Fauci says additional lockdowns’ not needed in response to COVID-19

• Anthony Fauci, MD, says states don’t need new lockdowns to control the pandemic.
• Four states instituted recent bans on elective surgeries amid the latest surge.
• Such restrictions will produce negative margins in the last two quarters of the year for the majority of hospitals.

States do not need to initiate broad coronavirus-related “lockdowns” like they did in the spring and like some are moving to do again, said the senior medical leader of the federal response to the pandemic.

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) and a senior member of the Trump administration’s coronavirus taskforce, spoke to healthcare reporters during an Aug. 6 briefing and addressed the divergent approaches states have taken to slow the spread of the virus.

Some states instituted broad restrictions in the spring, including banning elective surgeries for months, while others mandated few or no restrictions to try to slow the spread.

But states are not limited to either locking down or having no restrictions amid the pandemic, Fauci said.

“There’s a way in the middle there where we can open up the country and get the economy back,” Fauci said. “We can do it by prudent following of the guidelines.”

His comments may carry significance for healthcare leaders nervously watching a return of state lockdowns and bans on elective surgeries in parts of the South and West.

In, July, four states — Texas, Mississippi, Iowa and New Mexico — reissued bans on elective procedures in at least parts of the state.

Other states with recent surges of COVID-19, like California and Florida, have established capacity standards to keep beds open for COVID-19 cases but left it up to hospitals to decide whether they can continue with elective surgeries.

The financial impact on hospitals

Hospital advocates and leaders have warned that shutting down nonemergency treatment will endanger the financial sustainability of those organizations. Hospitals and health systems were projected to lose $202.6 billion from March 1 to June 30, according to estimates by the American Hospital Association (AHA).

Edward-Elmhurst Health, an integrated healthcare system in suburban Chicago, was ordered by the state to halt elective surgeries and prepare for a COVID-19 case surge in the spring. But relatively few such patients materialized as the organization’s revenue fell by 50% by April.

“I hope that that was a lesson that a lot of states learned, that hospitals do know how to multitask and we can take care of very infectious populations, and we do know how to segregate them and keep the rest of our patient population safe,” Denise Chamberlain, CPA, the health system’s CFO, said in an interview.

More than half of hospitals will have negative margins in the final two quarters of 2020 if there are sporadic COVID-19 surges and associated government-imposed restrictions, according to a July projection performed by Kaufman Hall on behalf of the AHA.

But such measures may not be necessary to control the virus.

“I am absolutely certain because it has been shown to happen and we can get this down enough to control it without necessarily needing to lock down,” Fauci said. “We can do it by prudent opening up according to the guidelines.”

On June 8, CMS issued Phase II Recommendations to guide the provision of elective procedures and treatment for non-COVID-19 patients.

Vaccines for healthcare workers

Although healthcare providers traditionally are first to receive vaccines for contagious diseases, it remains undecided whether that will happen with a vaccine developed for the coronavirus, Fauci said.

Fauci, who described himself as “cautiously optimistic” that a vaccine would be available by early 2021, said ultimately everyone will need to be vaccinated to control the pandemic.

Traditionally, the Advisory Committee on Immunization Practices, which advises the CDC, produces a vaccine prioritization list. But the process was amended for the COVID-19 pandemic to also include recommendations from the National Academies of Medicine.

“Generally, the priority is to get healthcare providers, who are going to be putting themselves at risk,” the first vaccines, Fauci said.

Fauci did not say when the groups will finalize the vaccine distribution recommendations.