Federal pandemic money fell for years. Trump’s budgets didn’t help


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  • Federal support to build state and local capacity to manage a new viral crisis fell by 50% after 2003.
  • The decline in federal aid spans three presidencies and many sessions of Congress.
  • President Donald Trump sought $100 million in cuts that would have made the situation harder.

President Donald Trump’s critics have charged that he undermined efforts that could have helped the nation respond faster and better to the coronavirus. He’s been criticized for downgrading the focus on pandemic threats on the National Security Council and chastised for seeking budget cuts at the Centers for Disease Control and Prevention.

That isn’t the full story of U.S. pandemic preparedness.

The broader picture is that money to prepare for this day has steadily dwindled over the past 15 years — across three presidents and many sessions of Congress.

The funds for pandemics remained about the same under Trump (and would have been lower if his budgets were enacted). But compared with where funding stood in 2003, support to build state and local capacity has fallen by half.

As hospitals and public health agencies aimed for leaner, more efficient operations, the combination of fewer federal dollars and market pressures left them with little cushion to meet the explosive demands of the novel coronavirus.

Over the years, Washington put more emphasis on fighting predictable problems, like the seasonal flu, and outright aggression in the form of chemical, biological and radiological terrorism.

Sandro Galea, dean of Boston University’s School of Public Health, said people like him have been hamstrung in the debate.

“Public health has been on the defensive,” Galea said. “There’s been no space except for talk of bioterrorism. The discussion about investing in the public health system has been utterly sidelined.”

The long-term decline

Frontline readiness for a pandemic depends on many factors.

There have to be enough people with the right skills; enough beds, equipment and materials to treat patients; and the right practices to coordinate efforts across a region. Federal money helps support all of that.

The Centers for Disease Control and Prevention distributes grants to state and local public health agencies, labs and hospitals. In nominal dollars, the funding for the CDC’s Public Health Emergency Preparedness grants went from $939 million in 2003 to $675 million in 2020.

Private health providers get money through a hospital preparedness program within the Health and Human Services Department. It helps local coalitions of hospitals, public health agencies and emergency managers plan and get ready for a sudden health threat. That money went from $515 million to $275 million in the same 17-year period.

Corrected for inflation, combined spending went from over $2 billion in 2003 to a bit under $1 billion in 2020.

These programs came to the fore after the Sept. 11 attacks when concern over bioterrorism spiked. For lawmakers, the concern was personal — letters tainted with anthrax reached Capitol Hill.

But the money gradually faded, and the capacity of state and local public health departments and labs did not keep pace with the likelihood of a viral disease like COVID-19.

“Health departments can’t retain workforce or modernize their disease surveillance and laboratory capacity without adequate, long-term funding,” said Dara Lieberman, director of government relations with Trust for America’s Health, a public health advocacy group. “Today, we’re paying the price.”

Local health systems needed to do their part, but the federal government was uniquely positioned to help.

“The purchasing power of the federal government is second to none, and it has failed to stockpile or otherwise negotiate pipelines to get access to the personal protective gear and medical equipment that it has known with certainty would be needed in a respiratory pandemic,” said Ellen Carlin at Georgetown University’s Center for Global Health Science and Security.

But the news hasn’t been all bad. 

After the Ebola scare in 2014, Washington and the states showed renewed interest in preparing for a naturally occurring viral threat.

Congress provided a bit of extra money, and according to a Health and Human Services study the improvement was striking: In 2014, about 70% of hospital administrators said they were unprepared for an emerging infectious disease like Ebola. Three years later, only 14% said they weren’t ready.

But hospital leaders also warned that it was hard for them to maintain that level “given competing priorities for hospital resources and staff time.”

Local hospitals and public health agencies have come a long way since 2003, said Crystal Watson, assistant professor, at the Johns Hopkins Center for Health Security and former staffer at the Homeland Security Department.

But she said they faced multiple pressures. In addition to falling federal support, Watson said the demand to maintain a healthy bottom line helped shape the situation today.

“Hospitals are under pressure to be efficient,” Watson said. “They don’t stockpile tons of equipment and materials and they don’t have tons of empty beds because that is not profitable. When you need more supplies, and more personnel, that’s when you learn what you lack.”

Today, Watson said, the lesson is clear.

“In retrospect, none of this has been funded at the level it should have been,” she said.

A thinly stocked stockpile

This crisis has also revealed the cracks in the Strategic National Stockpile, the current go-to source for ventilators, masks and other essential needs. States have clamored for supplies, and so far, deliveries have lagged far behind demand.

During her time with Homeland Security, Watson contributed to an assessment of the Strategic National Stockpile. Watson said the stockpile was designed with a long list of threats in mind, from chemical and biological terrorism to natural disasters. Something like COVID-19 would be just one threat among many.

“It’s primary purpose, and where it had more of a focus, was on bioterrorism,” Watson said. “That’s understandable. Who else but the government is going to buy a vaccine to protect the population against smallpox?”

The most recent strategic plan for the stockpile reflects the competing demands.

It mentions emerging infectious disease 15 times. Preparing for anthrax shows up nearly 50 times.

Criticisms of Trump need context

As the first cases emerged in the United States, Democrats criticized Trump’s preparedness on two fronts: He eliminated a key office in the National Security Council, and he tried to cut the CDC’s budget. 

The budget claims have merit. The complaints about the National Security Council  are reasonable, but could be more organizational streamlining than a loss of capability.

Until the spring of 2018, the National Security Council had an office that focused on global health and biodefense. When John Bolton took the lead on the council, he crafted an overall organizational reshuffle.

The functions of the global health division were absorbed into the council’s division that dealt with weapons of mass destruction and biodefense. The White House established a Biodefense Steering Committee headed by the Health and Human Services secretary, and issued a National Biodefense Strategy.

At the time, the Center for Strategic and International Studies think tank said the White House should name a senior-level leader to oversee the policy. The White House did not follow that advice.

The Trump campaign pointed to arguments from Bolton and the former senior director of the council, Tim Morrison, rejecting the idea that they lost their focus on this kind of threat.

On the budget, Trump unsuccessfully pressed for cuts in programs that relate directly to the current crisis. In his 2018 budget, he proposed cutting over $100 million from programs aimed specifically at strengthening public hospitals and labs — a 17% reduction. For fiscal year 2020, he wanted to cut $100 million, again about 17%, from programs that target emerging and zoonotic infectious diseases.

Congress ignored the president’s budget plans and largely kept the flow of dollars steady, even increasing them slightly. 

In 2018, Congress created a new Infectious Diseases Rapid Response Reserve Fund to provide quick money between the time when a crisis strikes and Congress delivers aid with real heft. The fund held $135 million when HHS secretary Alex Azar declared a health emergency in early February, which freed up that money.

That doesn’t mean the Trump administration’s preferences had no effect, said Tony Mazzaschi, with the Association of Schools and Programs of Public Health, a group that lobbies Congress on behalf of public health schools. The threat of cuts made the status quo seem like a win when it wasn’t.

“One of the perverse things that happens is the public health community has to play defense and can’t argue for increases,” Mazzaschi said.



California Hospitals Face Surge With Proven Fixes And Some Hail Marys

California Hospitals Face Surge With Proven Fixes And Some Hail Marys

California Hospitals Face Surge With Proven Fixes And Some Hail ...

California’s hospitals thought they were ready for the next big disaster.

They’ve retrofitted their buildings to withstand a major earthquake and  whisked patients out of danger during deadly wildfires. They’ve kept patients alive with backup generators amid sweeping power shutoffs and trained their staff to thwart would-be shooters.

But nothing has prepared them for a crisis of the magnitude facing hospitals today.

“We’re in a battle with an unseen enemy, and we have to be fully mobilized in a way that’s never been seen in our careers,” said Dr. Stephen Parodi, an infectious disease expert for Kaiser Permanente in California. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

As California enters the most critical period in the state’s battle against COVID-19, the state’s 416 hospitals — big and small, public and private — are scrambling to build the capacity needed for an onslaught of critically ill patients.

Hospitals from Los Angeles to San Jose are already seeing a steady increase in patients infected by the virus, and so far, hospital officials say they have enough space to treat them. But they also issued a dire warning: What happens over the next four to six weeks will determine whether the experience of California overall looks more like that of New York, which has seen an explosion of hospitalizations and deaths, or like that of the San Francisco Bay Area, which has so far managed to prevent a major spike in new infections, hospitalizations and death.

Some of their preparations share common themes: Postpone elective surgeries. Make greater use of telemedicine to limit face-to-face contact. Erect tents outside to care for less critical patients. Add beds — hospital by hospital, a few dozen at a time — to spaces like cafeterias, operating rooms and decommissioned wings.

But by necessity — because of shortages of testing, ventilators, personal protective equipment and even doctors and nurses — they’re also trying creative and sometimes untried strategies to bolster their readiness and increase their capacity.

In San Diego, hospitals may use college dormitories as alternative care sites. A large public hospital in Los Angeles is turning to 3D printing to manufacture ventilator parts. And in hard-hit Santa Clara County, with a population of nearly 2 million, public and private hospitals have joined forces to alleviate pressure on local hospitals by caring for patients at the Santa Clara Convention Center.

Yet some hospitals acknowledge that, despite their efforts, they may end up having to park patients in hallways.

“The need in this pandemic is so different and so extraordinary and so big that a hospital’s typical surge plan will be insufficient for what we’re dealing with in this state and across the nation,” said Carmela Coyle, president and CEO of the California Hospital Association.

Across the U.S., more than 213,000 cases of COVID-19 have been confirmed, and at least 4,750 people have died. California accounts for more than 9,400 cases and at least 199 deaths.

Health officials and hospital administrators are singling out April as the most consequential month in California’s effort to combat a steep increase in new infections. State Health and Human Services Secretary Mark Ghaly said Wednesday that the number of hospitalizations is expected to peak in mid-May.

Gov. Gavin Newsom said there were 1,855 COVID-19 cases in hospitals Wednesday, a number that had tripled in six days, and 774 patients in critical care. By mid-May, the number of critical care patients is expected to climb to 27,000, he said.

Newsom said the state needs nearly 70,000 more hospital beds, bringing its overall capacity to more than 140,000 — both inside hospitals and also at alternative care sites like convention centers. The state also needs 10,000 more ventilators than it normally has to aid the crush of patients needing help to breathe, he said, and so far has acquired fewer than half.

Newsom and state health officials worked with the Trump administration to bring a naval hospital ship to the Port of Los Angeles, where it is already treating patients not infected with the novel coronavirus. The state is working with the Army Corps of Engineers to deploy eight mobile field hospitals, including one in Santa Clara County. And it is bringing hospitals back online that were shuttered or slated to close, including one each in Daly City, Los Angeles, Long Beach and Costa Mesa.

The governor is also drafting a plan to make greater use of hotels and motels and nursing homes to house patients, if needed.

But the size of the surge that hits hospitals depends on how well the public follows social distancing and stay-at-home orders, said Newsom and hospital administrators. “This is not just about health care providers caring for the sick,” said Dr. Steve Lockhart, the chief medical officer of Sutter Health, which has 22 hospitals across Northern California.

While hospitals welcomed the state assistance, they’re also undertaking dramatic measures to prepare on their own.

“I’m genuinely very worried, and it scares me that so many people are still out there doing business as usual,” said Chris Van Gorder, CEO of Scripps Health, a system with five major hospitals in San Diego County. “It wouldn’t take a lot to overwhelm us.”

Internal projections show the hospital system could need 8,000 beds by June, he said. It has 1,200.

In addition to taking precautions to protect its health care workers — such as using baby monitors to observe patients without risking infection — it is working with area colleges to use dorm rooms as hospital rooms for patients with mild cases of COVID-19, among other efforts, he said.

“Honestly, I think we should have been better prepared than we are,” Van Gorder said. “But hospitals cannot take on this burden themselves.”

Van Gorder and other hospital administrators say a continued shortage of COVID-19 tests has hampered their response — because they still don’t know exactly which patients have the virus — as has the chronic underfunding of public health infrastructure.

Kaiser Permanente wants to double the capacity of its 36 California hospitals, Parodi said. It is also working with the garment industry to manufacture face masks, and eyeing hotel rooms for less critical patients.

Harbor-UCLA Medical Center, a 425-bed safety-net hospital in Los Angeles, is working to increase its capacity by 200%, said Dr. Anish Mahajan, the hospital’s chief medical officer.

Harbor-UCLA is using 3D printers to produce ventilator piping equipped to serve two patients per machine. And in March it transformed a new emergency wing into an intensive care unit for COVID-19 patients.

“This was a shocking thing to do,” Mahajan said of the unprecedented move to create extra space.

He said some measures are untested, but hospitals across the state are facing extreme pressure to do whatever they can to meet their greatest needs.

In March, Stanford Hospital in the San Francisco Bay Area launched a massive telemedicine overhaul of its emergency department to reduce the number of employees who interact with patients in person. This is the first time the hospital has used telemedicine like this, said Dr. Ryan Ribeira, an emergency physician who spearheaded the project.

Stanford also did some soul-searching, thinking about which of its staff might be at highest risk if they catch COVID-19, and has assigned them to parts of the hospital with no coronavirus patients or areas dedicated to telemedicine. “These are people that we might have otherwise had to drop off the schedule,” Ribeira said.

Nearby, several San Francisco hospitals that were previously competitors have joined forces to create a dedicated COVID-19 floor at Saint Francis Memorial Hospital with four dozen critical care beds.

The city currently has 1,300 beds, including 200 ICU beds. If the number of patients surges as it has in New York, officials anticipate needing 5,000 additional beds.

But the San Francisco Bay Area hasn’t yet seen the expected surge. UCSF Health had 15 inpatients with COVID-19 Tuesday. Zuckerberg San Francisco General Hospital and Trauma Center had 18 inpatients with the disease Wednesday.

While hospital officials are cautiously optimistic that local and state stay-at-home orders have worked to slow the spread of the virus, they are still preparing for what could be a major increase in admissions.

“The next two weeks is when we’re really going to see the surge,” said San Francisco General CEO Susan Ehrlich. “We’re preparing for the worst but hoping for the best.”





Trinity Health to furlough 2,500 employees in Michigan


Home - Trinity Health System

The two health systems that comprise Trinity Health’s Michigan region will furlough 2,500 employees at eight hospitals, according to MLive.com.

Livonia-based Saint Joseph Mercy Health System and Muskegon-based Mercy Health said the furloughs will occur over the next few weeks and will mostly affect nonclinical workers.

The furloughs, which represent 10 percent of the workforce at the two systems, will enable the hospitals to “focus resources on the functions directly related to essential COVID-19 patient care needs, while protecting people and helping to prevent the spread of the virus,” according to the report.

Livonia-based Trinity Health said the goal is for the furloughs to be temporary. 

To help offset financial losses from the COVID-19 pandemic, Trinity’s executive leaders are taking up to 25 percent pay cuts, and performance-based bonuses are being eliminated, according to the report. 




Jobless claims spike to another weekly record amid coronavirus crisis


Jobless claims spike to 6.6 million, another weekly record amid ...

6.6 million people filed for unemployment last week, a staggering number that eclipses the record set just days ago amid the coronavirus pandemic, according to government data released Thursday.

Why it matters: Efforts to contain the outbreak are continuing to create a jobs crisis, causing the sharpest spikes in unemployment filings in American history.

  • The colossal number of unemployment filings is worse than most Wall Street banks were expecting.

The big picture: Nearly 10 million Americans have filed for unemployment claims in recent weeks, as businesses around the country shut down in response to the pandemic.

  • But the data lags by a week, so it’s almost certain labor departments around the country are still processing claims and people are still applying.




Bon Secours Mercy Health to furlough 700, estimates $100M monthly operating loss


Bon Secours Mercy Health Sells $1.2B Majority Stake in Ensemble ...

Citing a revenue hit from the COVID-19 pandemic, Cincinnati-based Bon Secours Mercy Health will furlough 700 employees and freeze wages of all nonclinical personnel, according to The Cincinnati Business Journal

The furloughs will affect workers in the system’s shared services business office, which includes entry-level workers and those who are senior vice presidents. No caregiver, pharmacy or supply chain jobs will be affected.

The furloughs are expected to begin next week and last 30 to 90 days, depending on how long the pandemic lasts, according to Bon Secours Mercy Health CEO John Starcher.

The cost-cutting measures are a result of an anticipated decline in revenue due to government-imposed bans on elective procedures. Bon Secours Mercy Health estimates it will see an operating loss of at least $100 million per month while the pandemic lasts.

In addition to the furloughs and wage freeze, the health system is freezing hiring for all noncritical care positions.

“We don’t shy away from making the difficult decisions, and this certainly is one of those, because we always have a mind’s eye on what the long-term ramifications and implications are,” Mr. Starcher told the Business Journal. “We’re laser-focused on making sure this ministry is as successful and vibrant for the next 150 years as it’s been for the last 150.”






$40M sale of 2 California hospitals includes commitment to COVID-19 patient care


Verity Health gets $610 million offer for four hospitals

Verity Health Gets $610M Offer to Buy St. Vincent, St. Francis and ...

El Segundo, Calif.-based Verity Health has agreed to sell two California hospitals to AHMC Healthcare and is seeking an expedited review of the transaction, according to Bloomberg Law.

Verity, which entered Chapter 11 bankruptcy in 2018, filed a motion with the bankruptcy court March 29, seeking approval for the sale. Under the proposed transaction, Verity would sell Seton Medical Center in Daly City, Calif., and Seton Coastside in Moss Beach, Calif., to AHMC for $40 million. The agreement also includes a commitment by AHMC to continue to support the state’s efforts to address the COVID-19 pandemic.

The proposed deal comes after California Gov. Gavin Newson announced March 21 that the state will use $30 million in emergency funding to lease Seton Medical Center and St. Vincent Medical Center in Los Angeles, which Verity closed in January. The state is leasing the hospitals for three months to expand capacity for COVID-19 patients.




New York hospital to split with Ascension after 18 years


St. Mary's Healthcare announces it will return to being an ...

St. Mary’s Healthcare in Amsterdam, N.Y., is slated to become an independent hospital after 18 years as a member of St. Louis-based Ascension, according to The Daily Gazette.

There are several advantages to being a member of a large health system like Ascension, but being an independent hospital with a local board of directors is the best option for St. Mary’s Healthcare, CEO Vic Giulianelli told The Daily Gazette. He said the hospital could save millions from the split.

“When you belong to a system, there are system expenses, and upstate New York hospitals, like St. Mary’s, are among the least expensive in the country and that gets back to where we reside and to where we deliver care, and the cost here has to be lower, because the [Medicare and Medicaid] reimbursements here are not stellar,” Mr. Giulianelli told The Daily Gazette.

St. Mary’s joined Ascension in 2002. In 2015, the two organizations began exploring opportunities for St. Mary’s “to pursue a future apart from Ascension,” according to a March 25 news release.

“We believe this is the best approach for the individuals and communities St. Mary’s serves as well as for its dedicated and compassionate associates, providers and volunteers,” Ascension Executive Vice President and COO Craig Cordola said.