Hospitals waiting up to seven days for coronavirus test results while they are running out of beds, says report
The US has the highest number of cases globally, yet it does not seem to have learned its lessons. The US has earlier been severely criticized for messing up its testing, which health experts believe has allowed the virus to go undetected and move freely, leaving many Americans without a diagnosis. Things do not seem to have changed. American hospitals are reporting that severe shortages of testing supplies and extended waits for test results are limiting their ability to monitor the health of patients and staff.
The report — by the US Department of Health and Human Services (HHS) — found that hospitals had to frequently wait for 7 days or longer for test results. According to one hospital, 24 hours would typically be considered a long turnaround time for virus testing.
Hospitals explained that they were unable to keep up with COVID-19 testing demands because they lacked complete kits and/or the individual components and supplies needed to complete tests, such as nasal swabs, viral transfer media, and reagents used to detect the virus.
“Hospitals reported that their most significant challenges centered on testing and caring for patients with known or suspected COVID-19 and keeping staff safe. One hospital administrator said that across the industry, 'millions (of tests) are needed, and we only have hundreds.' Without access to needed testing materials, some hospitals described dividing the media in COVID-19 kits in half to double their capacity and resorting to using the transfer media in flu and strep kits to provide testing,” says the report.
According to one study, Modern viral transport media allow for more effective use of viral culture and culture enhancement techniques for the diagnosis of human viral infections. The hospital findings are based on telephone interviews conducted between March 23-27 with hospital administrators from 323 hospitals across 46 states, the District of Columbia, and Puerto Rico.
Hospitals’ reliance on external laboratories contributed to delays, particularly as these laboratories became overwhelmed with tests to process from around the state or country. The analysis says hospitals also reported delays related to infrequent specimen pickups, mailing delays, and labs’ restrictive business hours. Some hospitals described success getting results more quickly by using commercial labs, whereas others received more timely results from public sources.
But many others experienced inconsistent turnaround times, leaving them unable to predict when results would arrive or advise patients on how long they should self-quarantine or undertake other measures while awaiting results.
Hospitals said that to prevent the spread of the virus in the hospital and community, they were treating symptomatic patients as presumptive positive cases of COVID-19 (that is, an individual with symptoms that strongly indicate COVID-19 and tests have ruled out similar conditions, but without a positive COVID-19 test result). Accordingly, when patient stays were extended while awaiting test results, bed availability was strained, and personal protective equipment (PPE) supplies were depleted.
One hospital, for example, said that its staff, at the time of the interview, used 307 masks per day on average for its 23 patients with suspected cases of COVID-19.
“Hospitals reported that some presumptive positive patients remained in the hospital for days while awaiting test results, which reduced the hospitals’ availability of beds for other patients. A hospital administrator noted that the sooner the hospital knows whether patients are negative, the faster it can move them to a lower level of care that consumes fewer resources. As one administrator put it, 'sitting with 60 patients with presumed positives in our hospital isn't healthy for anybody',” says the report.
The inability to quickly identify confirmed cases exacerbated challenges with hospital staffing. In one hospital, between 20-25% of staff were determined to be presumptively positive for COVID-19. “Due to the lack of quick test results, staff who ultimately were not positive were prevented from providing clinical services for longer than necessary, causing a substantial strain on staffing availability. Another hospital noted that it wanted to set up a separate testing clinic to keep potentially infectious patients from exposing staff, but it did not have enough testing kits and/or related components and supplies to set up such a clinic,” it says.
Given supply shortages and uncertainty about future access, hospitals reported prioritizing testing for their employees and patients with more severe symptoms. Prioritized testing meant that many hospitals were currently unable to conduct widespread testing of patients and community members to help contain the spread of COVID-19.
Several hospitals said that they were competing with other providers for limited supplies and that government intervention and coordination could help reconcile this problem nationally. “For example, hospitals wanted the government to ensure that they have access to test kits and swabs, make tests faster by allowing more entities to conduct and produce tests, and help hospitals obtain PPE supplies and other equipment such as a ventilator,” says the report.
Over 399,886 cases have been reported from across the US, and over 12,900 have died in the COVID-19 pandemic, shows the John Hopkins tracker.
Widespread shortages of PPE put staff and patients at risk
Hospitals across the country said there was a shortage of PPE that was threatening their ability to keep staff safe while they worked to treat patients with COVID-19.
The most commonly needed PPE items across hospitals were masks (including N95 masks, surgical masks, and face shields), followed by gowns and gloves. The administrator of one hospital, for example, said that before COVID-19, the hospital’s medical center used around 200 masks per day and that it was now using 2,000 per day. Delays in test results also contributed to heavier use of PPE until a patient’s status was confirmed.
“One hospital noted that with its high 'burn' rate, its inventory of PPE would last only 3 more days. Another hospital administrator expressed a common concern: not wanting to put employees in a position that 'endangers their lives and the lives of their families because (they) do not have PPE',” the analysis found.
Hospitals pointed to the lack of a robust supply chain as delaying or preventing them from restocking the PPE needed to protect staff. Hospital administrators also expressed uncertainty about the availability of PPE from federal and state sources. “Some hospitals noted that at the time of our interview they had not received supplies from the Strategic National Stockpile, or that the supplies that they had received were not sufficient in quantity or quality. One administrator stated that getting supplies from the stockpile was a major challenge, saying that the supplies the hospital received 'won't even last a day. We need gloves, we need masks with fluid shields on — N95 masks — and we need gowns'. It's the number one challenge all across the system,” it says.
There are other problems. One health system said that it received 1,000 masks from the federal and state governments, but it had been expecting a larger resupply. Further, 500 of the masks were for children and therefore unusable for the health system’s adult staff. Another reported receiving a shipment of 2,300 N95 masks from a state strategic reserve, but the masks were not useable because the elastic bands had dry-rotted.
Multiple hospitals reported concerns that prices of equipment, particularly masks, had increased significantly. One administrator said that masks that originally cost 50 cents now cost $6 apiece.
“To secure the necessary PPE, equipment, and supplies, hospitals reported turning to new, sometimes un-vetted, and non-traditional sources of supplies and medical equipment. To try to make existing supplies of PPE last, hospitals reported conserving and reusing single-use/disposable PPE, including using or exploring ultra-violet (UV) sterilization of masks or bypassing some sanitation processes by having staff place surgical masks over N95 masks. Hospitals also reported turning to non-medical-grade PPE, such as construction masks or handmade masks and gowns, which they worried may put staff at risk,” says the report.
Inconsistent guidance
Hospitals rued that the changing and sometimes inconsistent guidance from federal, state, and local authorities posed challenges and confused hospitals and the public. Hospitals said that it was sometimes difficult to remain current with the Centers for Disease Control and Prevention (CDC) guidance and that they received conflicting guidance from different government and medical authorities. This includes criteria for testing, determining which elective procedures to delay, the use of PPE, and getting supplies from the national stockpile.
“One hospital noted '(the inconsistency) makes everyone nervous. It would have been better if there was coordination and consistency in guidance among the different levels of government.' Another administrator said, 'It’s difficult when a doctor or nurse shows you legitimate information from legitimate sources and they’re contradictory',” says the analysis.
Hospitals also reported concerns that public misinformation has increased hospital workloads — for example, patients showing up unnecessarily, hospitals needing to do public education — at a critical time. Hospitals said they had to spend time responding to fear, lack of information, and lack of understanding in public communities, which they attributed to an absence of accurate and consistent information.