Coming coronavirus surges will hit hospitals harder than earlier spikes did, disease expert says

• Hospitals will have COVID-19 patient surges larger than any that have occurred already, an infectious disease expert says.
• Hospitals are likely to have to stop elective surgeries again amid a longer-term pandemic.
• Hospitals can prepare for a long-term pandemic with more staffing flexibility and other steps, advisers say.

A prominent epidemiologist expects the coronavirus to resurge and send greater numbers of patients to U.S. hospitals than have been seen to date.

Michael Osterholm, PhD, an epidemiologist at the University of Minnesota, has garnered national attention for his contrarian analysis of the SARS-CoV-2 virus, which he anticipated would reach pandemic levels, would not come in waves and would remain active in the world for decades.

“This is going to continue on substantially,” Osterholm said in an interview. “This will be with us into the future.”

He worried that vaccines will not provide “durable immunity” for the population but stressed that many key questions remain unanswered.

Asked by HFMA about Osterholm’s expectation of a long-term pandemic, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases and a member of the Trump administration’s coronavirus taskforce, said he is hopeful the combination of vaccines and mitigation measures will prevent such a scenario.

“You can very well control and essentially eliminate from any given country the virus,” Fauci said. “We hope that we can do that, mainly very adequately control it with a combination of public health measures and a safe and effective vaccine.”

Fauci downplayed concerns that vaccines will protect as little as half the population and said a vaccine likely will be widely available in early 2021.

Effects on hospitals of a long-term pandemic

If a longer-term pandemic occurs, Osterholm expects hospitals will see COVID-19 patient surges larger than those they already have experienced.

“We’re going to see more and more outbreaks occur that could dramatically affect the community,” Osterholm said.

It’s not clear exactly what hospitals need to do to prepare for a long-term pandemic, he said.

“If this were anything, it’s a wake-up call to all of the world that we’ve got to start using a little bit of creative imagination and thinking about what the future might look like,” Osterholm said.

Key questions for hospitals, Osterholm said, include:

• Are their supply chains adequate?
• What is their surge capacity?
• What is an adequate level of preparedness for each locality and organization?
• How many trained and available intensivists are needed at each hospital?

Many states have required hospitals to maintain varying levels of reserve capacity to prepare for new surges, but Osterholm said it remains unclear how much capacity is needed.

Hospitals have urged states not to institute new bans on elective surgeries, arguing they can provide those services while treating any surge of COVID-19 cases.

But Osterholm was doubtful.

“I think they can do it while the capacity’s there,” he said, referring to elective procedures. “They just have to prepare that it is very possible they will have to shut down again.”

Osterholm said a lack of knowledge about the coronavirus makes clear answers impossible.

Hospital executives, Osterholm said, may be thinking, “‘Can I shut down? For how long until I’m done?’ Or, ‘I’m never going to have to shut down again?’ That’s the challenge with this virus. We can’t give them that.”

Considerations for hospitals include ways to control costs

Richard Bayman, co-founder and principal of Hammond Hanlon Camp, said hospital executives need to consider the possibility of a long-term pandemic.

“I don’t think this thing is going away, absent some sort of breakthrough therapeutic,” Bayman said in an interview. “Every community is going to be a hotspot at one time or other. It’s probably just a question of when, not if. Organizations need to be prepared to deal with this for an extended period of time.”

Local flareups are likely to last 30 to 90 days, he said.

In the case of a long-term pandemic, hospital finances will be affected by a variety of payment issues and many new costs, Bayman said. While organizations may have little control over changes in payment, they can control costs.

Richard Rollo, a managing director for Hammond Hanlon Camp, said as the pandemic and its economic consequences have progressed, payer mix has shifted from commercially insured to government-insured or uninsured.

“There are many hospitals and health systems that don’t make money on government-insured business or make very little,” Rollo said. “That’s a function of the specifics of their cost structures, where they’re located and what kind of business they have.”

Urban and suburban hospitals with typically higher costs tend to lose money on government-insured patients, he said.

In recessions, hospitals tend to lose commercially insured patient volumes, Rollo’s research shows.

“Since commercial volume is what pays the bills through cost shifting, losing that volume would hurt,” Rollo said. “And it will hurt more today than it did back in 2008 to 2010 because there is a lot more cost-shifting in general going on.”

Hospitals will need to reduce costs, which they did not do during the last recession, Rollo said.

For hospitals, the keys to financial survival during an extended pandemic include:

• Increasing liquidity
• Increasing supplies
• Improving their ability to flex down staff
• Preparing for the likelihood of lower rates from government payers

Hospitals with fluctuating patient flows need to figure out how to match their staffing levels to that demand. Sharp and fast patient-volume changes during the pandemic have eliminated the traditional option of making gradual changes to staffing levels at the unit and system levels, Bayman said.

“I don’t get the impression that people are yet thinking about this being a permanent state of having a flu that kills tens times as many people as any other flu,” Rollo said. “There’s a lot of this that we can’t forecast, but we can explore implications.”