Hoping to avoid being overwhelmed, safety-net hospitals urge COVID-19 prevention

• Safety-net hospitals are warning the public that local COVID-19 outbreaks can threaten hospital capacity.
• They urged the public to seek hospital care for serious conditions.
• Hospitals continue to oppose further government-ordered shutdowns of elective care.

Safety-net hospitals are urging the public to take steps to avoid contracting COVID-19 in order to prevent the overload that at least a couple of organizations are experiencing amid the latest surge.

In an Oct. 26 webcast on Facebook, Bruce Siegel, MD, CEO of America’s Essential Hospitals, which represents more than 300 safety-net hospitals, urged the public to follow preventive steps to avoid more COVID-19 infections “that fill emergency departments and can threaten a hospital’s ability to meet all of its community’s needs.”

The campaign comes amid the early stages of the annual flu season, which some worry could combine with COVID-19 spikes to overwhelm hospital capacity.

The “rising number of COVID cases could overwhelm hospitals if left unchecked,” Siegel said. “We are already seeing troubling signs of this with bed shortages in some states and daily case counts equal or surpassing the surges we saw in the spring and summer.”

The University of Utah Hospital and the University Medical Center of El Paso were both “at capacity” due to COVID-19 outbreaks, Siegel said in an interview.

It was a situation Valleywise Health in Phoenix experienced in September, when the 230-adult-bed health system “came close to capacity,” with 48% of beds occupied by COVID-19 patients, said Michael White, MD, the organization’s CMO.

The capacity issue for that hospital was not beds as much as it was a shortage of staff for additional patients, White said in an interview.

“We don’t have as many large pools of staff that we can call upon when we start to see a surge, so that begins to stretch our capacity,” White said.

The hospital-capacity situation has varied widely across the country, as seen in figures from the national hospital chain HCA. The company’s 185 for-profit hospitals had nearly 40,000 inpatient COVID-19 cases in the third quarter, representing about 8% of total admissions, executives said in an Oct. 26 call with investors.

Walking a tightrope in public messaging

The safety-net hospitals’ public-information campaign on preventing hospital overload followed several months of numerous campaigns by hospitals, health systems, hospital advocacy groups and some local and state governments urging patients to go to hospitals for needed care. Those campaigns were responding to a growing body of evidence that large shares of heart attack, stroke and even cancer patients may not be seeking needed hospital care over fears of the SARS-CoV-2 virus.

The messages for patients to return but not to overwhelm hospitals walk “a fine line,” White said.

“We want people to not sit at home if they have those critical illnesses,” White said. “We know that early interventions in those acute medical conditions truly have a positive outcome and can help people in the long term.”

The effort to limit hospital use is focused on nonurgent cases “that would tie up those resources,” he said. The key for hospitals is good relationships with medical professionals to whom the public can turn to determine the proper site of care for their problem, he added.

White’s health system has seen 20% reductions in seriously ill patients presenting for care, and its emergency department (ED) volumes remain below pre-pandemic levels.

Similarly, HCA reported its ED volumes are 60% to 65% of capacity, compared with a 2019 average of about 85%.

Hoping to avoid elective-procedure suspensions

The latest wave of the pandemic has raised other critical issues for hospital solvency.

For instance, hospitals are worried that additional bans on elective procedures may further devastate their finances, even as they are still trying to recover from bans that were implemented earlier in the year.

Many hospitals undertook voluntary suspensions of elective procedures — and some states issued bans — based on CMS guidance issued in the spring. Since then, some governors and state officials have issued further bans amid subsequent outbreaks, while other governors have vowed to issue no more restrictions.

Siegel emphasized that in the future, “Any guidance should be guidance” and “local conditions should dictate what the hospital actually does. I don’t think there should be a blanket dictate from CMS on that.”

White said future bans are not needed.

“As we come into this second wave, I’m hopeful that we have demonstrated to our state and leadership throughout the country that we as hospital organizations can maintain that balance: being able to take care of the needs around the COVID patients but still maintain our ability to do our hospital business that needs to be taken care of without some of these strict moratoriums on procedures,” White said.  

HCA highlighted hospitals’ ability to judge when such suspensions are needed by noting the company voluntarily suspended elective procedures in more than 100 of its hospitals for varying periods during July and August surges.