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Unsanitized: The COVID-19 Report for Dec. 2, 2020

Hospital Understaffing, Lack of Capacity Coming Back to Bite

Plus, Mitch McConnell isn't doing coronavirus relief

 

A newly opened field hospital for coronavirus patients in Cranston,
Rhode Island. (David Goldman/AP Photo)

First Response

The United Kingdom has become the first Western country to authorize a
coronavirus vaccine
,
green-lighting the Pfizer/BioNTech for emergency use. The first shots
could be deployed by early next week, as shipments come in from a
factory in Belgium. Pfizer's vaccine will probably get the go-ahead
from the U.S. next week.

The British priority order for deployment of the vaccine, which will be
in short supply until the manufacturing ramps up, begins with nursing
home residents and their carers, followed by citizens over 80, and
frontline healthcare workers. That's similar to the priority order for
the U.S., which a CDC panel announced yesterday
.
The panel put healthcare workers first, followed by nursing home
residents and personnel.

One reason that healthcare workers need to take priority here is that
they're currently overloaded
from
caring for over 100,000 COVID patients
.
Capacity

is on everyone's minds
,
as the system nears that fateful decision to decide who to care for. One
way hospitals are coping is by literally accepting fewer COVID patients
for
admission (a "hospital-at-home
" program has been
initiated in several areas). Another way is the increase in mobile
hospital units
in parks
and other offsite locations, or repurposing space

within the hospital. But capacity is not the only issue; there's also
staffing.

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There are increasingly not enough nurses

to staff beds in the Kansas City metro area. Staff is running out

in San Diego. And obviously, every time a healthcare worker contracts
the disease-they are constantly around the virus and PPE can only do
so much-that becomes one fewer staff member, especially if they get
sick. (North Dakota for a time was trying to get positive-testing
workers to come in if they were asymptomatic.) There are often traveling
nurses that pick up shifts, but when everyone needs them, that doesn't
stretch as far. Some states, like Maryland
,
are frantically recruiting medical professionals and developing
emergency academic programs to rush through students.

What you won't hear quite as much about is the lack of medical
professionals and locations before the crisis hit. It sneaks into this
Washington Post report
,
as Jean Ross of National Nurses United dares to mention it: "She said
many nurses across the country were already spread thin before the
pandemic arrived, which she blamed on hospital administrators who are
ultimately driven by financial interests."

That is a reality in this country, where hospital coverage is uneven and
staffing is motivated by concerns other than caring for patients.
Nursing labor fights habitually include patient ratios, as nurses are
routinely expected to care for more patients than they can handle at one
time. And money plays a role in how many beds a hospital administers and
how many people they have on the floor.

We Can't Do This Without You

This story out of California

is instructive. The state has long lagged the rest of the country and
the world in hospital beds per 1,000 residents, with only 1.8 as of
2018. This is a deliberate design, to limit patient stays. It sounds
like making, say, a restaurant with only 6 tables, forcing waitstaff to
keep turning them over, would not be lucrative. But healthcare is a
different kind of market.

Long-term hospital stays are the most expensive to manage for a
hospital, relative to their cost to the patient or insurance company.
Outpatient care is much more lucrative, because it reduces labor costs,
physical real estate, supplies, everything. This "just-in-time" kind
of logistics just destroys preparedness. Just as retailers don't want
to hold inventory because they'd have to pay for storage, hospitals
don't want to hold patients. Therefore the excess capacity is rooted
out of the system, both in terms of beds and staff.

Then there are the "unprofitable" hospitals and unprofitable
services. If you aren't doing a bunch of elective surgeries, if
you're just the source for healing in communities that aren't
terribly dense, it doesn't make financial sense. Rural hospital
closures have reached new heights, forcing people to travel 50, 75 miles
or more to see a doctor.

But the staffing shortages are almost worse. There's a deliberate
shortage keeping doctors out of the profession, through American Medical
Association accreditation. Bringing in foreign doctors would sharply
reduce costs, but also cut the salaries of the wealthiest people in
healthcare. Nursing staffing is controlled by cost-conscious hospitals.

The concern with this approach was always a disaster that would magnify
the shortages. That's where we are right now, with deadly
consequences. The drive has been to reduce the cost of health care, not
by cutting administrative bloat or the price of treatments and medical
devices, but by cutting staff and capacity. That only works outside of a
catastrophe.

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Wake Me When McConnell's Ready

There was lots of coverage of the bipartisan "deal" on COVID relief,
and the usual suspects saying that Democrats should "take
"
said deal. I hate to be a broken record on this stuff, but there is no
deal. There's a set of numbers on a paper created by a small minority
of Senators, which bears no resemblance to the priorities of the guy who
gets to decide what the Senate votes on. That guy, Mitch McConnell, has
still, in nine months, not sat down to negotiate with anyone over a
follow-up package after the CARES Act. He or his staff was not present
at the Pelosi-Mnuchin talks, he was not part of appropriations
discussions, he was not party to this bipartisan deal. And until he does
anything approaching a negotiation, there's not going to be any bill.
Whether Jerome Powell likes

the bipartisan package does not matter.

McConnell released his own proposal

yesterday, which doesn't give any new money in unemployment payments,
doesn't give any money to state and local governments, doesn't give
any money for transit, doesn't give any new stimulus checks, and only
extends the two expiring unemployment programs, the lifeline for 12
million people, by one month. It's essentially the same proposal
he's put up in the Senate like 6 times. He's not interested in a
deal.

The one notable addition here is $31 billion for vaccine development and
distribution, about the level Chuck Schumer has said was necessary. As
I've said
,
getting the vaccine to people is an economic stimulus beyond all others,
worth literally trillions of dollars. If McConnell is willing to put
that forward, I'd take the vaccine money tomorrow, passing it as an
emergency supplemental with the omnibus spending bill that has to happen
by next week. What matters in the long-term above everything else is
getting that vaccine out.

Days Without a Bailout Oversight Chair

250
.
A MILESTONE!

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Today I Learned

* Lack of economic relief in the pandemic is literally killing people
.
(Vox)

* Steve Mnuchin, of course, thinks everything's rosy
.
(U.S. News and World Report)

* The post-vaccine future is bright but scarring now could hamper
recovery
.
(New York Times)

* One in six deaths in Vermont from COVID attributable to one Genesis
Healthcare nursing home
.
(The Intercept)

* The Cherokee Nation has had one of the best COVID responses
.
(Stat News)

* Small Business Administration data finds
that
large businesses were favored in the small business grant program.
(Washington Post)

* California Democrats can't stop eating out
.
I've been to a restaurant for in-person outdoor dining once in nine
months, vote for me! (New York Magazine)

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