- A survey of hospitals by the HHS Office of Inspector General found systems across the country are ill-equipped to deal with COVID-19 patients, in large part due to severe shortages of testing supplies and extended waits for results.
- Without knowing who is infected, hospitals and staff are ramping up their use of personal protective equipment, beds and staff, sometimes unnecessarily, causing other shortages. The administrator of one hospital surveyed in the report said that before COVID-19, the hospital's medical center used around 200 masks per day but now it uses 2,000 daily.
- Some hospitals are turning to on-site testing to speed up results and gain insight so they can better allocate limited resources, though they still face limitations.
Hospitals can send tests out to commercial or public labs or perform the diagnostics in-house. For health systems unable to perform testing in-house, delayed confirmation of positive cases means little can be freed up — leading directly to additional shortages, according to hospital administrators who responded to OIG.
The report surveyed administrators from 323 hospitals across 46 states from March 23 to March 27.
Mayo Clinic in Florida sent its patient test samples to its parent health system's partner laboratory in Rochester, Minnesota, for processing when the COVID-19 outbreak began in the United States.
But since it made the switch to in-house testing last month, turnaround time has significantly improved, according to Jane Hata at the Florida Mayo Clinic's Department of Laboratory Medicine and Pathology.
Mayo developed its own test detect COVID-19. Its expanded testing capacity is made possible by three high-throughput diagnostic processors from Roche Diagnostics, allowing it to process COVID-19 test samples from all Mayo Clinic sites, averaging about 4,000 COVID-19 tests daily.
Hata told Healthcare Dive in an email the rapid results are helping physicians determine who needs to self-quarantine and who may have been exposed. Negative results are especially helpful in identifying which patients can be moved out of isolation rooms, freeing them up for those who do test positive, she said.
Hospital administrators reported frequently waiting seven days or longer for COVID-19 test results. Their reliance on external laboratories contributed to delays, particularly as the laboratories became overwhelmed with tests to process from around the state or country, the OIG report found.
Responses were mixed when asked about turnaround time for results at commercial laboratories versus public health labs.
Among health workers specifically, the inability to rapidly scan for COVID-19 is making it difficult for some clinics to maintain adequate staffing.
The report found that in one hospital, between 20% to 25% of staff were determined to be presumptively positive for COVID-19. Staff who ultimately were not positive were prevented from providing clinical services for longer than necessary, causing a substantial strain on staffing availability.
To speed up the wait-time for results and mitigate demand for potentially unnecessary beds, staff and PPE, other health systems beyond Mayo have implemented their own in-house COVID-19 testing systems.
Clinical microbiologists at Johns Hopkins hospital in Baltimore developed an in-house coronavirus screening test that turns results in about 24 hours, although they hope to speed up the result time to about three hours.
Cleveland Clinic is another example. The system did not develop its own test, but purchased necessary Centers for Disease Control components for testing and validated the test in its own lab, and now has two drive-thru testing locations where patients remain in their cars while a test is administered. Results are sent through its online health management tool.
But a recent press release notes that Cleveland Clinic's rapid testing is still reserved for patients at the highest risk.
"We currently have a supply of testing swabs on hand, however, we did not fully anticipate the impact of the crisis in Italy which is where the swabs are manufactured. We hope to continue to receive additional supplies, which will be a key part of our decision-making," according to the release.
Hospital administrators in the report also mentioned such shortages and said specific testing components such as nasal swabs, viral testing media and reagents to detect the virus are further straining their screening capacities.
Without access to needed testing materials, some hospitals described dividing the media in COVID-19 kits in half to double their capacity and resorting to using them.
At Monday's White House Press briefing, President Donald Trump downplayed the findings of the inspector general report calling them "wrong," without providing evidence.
The American Hospital Association said in a statement that the report "accurately captures the crisis that hospitals and health systems, physicians and nurses on the front lines face of not having enough personal protective equipment (PPE), medical supplies and equipment in their fight against COVID-19."