This March 23, 2020 photo shows the former MetroSouth Medical Center in Blue Island, Ill. U.S. … [+]
Under normal circumstances leaders must deliver credible, fact-based, focused communication in order to provide direction and a clear sense of purpose. Such communication becomes even more critical during times of change and uncertainty. In the face of a global pandemic which has already resulted in mass layoffs, generalized anxiety about health risks and uncertainty about economic turnaround, the need for clear, accurate, fact-based communication is exponentially greater. The media in the US play an important role in providing what should be objective, balanced reporting of the facts. Unfortunately, this has too often not been the case.
Take, for example, a recent factoid presented by PBS NewsHour that was used to punctuate a segment on shortages of equipment like ventilators. It read:
“The number of hospital beds per capita in the US has fallen by more than half since 1980, from 6 per 1,000 people to 2.8 per 1,000 people.”
The implication is that we don’t have enough hospital beds across the country. The factoid is accurate; the implication, however, is erroneous. Let’s put this in perspective.
Much has changed in 40 years that impact demand for inpatient beds. In 1980 cataract surgeries were being performed in hospitals. By the end of the decade hospital executives were expressing their displeasure with ophthalmologists who were beginning to perform these procedures safely and successfully in their offices. At the time several executives noted, “you’re creaming the top and leaving us with the sickest cases.”
At the same time, open heart procedures required 10-12 days in the hospital with extended recovery periods lasting several weeks following surgery. Today, these procedures may be done in 5 days with much shorter recovery periods. Maternity stays for normal vaginal births typically required a 5-7 day stay in 1980. Today, a 2- day stay is common. Knee and hip replacement surgeries are increasingly performed in hospital outpatient settings and ambulatory surgery centers for patients without co-morbidities. The latter might require a more intensive hospital- based setting. Since 1980 new pharmaceuticals have dramatically reduced the number of patients who need hospitalization in the first place. Statins and blood pressure medications are most notable among the list. Taken together the need for hospital beds has been steadily decreasing.
In short, the introduction of innovative technology across multiple therapeutic specialties over the last 40 years has enabled complex procedures to be performed in more accessible, less costly, and more patient-centric settings without compromising safety assuming appropriate patient selection. Much to the dismay of many health care delivery executives, the migration of care to outpatient settings has eaten into profitable margins for traditional hospital-based interventions.
In response, many hospital systems have converted double bedded rooms, which had become ‘standard’ in the US, into private rooms—partly as a marketing tool, but largely due to excess bed capacity.
So, what is the implication of the headline that states we have fewer hospital beds per 1,000 than we did in 1980? The statistic is accurate. However, taken in the context of continuous news coverage of ICU bed shortages, limited supplies of PPE and ventilators, that factoid can be seriously misleading. The purpose seems designed to fuel fear and sensationalism, reducing confidence in the nation’s healthcare systems just when confidence is in short supply.
We have certainly made very serious mistakes reflected in our lack of preparedness in anticipating what would be needed once COVID-19 landed on our shores—and we certainly had plenty of evidence to know that it would land here with a vengeance. These mistakes have emanated from the White House through the supply chain to States, local communities, and individual citizens who have failed to heed warnings about social distancing and take personal precautions.
But blanket innuendos by nationally recognized news outlets don’t help us address the problems in front of us. Instead, they undermine confidence in our institutions. It is unrealistic to have ‘at the ready’ the number of beds that are needed in an epidemic, let alone a pandemic. This is where repurposing beds, setting up MASH type units, and bringing resources to bear quickly to meet spikes in demand enable critical clinical and logistics teams to respond. Deploying the US Navy Hospital Ships Mercy and Comfort to relieve pressure on local hospitals represents an excellent use of talented resources. And, Governor Cuomo’s efforts to stage MASH type units in each of the 5 boroughs in New York City is another example of innovation and resourcefulness in the face of crisis. His request for local competing healthcare systems to take a regional perspective in caring for the critically ill is yet another demonstration of leadership. Redeploying staff and moving patients to less burdened facilities, relieves pressure on those in densely populated areas unable to cope with the sheer magnitude of demands. Companies who voluntarily or otherwise have risen to the occasion to repurpose their manufacturing capacity to help close the gap in PPE or ventilators are other examples of responsiveness in time of great need.
The coronavirus crisis shines a spotlight on serious vulnerabilities in our economy. We have grown too reliant on outsourcing to drive profitability at the risk of maintaining adequate capacity for unexpected events. And, we have inadequate strategic reserves to bring to bear in a crisis. Bioterrorism planning should have been in place, and the fact that this country has been unable to mobilize a concerted effort to deploy needed resources in light of advance notice of several months should be of great concern to all Americans. We can and must do better.