COVID-19 Testing Shortage Hinders Hospital Efforts to Combat Virus

April 07, 2020 - Hospitals across the country cannot keep up with coronavirus demands due to a severe COVID-19 testing shortage, and the lack of testing kits is exacerbating other key issues, including personal protective equipment (PPE) shortages and limitations on capacity, according to HHS’ watchdog.

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A recent survey of hospital administrators fielded by the Office of the Inspector General (OIG) at HHS from March 23 through 27, 2020, found that the most commonly reported challenges with the coronavirus centered on hospital efforts to confirm cases of COVID-19 and keeping staff safe while doing so.

However, hospitals are struggling to step up to the challenges because of a COVID-19 testing shortage.

Hospital administrators explained that their organizations were “unable to keep up with testing demands because they lacked complete kits and/or the individual components and supplies needed to complete tests, such as nasal swabs, viral transfer media, and reagents used to detect the virus.”

READ MORE: Primary Care Practices Overwhelmed by COVID-19, PPE Shortages

As a result, hospitals were unable to effectively test patients, staff, and others in the community who reported on possible exposure to the highly contagious coronavirus. Some administrators reported dividing the media in COVID-19 testing kits in half to double their capacity, while others resorted to using the transfer media in flu and strep kits to provide testing.

But even when testing was available to patients and staff, hospitals reported significant delays in receiving results, with most hospital administrators waiting seven days or longer for test results.

The COVID-19 testing challenges also exacerbated other issues hospitals are facing due to COVID-19, including bed availability, PPE supplies, and staffing shortages, OIG reported.

Hospital administrators told federal officials that to prevent the spread of the novel coronavirus in their hospital and community, providers were treating symptomatic patients as presumptive positive cases of COVID-19.

Some presumptive positive patients remained in the hospital for days while providers waited on test results, which significantly impacted the organization’s availability of beds for other patients. These cases also depleted PPE supplies, which were being used more than normal and could be completely gone in a matter of days at the current utilization rate according to some hospital administrators.

READ MORE: How Much Will the COVID-19 Pandemic Cost Hospitals?

Delays in testing and results also made it more difficult for providers to deliver the most appropriate care, the OIG report stated.

The COVID-19 testing challenges could impede hospital efforts to limit the transmission of COVID-19 within their communities. Given the COVID-19 testing shortage, as well as uncertainty about future access, hospital administrators said widespread testing is not currently an option and their organizations are prioritizing testing for employees and patients with more severe symptoms.

In the meantime, hospitals reported several workarounds, including using new, sometimes unvetted and untraditional sources for supplies and medical equipment. Hospitals are also making existing supplies last through conserving and reusing PPE and using non-medical-grade PPE, OIG found.

The organizations are also leveraging other types of providers, telehealth services, and alternative care settings, including fairground and college dorms, to overcome workforce and capacity challenges of COVID-19.

But hospitals surveyed by OIG also called on the government for assistance with acquiring COVID-19 testing, supplies, and equipment. Administrators often said the government could alleviate challenges associated with competition for limited supplies and provide equitable distribution.

READ MORE: CMS Offers Upfront Medicare Reimbursement During COVID-19 Pandemic

Hospitals also said the government could:

• Provide test kits and swabs or ensure supply chains can offer hospitals a sufficient supply of tests
• Make testing faster by permitting more entities to create tests and relate supplies or conduct the tests
• Assist in obtaining a range of supplies
• Offer equipment such as ventilators, triage tent, and beds, or enforce actions to bolster supply chains for medical equipment
• Relax restrictions on the transfer or gifting of equipment and supplies

The hospital administrators also advised the government to help with workforce, capacity, and financial challenges through accelerated Medicare reimbursements and regulatory flexibilities.

President Trump criticized the OIG report in a press briefing on April 6, saying the findings were “just wrong” and may have been politically motivated. The president later denounced the report in a tweet on April 7, calling it “Another Fake Dossier.”

OIG at HHS is currently overseen by Christi Grimm, the principal deputy inspector general. Grimm has been the acting inspector general since January 2020. She was the chief of staff and deputy inspector general under the Obama administration.

The American Hospital Association (AHA) backed the report in a recent statement on its website.

“This important and timely report by the HHS Office of the Inspector General 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,” stated Rick Pollack, president and CEO of the AHA.

“The OIG report also highlights the tremendous strain – both physical and emotional – that this pandemic is putting on the shoulders of heroic physicians, nurses and other caregivers and their families, and why they need our support during this critical time.”

The AHA added that hospitals are also facing a shortage of critical drugs for patient care, which was not addressed in the OIG’s report.

The association applauded “certain agencies within the Administration” that “responded to many of our concerns, particularly CMS, which has cleared regulatory red tape to allow hospitals the flexibility to take quick and decisive action in this rapidly changing situation to better care for patients.”

CMS recently issued a wide range of regulatory flexibilities to allow providers to get payments faster, use providers from different states, leverage alternative care sites, and focus on patient care rather than documentation and compliance.

The AHA also commended the agency for quickly implementing provisions the Coronavirus Aid, Relief, and. Economic Security (CARES) Act, which was signed into law the day OIG’s survey ended. The act will provide more than $100 billion in financial assistance to hospitals and bolster the supply chain for PPE and other critical supplies.