Political and business leaders in Kansas and Missouri are preparing for a gradual return to normal life in response to economic pressure and some positive signs that COVID-19 may be waning.
Hospitals are also taking their first steps toward business as usual, as financial pressures and demand for care increase.
Children’s Mercy doctor Angela Myers says the pediatric hospital needs to resume care for patients whose health issues have worsened after treatment delays.
“As children have waited to have procedures and surgeries over the last two months, they have become essential,” Myers says.
But Children's Mercy is also among the area hospitals that have had to furlough workers, cut pay or reduce employee hours. Others include HCA Midwest Health and Truman Medical Centers.
Since mid-March, hospitals across the country have provided only COVID-19 and urgent care, after the federal Centers for Medicare and Medicaid Services recommended that hospitals stop performing non-urgent procedures to conserve resources for potential COVID-19 surges. Some projections estimated that health care providers could be overwhelmed.
For weeks, the shining AdventHealth Shawnee Mission tower in Shawnee, Kansas, has been much quieter than usual, as the hospital has worked to keep beds free for COVID-19 patients. The hospital will begin opening its doors for more patients this month, but Regional CEO Sam Huenergardt says this will be a slow process.
“We’re looking at this as a dial, not a switch, to gradually increase what we do in a very safe and responsible way,” Huenergardt says.
That means going to the hospital will be a very different experience for patients than it used to be, at least for the near future.
As AdventHealth Shawnee Mission and other Kansas City area hospitals gradually increase procedures in the coming weeks, most of the measures they’ve implemented to prevent the spread of COVID-19 will remain in place.
Among the differences patients may notice:
- Many hospitals in the Kansas City area say they will continue to restrict visitors, and people entering hospital buildings will be screened for fevers and other symptoms of COVID-19.
- Hospitals are requiring masks for all staff and for patients.
- Patients who are getting surgery will be required to be tested for COVID-19 prior to their procedure.
- Social distancing will continue inside hospitals when possible, and patients will be encouraged to use telehealth, rather than in-person visits, to consult with doctors.
- Children’s Mercy Hospital will continue to allow only one parent or guardian to accompany a patient, in most cases.
Though the threat of COVID-19 remains, hospitals are under enormous pressure to reopen due to financial strain from the suspension of care.
Missouri hospitals have been losing an average of $34 million a day since mid-March, according to the Missouri Hospital Association.
Chris Garmon, a health care economist at the University of Missouri–Kansas City, says the last two months have sent hospitals into uncharted territory.
“I really can’t think of anything that’s similar to this,” Garmon says. “The hospitals are still operating. They are expected to operate. They are really on the frontlines of this. And yet their volumes have dropped, and their finances have worsened.”
Congress has authorized some funding to help hospitals, but it may amount to only a fraction of their losses.
Missouri hospitals have received a total of $390 million in federal relief funds so far, which covers only about 12 days of losses, according to hospital association spokesperson Dave Dillon. Other emergency funding is expected, but hospitals are unsure what they will receive.
Hospitals appear to have avoided the worst-case scenarios of overwhelming COVID-19 surges for now.
In statements about ending stay-at-home orders on May 3, Governor Parson has pointed to data showing that hospital admissions due to COVID-19 have declined in April in most of the state, and he said that many of the dramatic steps taken to protect their capacity could be safely be eased.
While hospitals expect huge demand for treatment that has been delayed, hospitals officials say that many patients have been too scared of COVID-19 to go to hospitals even for urgent care.
Eighty percent of Americans said they would be worried about contracting COVID-19 at an emergency room, according to polling conducted by Morning Consult in mid-April.
Fifty-nine percent of people aged 40 to 74 said they had delayed or avoided medical care due to COVID-19 concerns.
Truman Medical Centers CEO Charlie Shields thinks that fear may persist, causing some people to stay avoid hospitals even in emergencies.
“I think there will still be some hesitancy with patients to come back into the clinics, come back into the hospitals,” Shields says. “I think we’re a ways away from people feeling totally comfortable coming back in.”
Though hospital leaders insist that safety will be a top priority as they move forward, many of their facilities may not be as prepared as some guidelines and experts have called for.
The White House's Opening Up America Again plan issued in mid-April advises that communities should meet two criteria for hospitals before they ease measures like stay-at-home order: hospitals should be able to treat all patients without crisis care and they should have “robust” COVID-19 testing for at-risk hospital employees, including antibody testing.
Hospitals in the Kansas City area have generally only tested employees who show symptoms, and experts say they may be missing asymptomatic cases.
Washington University health quality researcher Dr. Karen Joynt Maddox says that, with a roughly 10% positive COVID-19 test rate in Missouri, the current testing practices may be adequate for now, although as more patients go to hospitals in coming weeks and risks of infection increase, testing will become increasingly important.
“The actual rates of infection are pretty low, but since we haven’t been testing all staff, we don’t actually know what that is at any given place,” Maddox says. “So I think, ideally, we would test all staff and know not only who might have the disease but also who’s already been exposed.”
As part of his Show Me Strong Recovery plan, Missouri Gov. Mike Parson announced that the state had the capacity to test 50,000 people a week and that testing would be opened to allow for more testing of health care providers, although labs are still testing people in Missouri at rates far below that capacity.
At least one Kansas City area hospital, AventHealth Shawnee Mission, says it will start testing all employees for COVID-19 in the first half of this month.
Some testing experts have said that, ideally, many health care workers should be tested as frequently as every few days to be sure they are not infected asymptomatically. But the capacity to do this may still be months away.
The future of antibody tests is even more unclear. These tests are slowly becoming more available, but many have been shown to be unreliable, and it’s uncertain whether the presence of antibodies indicates someone has immunity to COVID-19.
Meanwhile, though hospitals in Kansas and Missouri have avoided being overwhelmed, they have been coping with low supplies of personal protective equipment for weeks.
Many hospitals have been reusing disposable equipment, like masks, to conserve personal protective equipment for the possibility of COVID-19 surges, but they insist that they have enough.
However, other hospitals say they’re near the end of their supplies. A report from the Missouri Hospital Association last week showed that more than two dozen Missouri hospitals have shortages of supplies like masks, face shields and single-use gowns.
Maddox says that the demand for personal protective equipment will ramp up dramatically as hospitals reopen under new conditions.
“In many cases, we’ll be using PPE for procedures where we wouldn’t have used it before,” Maddox says. “So it’s a different level of need that before, and that means that the biggest challenges are on supply chain. Where can we get it, and what can we get, when everyone in the country is trying to get these same things.”
Though data show some promising signs that COVID-19 may be slowing down, health experts say this is due largely to social distancing efforts.
Now that those efforts are being eased, communities will be at higher risk for increased COVID-19 transmission which could appear within the next few weeks. Even with distancing efforts in place, most experts anticipate COVID-19 will ramp up in waves, if not in the coming weeks, then later in the summer or fall.
Some say COVID-19 surges later in the year could far exceed what communities have experienced this spring and strain hospital resources even further if they occur during flu season.
Shields insists that, for now, hospitals are in better shape to handle COVID-19 than they were earlier in the year due to more testing and improvements in supply chains.
But he says Truman is closely watching COVID-19 data and ready to reserve course on reopening if cases surge again.
“Our first priority is to keep our staff and our patients safe,” Shields says. “And we’re not going to do procedures without the proper protective equipment.”
