“The U.S. Bankruptcy Court approved Astria Health's motion to lease the closed Astria Regional Medical Center in Yakima to the state of Washington as part of its coronavirus response. While there were questions and some concerns raised, creditors supported the motion. "This is an easy call," said Judge Whitman L. Holt of the court's Eastern District of Washington during a telephonic hearing Tuesday. "The coronavirus has been ravaging communities throughout the country and appears to be getting worse over time… The state would run any operation at the Astria Regional site. Astria Health would not be involved caring for patients at the location…Astria, in this context, is a landlord," said Health Attorney Sam Maizel. "(The organization is) not going to be providing medical care. They're providing a site.” Nathan Weed, Director of Community Health Systems for the Washington Department of Health, indicates "all its beds can be made available immediately for COVID-19 patients." Still, it's a process. "Getting all the pieces in place to reanimate a closed hospital, it takes a little time.”
1. That little piece of news points to the biggest issue: cutting through the red tape
of all the apparent stakeholders quickly. This is necessary to make sure all the
ground rules for initiating new operations are coordinated and ready to move
forward on day one. Anyone who deals with government agencies on a daily basis
knows this is not a typical strong suit.
In Philadelphia, a hospital that was shuttered just over a year ago will not be opened as the government and current owner of the facility could not come to terms. The government actually suggested the facilities owner was only interested in his return on investment. Here it is quite easy to see the types of issues that may surface.
The State Health Department of New Jersey is attempting to reopen the Medical Center in Woodbury. New Jersey Health Commissioner Judith Persichilli said it will take between three and four weeks to get the facility up and running with three hundred beds. These examples of the rush to add beds to a system that has been shrinking continues to flood the news
2. If the red tape can be cut then the technicalities of reinvigorating engineered systems, staffing, and outfitting the shuttered facility have a new and completely different set of requirements. And these same requirements are being challenged just maintaining the current overwhelmed operations in the more urban centers.
Staffing is Persichilli’s biggest concern. We have shortages during our normal (non-pandemic times). You may have a facility ready to go, but if you have no care givers or a plan to get caregivers, what good is the facility? The federal government reported there were more than 7,200 designated Health Professional Shortage Areas lacking adequate primary care nationwide, and we are not even touching on the critical care portion of the equation. The Demand for Inpatient and ICU Beds for COVID-19 in the US: Lessons from Chinese Cities indicates that a Wuhan-like outbreak in the United States would require 2.1 to 4.9 critical care beds per 10,000 adults. However, a majority of those beds are in use for non-COVID-19 patients requiring critical care for other conditions. The authors of this research estimate that approximately 5–7 beds per 10,000 adults would accommodate both patient groups.
The US only has approximately two critical care beds per 10,000 adults. Opening the general care beds in the shuttered hospitals may not actually address this issue without careful and wider thinking.
Finally, turn on a switch and all the engineered system just reenergize in perfect condition? Doubtful, and where are all the personnel that knew where each valve was closed or opened? Where each electrical circuit was routed?
We like the concept of this, but we really need to think of what will change when the dust clears.
Will we rebuild for the Next Pandemic? After we successfully defeat COVID-19, we must ensure that America is never again unprepared to face a new infectious disease threat. This will require investment into research and development, expansion of health care infrastructure and workforce, and clear governance structures to execute strong preparedness plans. I do not think a low voltage communication and electronic medical record alone will resolve or address the issue when it comes again. It may help but this virus is not virtual.
Ruoran Li *1; Caitlin Rivers 2; Qi Tan 3,4; Megan B Murray 3; Eric Toner 2; Marc Lipsitch 1
1. Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H.Chan School of Public Health, Boston, Massachusetts, USA2. Johns Hopkins Center for Health Security and the Department of Environmental Health andEngineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA3. Department of Global Health and Social Medicine, Harvard Medical School, Boston,Massachusetts, USA4. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of NanjingMedical University, Nanjing Medical University, Nanjing, China*Corresponding author: rul612@mail.harvard.edu
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