Hospitals are struggling with staff shortages as federal Covid funds run out.

“We had to ramp up during growth and then try to figure out, ‘Do we keep people or do we let them go when we’re not growing?'” of molecular pathology at the Medical University of South Carolina. Director Julie Hirschhorn said. In Charleston “the trend of growth is just so far away that we don’t know what to do … it’s a difficult new normal.”

The current wave, which has outpaced the number of new hospitalizations with Covid-19. 40 percent In the past month, facilities have also been under fresh pressure as federal funding for the pandemic response has dried up, leaving some with the flexibility to hire more staff if needed.

In March, to cover part of a funding deal The White House’s request for $22.5 billion The split came as Democrats in Congress objected to repurposing unspent funds promised to states earlier in the pandemic, while Republicans said they had to include them in past funding bills before approving the new money. Congress needs to account for the $6 trillion earmarked for pandemic relief.

“There is growing concern that this money is gone,” said Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association. “It’s not really getting enough attention.”

As of July 22, hospitals in nearly 40 states reported. Severe shortage of staffwhile hospitals in all 50 states said they were expected within a week.

Several states where the number of CoVID-19 cases are increasing have large and growing problems, although factors beyond Covid are involved.

In California, for example, only eight hospitals rated their staffing shortages as critical as of July 22, but 118 expected to be within the week. In Louisiana, only one hospital reported severe shortages last week, but 46 are expected to have one by this week. Shortages were also expected at more hospitals in Alabama, Florida, Kentucky, New Mexico, Tennessee and West Virginia — all states with increasing case numbers.

“While we have experienced staffing shortages before, we are currently acutely aware of staffing shortages in virtually every position within the hospital,” Foster said. “If we have a large influx of Covid patients, it will be harder than ever to meet these demands.”

Chronic shortages in hospital staff will remain a long-term problem, the administration said, because even vaccines that have proven highly effective at preventing serious illness are not keeping everyone out of the hospital. There is also strong American resistance to mitigation measures such as social distancing and masking, and public officials are reluctant to sound the alarm during a wave in which fewer people are seriously ill and dying than in the past.

Hospital ICUs are not inundated with Covid-19 patients as they were in earlier waves. An average of 350 deaths are occurring daily.That’s far fewer than the thousands of Americans who died each day in previous peaks, according to the Centers for Disease Control and Prevention.

But serious strains on the health care system persist without these critical tools.

“I don’t think people appreciate the impact of allowing us to transmit the virus anymore,” said David Wohl, an infectious disease specialist who led the Covid-19 response at UNC Health in North Carolina. “If there are supply chain issues, if there’s a delay in hiring, or if people say, ‘Well, I’m short of employees, I can’t do this,’ it’s because of the pandemic.” “

‘Robbing Peter to Pay Paul’

Hospital staffing shortages — from nurses to physicians to medical laboratory technicians — existed before SARS-CoV-2, due to both an aging and aging population in the health care workforce. The result is increasing demand for care.

Sherry Polhill, associate vice president of hospital laboratories, respiratory care and pulmonary function services at UAB Medicine in Birmingham, Ala., said the pandemic created a kind of domino effect in the medical community.

This prompted older workers to leave their jobs early and created a boom in the lucrative traveling medical professional industry that lured people away from their staff jobs.

“You have this gap of vacancies that you need to backfill and you can’t do that easily,” Polhill said, adding that it could take years to fill open positions in his labs. are

This shortage is impacting hospitals and their patients in a variety of ways as BA.5 has proven to be the dominant strain in the country and immune evasion.

In North Carolina, where cases are on the rise. About 20 percent Over the past two weeks, UNC Health has been struggling to meet increased patient demand for monoclonal antibody treatments.

Hospitals are still offering antibody treatments to drugs that can interact negatively with a simpler treatment, Paxlovid.. Unlike Paxlovid, a pill that can be taken anywhere, monoclonal antibodies are given by infusion, a laborious process that requires careful infection control in infusion centers to treat patients who are immunocompromised. Individuals are also treated.

To do this, the hospital has to pull in staff from other departments, Wohl said.

“We have to rob Peter to pay Paul,” he said. “If you have people working in an infusion center doing this, what was their day job before Covid? Some of them were working in the emergency room. Some of them were working in the operating room. You can’t take people out of these other important jobs and force them to work somewhere else forever.

Next door in South Carolina, staff shortages at the Medical University of South Carolina have already prompted the hospital to stop testing all inpatients for CoVID-19 as it did earlier in the pandemic.

The facility received funds from the Covid-19 relief act Congress passed in March 2020 to expand its testing capacity with new equipment and staff.

Now that money is starting to dry up, and Hirschhorn has had to cut shifts and employees. His lab, one of his network of hospitals, had 44 staff and contract workers at the height of the pandemic, but today has only 10 full-time staff. of that The capacity to test for CoVID-19 has been reduced from about 3,500 to 1,500 per day.

The decision to stop routine Covid testing has helped keep the lab from being overwhelmed, Even in the past two weeks, South Carolina has seen a 34 percent increase in the number of people hospitalized with Covid. But Hirschhorn said it worries him to know he doesn’t have the resources to back up if he needs it.

“We’re all trying to figure out what our lab looks like now, and what we can do to help prepare ourselves for another addition, knowing that we won’t have the same staff that we did. We had it in the second addition.” . “We’re going blind.”

Epidemic fatigue

That anxiety has spread to hospitals, where the pandemic has exacerbated staff shortages that already exist.

“Medical lab scientists are unhappy right now,” said Susan Harrington, a microbiologist at the Cleveland Clinic and chair of the American Society for Clinical Pathology’s Laboratory Workforce Steering Committee. “They’ve been working very hard, and they’ve been working very hard for a very long time.”

“What is the end of it?” he asked. “I don’t really know the answer to that.”

Although hospital labs are, by and large, far more prepared to handle this wave of cases than they were in 2020, the Medical University of South Carolina is not alone in ending all inpatient testing for Covid-19 due to staffing. is, said Jonathan Myles, chair of the College of American Pathologists’ Council on Government and Professional Affairs.

A lack of local testing options creates greater risk for patients and the community, especially in rural facilities that operate in economically disadvantaged areas, he said. “They’re working on a shoestring,” he said. “If you limit testing to rural settings, you increase the inequity of care.”

Large urban hospitals may be better positioned to juggle times of high transmission, but with more employees sick and more patients testing positive, they too are under pressure.

In Los Angeles County, the number of Hospitalized patients with covid-19 Despite the area has increased dramatically since May. High vaccination ratesHarbor-UCLA Medical Center had to find ways to manage.

“People are getting Covid left and right,” said Anish Mahajan, the facility’s CEO and chief medical officer.

So far, he said, the hospital has dealt with this spike in cases, with some long wait times in the emergency room due to staff shortages and more patients. As conditions worsen, the hospital may have to re-prioritize urgent care cases.

The only real way to end the uncertainty is to contain the virus, through vaccination and by taking measures to prevent its spread, he said, such as wearing masks again when transmission is high.

“The more viruses spread in our world, the more likely we’ll see future generations of different species taking hold,” Mahajan said. “This type may not make many people sick in the hospital. But we don’t know what the next types may do.