Lack of preparedness is a choice.
All of this - all of it - was an obvious possibility as soon as we saw what happened to hospitals in Wuhan. It is a damning indictment of federal leadership that this sort of guidance is coming reactively now, not proactively a month+ ago.
All of this - all of it - was an obvious possibility as soon as we saw what happened to hospitals in Wuhan. It is a damning indictment of federal leadership that this sort of guidance is coming reactively now, not proactively a month+ ago.
It was not hard to do the math on this. A paper I co-wrote over a month ago called for these measures. Our top 3 recs:
- Prepare guidance for overwhelmed health systems
- Scale up support to frontline health workers
- Reinforce the PPE supply chain
- Prepare guidance for overwhelmed health systems
- Scale up support to frontline health workers
- Reinforce the PPE supply chain
Addendum:
Have gotten a number of @'s asking why this lack of prep isn't the hospitals' fault. It's a fair question.
The short answer is - the economics of our health system strongly disincentivize this kind of preparedness without direct government action.
Have gotten a number of @'s asking why this lack of prep isn't the hospitals' fault. It's a fair question.
The short answer is - the economics of our health system strongly disincentivize this kind of preparedness without direct government action.
Through late Jan, Feb, even into early March I spoke with infectious disease docs in several major hospital systems who recognized the risk. They struggled to persuade their leadership to take it seriously because the federal gov't kept assuring the country that the risk was low.
For a hospital exec, this kind of prep is a costly business decision. In the US system, costs have to somehow be charged either to private insurers or to Medicaid/Medicare. Downpayment on advance preparedness can't be charged that way.
So the choice to hospital execs in Feb was: do I take on a bunch of unfunded expenses to buy extra PPE stock, reinforce infection control protocols, divert staff time to contingency training, rearrange hospitals to increase ICU capacity, initiate plans for care rationing....
...all on my own dime, all to prepare for a risk that HHS, NIH, and CDC keep saying is low?
Not surprisingly, hospitals execs were not eager to do this. This was why I was urging back in Feb for CDC and HHS to more explicitly tell hospitals to do this.
Not surprisingly, hospitals execs were not eager to do this. This was why I was urging back in Feb for CDC and HHS to more explicitly tell hospitals to do this.
The few US hospital systems that have built stronger capacity to manage novel pathogens have done so with federal funding - such as NYC Health & Hospitals and University of Nebraska. NYCHH wrote here about why sustaining that federal funding is critical: washingtonpost.com/opinions/a-pro…
So could hospital execs have done more? Yes.
But was it realistic to expect them to do this while the feds were signaling low risk/under control? Nope.
Is a profit-based health care model financed by private insurance a tangible obstacle to pandemic prep? You bet.
But was it realistic to expect them to do this while the feds were signaling low risk/under control? Nope.
Is a profit-based health care model financed by private insurance a tangible obstacle to pandemic prep? You bet.
But hey, don't take my word for it. Listen to @SaskiaPopescu: “Hospital leaders often note that investment in prevention and response efforts for seemingly improbable biological events is unlikely due to competing interests”
