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The second wave of Covid-19 could turn cracks in the hospital system into ‘earthquakes’

 


When Dr. Sherif Al-Nahhal walked into a New Jersey hospital in April, he could not believe what he was seeing.

There were 300 patients being treated for Covid-19, filling up hospital rooms and transporting to emergency rooms. The trauma center, which was previously used for bullet wounds and car accident victims, is now filled with people on ventilators.

“It was really like anything we’ve seen before,” said the beekeeper, president and CEO of University Hospital in Newark.

“I have memories of wandering around and will look inside the rooms where possible.” He told NBC News, “Almost everyone was colored.”

Beekeeper Hospital is one of more than 100 major medical centers treating America’s most vulnerable patients – colorful communities disproportionately affected by Covid-19. Data is increasingly showing that black and Hispanic patients are more likely to be hospitalized with the virus, and in many cases, are more likely to die from it.

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“We are learning more and more that these vulnerable communities are the hardest hit by the pandemic,” said Beth Feldbush, senior vice president of policy and advocacy at America’s Essential Hospitals, a group representing more than 300 hospitals that treat uninsured patients. “Our hospitals definitely serve the most affected communities.”

The second outbreak of Covid in the fall and winter could be disastrous for the United States and not just more patients are what doctors worry. The very hospitals that treat low-income patients may be forced to close or cut vital services.

Dr. Sherif El-Nahhal and the staff at University Hospital in Newark say goodbye to US Army healthcare workers who helped carry patients during the height of the epidemic in May.

“We will definitely be in danger of being closed,” the beekeeper said. “It will be a public health disaster for this community.”

Aaron Wysolovsky, American Hospital Association vice president for policy, research and analysis, said the pandemic had hit all American hospitals in a “triple whammy”. Costs increased dramatically, while revenues decreased.

Hospitals have had to cover the exorbitant costs of purchasing additional personal protective equipment such as N95 masks, as well as shifting the wards to treat Covid patients and treat more uninsured patients. At the same time, they had to stop implementing income-generating procedures such as elective surgeries.

By the end of 2020, hospitals across the United States will lose about $ 300 billion, according to the American Hospital Association. But for major medical centers like the University Hospital in Newark, the financial blow to the second wave of Covid would be particularly devastating.

“Where there are fissures already in the system, those fissures become earthquakes,” said Dr. Chris Burnell, head of the Department of Strategic Integration and Health Equality at the University Hospital.

That’s because these safety net hospitals are not-for-profit and promise to care for all patients, regardless of insurance coverage. Even before the pandemic, they were operating on shaky budgets. Jackson Health System in Miami, for example, has enough cash on hand to work for 50 days. Private hospitals usually have more than three times this amount of cash in reserve.

“Where else do they go?”

Mark Knight, chief financial officer of the Jackson Health System, said that had it not been for the federal money infusion, the hospital system, which serves between 1,200 and 1,300 patients per day, would be in trouble.

“This year could have been a financial catastrophe,” he said, adding that the local government is acting as a lever in case they reach crisis point.

While most safety net hospitals, including Jackson Health and University Hospital, received federal money this year to bail them out, other hospitals like Valleywise Health in Phoenix have gotten nothing. Chief Medical Officer Dr. Michael White blamed a flaw in the formula used to account for safety net hospitals that would receive funds through the CARES Act Provider.

The health system, which serves more than 400,000 mostly Hispanic patients annually, is still trying to figure out the extent of the loss from the first wave of Covid. White said that if another missile struck, they might have to cut services.

“Anytime you see health care services diminish, there is dwindling access to care for those who are most vulnerable and who need it most,” White said.

A recent study from the University of California, Berkeley revealed that there may be racial bias in the formula the government has used to distribute CARES money to hospitals, leaving some predominantly black and Latino communities deficient, even though they have been affected the most by the pandemic.

“Given how the funding has gone out, the service providers serving these vulnerable communities have not received much funding,” said Feldbush, adding that subsequent distributions targeted some Covid hotspot hospitals.

The hope is that if it re-emerges, the federal government will intervene again, but there is no guarantee. In fact, HHS says HHS still has another $ 50 billion earmarked for service providers that should have already been distributed. Even this will not be enough to cover the costs of a resurgence of Covid.

Meanwhile, hospitals are preparing for the second wave, stockpiling personal protective equipment despite ongoing shortages, and implementing lessons learned from first increases, especially when it comes to treatment.

However, for the patients who rely on these hospitals, their concerns are not about budgets and final results.

“The hospital means everything to the community,” said Tawanda Sheard, 49, a university hospital employee who has lived in the neighborhood for 25 years and was rushed to the hospital there with Covid last spring. “They may not have the best insurance, but they know they can come there. Where else will they go for treatment?”

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