Hospital Staffing Shortages

As reported in multiple sources, including this STAT article and this NPR article, hospitals across at least 25 states are experiencing critical staff shortages. While many of these hospitals have built up their reserves of other resources (e.g., PPE and medical equipment), staffing shortages limit their ability to respond to the current surge in cases nationally. Additionally, unlike prior surges that were concentrated in a few geographic areas, the current surge is widespread, limiting the ability of facilities to bolster staffing by drawing volunteers from other locations. Increased numbers of infections in more rural areas also increases pressure on systems that have experienced general health care staffing shortages historically and which in some cases lack necessary equipment to treat severe cases (e.g., ventilators) without transferring patients to more urban systems. Staffing may become the primary limitation on hospital capacity in many areas, potentially increasing the risk that health systems may have to utilize crisis standards of care to prioritize allocation of resources if demand outstrips supply without available relief.

Health Care Worker Vulnerability

This pre-proof by Greene & Gibson examines risks to health care workers in long-term care (LTC) facilities, which have been especially hard hit by the pandemic due to the vulnerabilities of the population they serve. The nature of work in LTC facilities often requires close contact with residents, and PPE shortages have been common in these facilities, placing workers at increased risk of infection. These workers also appear to be at increased risk of experiencing severe illness based on population comorbidities and other information. Based on sample data, the authors estimate that 50% of LTC workers are at increased risk of severe COVID-19 illness based on current CDC information (age >65 or history of chronic kidney disease, COPD, diabetes, obesity, or cardiovascular disease), and an addition 20% are at potentially increased risk (history of moderate to severe asthma, strike, liver disease, hypertension, current pregnancy, or cigarette smoking). Moreover, LTC workers are disproportionately Black, female, and low income, indicating that the impact of the pandemic on such workers is likely to exacerbate existing health disparities tied to systemic inequity.

Skilled Nursing Facilities and Health Disparities

This brief piece by LeRose et al. examines the relationship between Social Vulnerability Index (SVI) score and PPE shortages, number of cases, and associated mortality in skilled nursing facilities (SNFs) during the pandemic. SVI is a metric based on 15 variables that include available resources and key social determinants of health, such as socioeconomic status, disability, and transportation. SVI score is used to identify communities requiring additional support during disasters, such as the current pandemic, and communities are ranked by quartile. SNFs have been subject to resource scarcity, particularly PPE, during the pandemic, placing both residents and staff at increased risk of infection.

The SNFs studied were located in Southeastern Michigan (primarily Metropolitan Detroit). Facilities in more vulnerable areas were more likely to suffer PPE shortages, which the authors suggest is likely due reduced financial resources and greater reliance on government payers (particularly Medicaid) leading to the facilities being outcompeted in the marketplace for scarce PPE. SNFs in more vulnerable areas also experienced a higher number of cases and deaths (on a per bed basis), which the authors suggest is likely impacted by patient demographics and staffing shortages, as well as potentially by their greater PPE shortages leading to increased transmission. While the authors note several limitations of this study, it contributes to the growing body of literature highlighting the inequitable impact of the pandemic on more vulnerable populations and communities already subject to existing health disparities and the concordant need for prioritizing aid to these groups.