As COVID-19 cases increase, La. hospitals take care to ensure they remain resourced

20th April 2020   ·   0 Comments

By Ryan Whirty
Contributing Writer

As the COVID-19 crisis continues unabated, and as government officials and community leaders grapple with the emerging demographic and sociopolitical realities of the pandemic in Louisiana, steps are being taken to ensure that the state’s hospitals remain open and sufficiently staffed to meet the dearth of patients suffering from the virus.

Achieving those goals has taken some creativity, say experts in the hospital industry. Dr. Stephen Murphy, an assistant professor at the Tulane University Department of Environmental Health Sciences of School of Public Health and Tropical Medicine, said that to his knowledge, no Louisiana hospitals have experienced closures or employee furloughs as a result of manpower depletion.

In fact, he said, health-care institutions and government agencies have had to find ways to increase the amount of available beds and open areas required to accommodate the demand and need for treatment.

“During outbreaks of this magnitude, hospitals absolutely need providers and staff,” Murphy said. “They are quickly assessing strategies which would allow them to treat as many patients needing hospitalization as possible while at the same time assessing ways to decompress the hospital setting itself to ensure more advanced critical care can be provided to the sickest of those hospitalized patients. This requires a significant amount of healthcare providers and staff.”

A spokesman for the Louisiana Hospital Association said health facilities in New Orleans and across the state have gotten creative in ensuring sufficient staffing in every area of Louisiana, including by shifting employees from place to place as needed, as well as launching intensive recruiting efforts.

“Our hospitals face numerous workforce challenges during the COVID-19 pandemic,” said the LHA’s Paul Salles. “As they work to ensure adequate ICU bed capacity, they’re recruiting more nurses, pulmonologists and intensivists. They are moving clinicians between departments to help in these critical care areas and are contracting with travel nurses. They are also seeking help from retired medical providers and recent graduates, as well as recruiting out-of-state volunteers through the Louisiana Department of Health (LDH).”

Salles pointed to the previously-established Louisiana Department of Health and Hospitals’ Louisiana Volunteers in Action program, which recruits retired health-care professionals and other medical and non-medical volunteers to serve during times of crisis, such as hurricanes, floods, pandemics and terrorist attacks.

LAVA is the state’s mechanism to meet the federally mandated Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) Program. LAVA is operated in collaboration with the South Central Public Health Partnership, which includes four states (Alabama, Arkansas, Louisiana and Mississippi), as well as the schools of public health at Tulane University and the University of Alabama-Birmingham.

In recent days, one glaring, troubling factor has emerged in Louisiana’s fight against COVID-19 – the disproportionate percentage of deaths in communities of color. Gov. John Bel Edwards said last week that even though 32 percent of Louisiana’s population is Black, 70 percent of the state’s coronavirus deaths have been African American.

In addition to analyzing the figures in the state as a whole, questions arise about whether geography, population density and per-parish demographics. Some of the parishes with the most coronavirus cases and death – such as East Baton Rouge, Jefferson, St. Tammany – have larger overall populations than more sparsely populated parishes outside of urbanized areas.

However, these more densely-populated parishes actually have lower percentages of Black residents than do many of the parishes with smaller overall populations. Parishes in northeast Louisiana – such as Tensas, East Carroll and Madison – have reported few coronavirus cases and deaths but have relatively large percentages of Black residents.

An April 8 report by KNOE TV in Monroe reported that the 16 parishes that make up its viewing area in the northeast part of the state had about 450 COVID-19 cases and deaths numbering as low as 10 total.

Other parishes with relatively larger populations but smaller numbers of COVID-19 diagnoses include Claiborne and St. Helena.

Also possibly factoring into the capacity and quality of health-care professionals, medical resources and coronavirus readiness is the average income of a given population, and how those numbers dovetail with statistics of racial composition and COVID-19 numbers.

For example, state officials and civic organizations are monitoring how many of the hardest-hit parishes and regions in Louisiana are also federally-designated health professional shortage areas – parts of the state “defined [as] service areas that demonstrate a critical shortage of primary care physicians, dentists or mental health providers,” either by geographic location or average income.

Salles credited the federal government for its passage of bipartisan legislation that addresses such factors by preventing slashes to Medicare and Medicaid funding, and providing funding to help regions cover expenses relating to COVID-19.

“Louisiana hospitals are committed to protecting access for all patients, especially those who live in geographic or low-income areas where the federal government has recognized a shortage of healthcare workers,” Salles said. “Congress recently approved legislation that helped many rural and safety-net providers remain open for patient care.”

Another absolutely critical aspect of ensuring that every part of New Orleans and the state of Louisiana has enough qualified and able-bodied medical professionals to administer care to those with COVID-19 is supplying the workers with adequate personal protective equipment. That mission includes supplying hospital and clinical staffers with adequate protective equipment so they remain healthy and able to care for the thousands of infected Louisianians seeking treatment. Avoiding shortages in equipment like gloves and masks at emergency health-care facilities is vital, experts say.

“A major challenge facing our area’s providers is not closures or furloughs [of hospitals and clinics], but personal protective equipment,” Tulane’s Murphy said. “We need to protect our hospital and pre-hospital frontlines. Period.

“Without these expert men and women, we would be in real trouble. It is vital to provide them with adequate personal protective equipment to protect themselves while they care for our community. Without proper PPE, we run the risk of them getting sick and not being available for everyone else who then needs their care and expertise,” Murphy said.

Also critical in maintaining the health of care providers and protecting their ability to serve, Murphy said, is providing them psychological support and rest in order to relieve stress and take a breather.

“[F]acilities should strongly consider allotting time for the frontline personnel to mentally decompress and even providing onsite counseling by a licensed provider such as a social worker or psychologist,” Murphy said. “Burnout and compassion fatigue are real for healthcare providers, which can be the result of physical and mental exhaustion. And a pandemic like this one can certainly lead to both physical and mental exhaustion. Every effort needs to be made to ensure we keep them safe and healthy as well.”

The LHA’s Salles noted that the U.S. Department of Health and Human Services’ Office of Inspector General just released a report that “provides the Department of Health and Human Services… and other decision-makers (e.g., State and local officials and other Federal agencies) with a national snapshot of hospitals’ challenges and needs in responding to the coronavirus 2019 (COVID-19) pandemic.”

The report, covering a national pulse survey for the period from March 23-27, found that health-care facilities, unlike other industries experiencing closings, furloughs and slashing of staff, instead “reported that they were not always able to maintain adequate staffing levels or offer staff adequate support. Hospitals reported a shortage of specialized providers needed to meet the anticipated patient surge and raised concerns that staff exposure to the virus may exacerbate staffing shortages and overwork.”

The DHHS study also found that “[c]apacity concerns emerged as hospitals anticipated being overwhelmed if they experienced a surge of patients, who may require special beds and rooms to treat and contain infection,” as well as “shortages of critical supplies, materials, and logistic support that accompany more beds affected hospitals’ ability to care for patients.”

However, Salles highlighted several specific findings in the report that showed how many health-care institutions are using unique ways to meet the crises and shortages, including training hospital staff like anesthesiologists, hospitalists and nursing staff to operate ventilators; helping staff access such basic daily chores and activities like childcare, laundry and grocery services “to promote separation from elderly family members;” and relaxing rules around such factors as bed designations, the employment of non-traditional treatment settings, and expanded flexibilities in telehealth.

Murphy noted that health-care providers and responders are trying to adapt to the ever-changing pandemic.

“Some healthcare systems have redeployed providers to hotspots from other locations or consolidated COVID-19 response operations at a single facility, which is what we’ve seen with Ochnser and Tulane,” he said. “Not every hospital or community can leverage such tactics though.”

In New Orleans, according to the LHA, the most prominent example of using non-traditional medical treatment approaches during the coronavirus pandemic is the Louisiana Department of Health’s opening of a field hospital at the downtown New Orleans Convention Center to provide expanded access to care for patients.

Murphy also praised the opening of the convention center as an alternate treatment facility, as well as meeting its expanded staffing needs. By bringing patients who are either recovering from a COVID-19 infection, or suffering from non-coronavirus patients.

“This specific strategy of the ATF at the MCC allows the hospital providers to be more focused on the sickest patients at their facility and remain confident the recovering patients are being cared for offsite,” he said. “The site can be run efficiently and provide safe, trusted care with a smaller number of providers than those patients requiring ICU and critical care beds and ventilators.”

Overall, Murphy said the COVID-19 response in New Orleans and Louisiana has been good up to this point, saying that the city and state have adjusted to and prepared for the massive surge in patients and treatment requirements brought on by the pandemic, including keeping health-care facilities open, expanded and sufficiently staffed.

He said that at a time when “[s]tates and cities across the U.S. have been forced to think outside of the traditional box to combat this pandemic” and as “[i]ncreasing surge capacity to meet such a high demand is a daunting task for any hospital, city, or state,” Louisiana has done a good job of meeting the challenges and employing surge strategies.

The LHA’s Salles said Louisiana has gone above and beyond to support health-care workers and emergency-services providers during the pandemic. With a critical need to make sure enough resources, in terms of both facilities and staffing, exist to meet the crisis challenge, Salles praised the efforts of Louisianans across the state.

“Louisiana has shown overwhelming appreciation for frontline healthcare heroes who are caring for our communities during this unprecedented pandemic,” he said. “They continue to show up despite these challenges. They are essential to stopping the spread of COVID-19, and we are doing everything we can to protect them.”

This article originally published in the April 20, 2020 print edition of The Louisiana Weekly newspaper.