 beds available, and have 2,264 ventilators available to provide respiratory support to patients.)
“In the meantime,” wrote Connaughton, “it is estimated that 60,000 Virginians have had their non-urgent inpatient and outpatient medical procedures canceled over the past month and 15,000 procedures will be canceled every week going forward.”
Allowing the order to expire would put Virginia on similar footing with at least 17 other states, which have lifted restrictions on non-emergency procedures: Alaska, Arizona, Arkansas, California, Colorado, Georgia, Indiana, Kentucky, Nebraska, New York, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Utah, and West Virginia.
According to the VHHA Framework, the Commonwealth has more than 6,000 hospital beds, many of which are medical/surgical beds. Additional beds can be added if needed. “Given the large number of available beds and the ability to track them, we believe hospital bed usage can be managed both regionally and statewide,” the document says.
The supply of personal protection equipment “remains a challenge,” says the Framework. But the ban on elective procedures has made only a nominal difference.
This is in large part due to the different PPE requirements for infectious disease patients compared to requirements for surgery and other medical procedures. The supply chain for most standard PPE for surgery has not been impacted to a significant degree due to COVID-19. Health care professionals performing surgeries have supplies to safely care for patients.
Meanwhile, the number of facilities reporting PPE shortages for COVID-19 patients “has decreased over the past week.”
Availability of staff is not an issue, says the Framework. Only one of 115 hospitals has reported data indicating potential staffing challenges. At the same time, many hospitals have furloughed staff not engaged in urgent care treating COVID-19 patients.
Testing, while still an issue, is improving. Health systems and private labs have increased their testing capacity. “Hospitals report that processing times are declining from 7-10 days to 24 to 48 hours.”
COVID-19 is impacting each region of the state differently. The VHHA advocates taking a regional approach based on Regional Healthcare Coalition boundaries, tracking critical metrics for each region, and committing to “a circuit breaker philosophy” should any of the metrics be exceeded. If shortages of beds, staff or protective gear crop up, non-urgent procedures can be postponed until the indicators stabilize.