COVID-19 infection shows no signs of slowing in the United States, with a record number of 60,000 cases recorded in one day this week and the total nearing three million.
The United States is still "knee-deep in the first wave" of the coronavirus outbreak, Dr. Anthony Fauci said on Monday.
Hospitals remain on the front lines as the coronavirus pandemic moves from the epicenter of New York to other surge areas in Florida, Texas, Arizona and elsewhere.
"We're still in the midst of pandemic response," said Akin Demehin, director of policy for the American Hospital Association.
Hospitals are stepping up to respond, working with their state and federal partners, he said. But from a financial perspective, the coronavirus is having an enormous impact on hospitals.
The AHA recently estimated that hospitals will lose $323 billion through the end of the year due to COVID-19's effect on regular revenue streams and the additional expense of equipping facilities to respond, such as having separate treatment areas and replenishing the supply of personal protection equipment.
The AHA and other organizations are asking Congress to again consider financial support beyond the $175 million allocated in the Provider Relief Fund of the Coronavirus Aid, Relief, and Economic Security Act and in the Paycheck Protection Program and Healthcare Enhancement Act.
Despite the CARES Act and other funding, many hospitals have needed to reduce expenses through layoffs and furloughs.
Michigan-based Trinity Heath said it anticipated $2 billion in losses and further layoffs as COVID-19 continues.
"That is part of the reason we are continuing to push for support," Demehin said. "We've been grateful for $175 billion that came through. We are pushing financial support for hospitals. We certainly view significant financial losses as an urgent matter for Congress to respond to."
The pandemic is spreading to more rural areas, where hospitals are already under financial strain.
Rural hospitals were part of a $50 billion distribution of relief funding.
"We were pleased with the allocation made targeted at rural providers," Demehin said.
The AHA said in the letter that it anticipated the challenges associated with COVID-19 will continue for the foreseeable future, and perhaps until there is a vaccine or reliable treatment.
WHY THIS MATTERS
The earliest hospitals can expect relief is in August, before the Senate recess. Senate Majority Leader Mitch McConnell on Tuesday reportedly said he would delay the recess by two weeks to finish work on a healthcare bill and other legislative items.
A legislative relief package passed the House in May, but at an estimated cost of $3.5 trillion, the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act got nowhere in the Senate.
Other relief has been in the form of regulatory measures, the biggest being the flexibility to use telehealth.
"Over the past six months, we've seen successive waves of regulatory relief," Demehin said. "The most successful has been telehealth relief. Our members have put that to great use."
The Centers for Medicare and Medicaid Services allowed for more than 80 additional services to be furnished by telehealth during the duration of the public health emergency.
The emergency expires at the end of the month, but the Department of Health and Human Services is expected to extend it.
Still, the question remains as to what CMS will allow for permanent telehealth services when the pandemic ends. Hospitals have invested in infrastructure and reconfiguring staff to accommodate the virtual services.
The AHA is in the process of engaging the Administration to extend telehealth authority on a more permanent basis, Demehin said.
THE LARGER TREND: WHAT MUST HAPPEN
Hospitals are already rescheduling elective procedures in areas where the number of COVID-19 cases has stabilized.
One area is Boston, which had its surge in the spring,
While the number of confirmed cases in Massachusetts climbed by 140 on Tuesday, bringing the total to 104,799, and the death toll climbed by 15 to 7,998, according to The Boston Globe, key metrics being used by the state to monitor the reopening remain generally steady.
Massachusetts General Hospital is in the mode of getting back to a new normal, according to Dr. David Hooper, chief of the infection control unit. The number of COVID-19 cases are down to a manageable level, and the hospital is catching up on delayed elective procedures.
Hooper has been tracking the state's numbers, which he said remain pretty consistent, and in-house figures, through the number of hospital admissions, which also have remained stable.
"The majority of our patients are non-COVID nowadays," he said. "We had our surge earlier and right now things are under control."
However, the key factor to reopening while waiting for a vaccine is based on factors outside of hospitals' control, according to Hooper and Demehin.
This is the control of the spread of the virus by the public.
"It's clear to me and others in hospitals around the country, in response (to a surge) you have to postpone elective surgery, clinic visits, though many are being done virtually," Hooper said. "Revenue sources are heavily compromised. That's why getting the pandemic under control … is so important for the health system."
Managing a steady state involves the public's general buy-in, maintaining social distancing, wearing face masks and practicing good hand hygiene, Hooper said.
"There is clear evidence when done aggressively, you can damp down the surge," he said.
Currently, 40% of transmission is from people who have no symptoms, he said.
Everyone who comes to Massachusetts General Hospital is tested for the virus and the result is known in a matter of hours.
There is an adequate amount of tests. Originally Mass General did an in-house, testing but now it uses a commercial platform, because those have become more widely available.
There is also drive-through testing available in the community.
"We want to avoid the surge we had in the spring," Hooper said. "The risk to the healthcare system, as New York, Boston and New Jersey know from the spring surge, can push your healthcare system to the edge, even with just a subset of the population."
That subset of the population at risk are those who are older and anyone who has comorbidities for severe disease. But younger people have also been admitted to Mass General for COVID-19.
The AHA recently joined with the American Medical Association and American Nurses Association in an open letter encouraging public health interventions to help dampen the spread, including the practices of social distancing, wearing a mask and staying at home.
Until there is a vaccine, the United States is dealing with the virus for the long-term.
So far, COVID-19 has infected 10% of the population or less, according to Hooper.
In comparison, the flu pandemic of 1918 is estimated to have infected about a third of the world's population.
For the coronavirus to develop what's known as "herd immunity," between 60% and 80% of the population must become exposed and therefore immune, according to Hooper.
There is hope for a vaccine early next year.
On Monday, Fauci, the nation's infectious disease expert, and Francis Collins, director of the National Institutes of Health, said the first phases of vaccine trials are complete with the next phase giving 30,000 doses – with 15,000 as placebo – to patients, for an eventual 30 million tests.
"We will get through this," Fauci said, "hang in there. It will end, we promise you."
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