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Today’s @nytimes story highlights a familiar but lethal disparity issue in COVID-19 care: Ensuring that patients get care at the right hospitals--and that hospitals actually providing such care have the resources they need for proper care. https://www.nytimes.com/2021/02/08/us/covid-los-angeles.html?action=click&module=Top%20Stories&pgtype=Homepage Thread (1/n)
Vaccines, PPE, distancing+hand-washing are obviously critical. Another immediate imperative to save lives: Ensuring that COVID patients receive care at hospitals w/staffing, resources+expertise to treat them—and that front-line hospitals are supported with these resources. (2/n)
Dr. James Mahoney’s death last April from COVID early last year offers one heartbreaking case. https://www.nytimes.com/2020/05/18/nyregion/doctor-dies-coronavirus-james-mahoney.html [pics]. Too many other cases continue to accumulate.(3/n)
Marquis hospitals face clear financial incentives and have other organizational reasons to decline COVID-19 transfers. While their bed capacity sometimes sits idle, the pandemic overwhelms community hospitals that serve the poor and people of color. (4/n)
Another uncomfortable reality: Safety-net providers may be reluctant to transfer patients to more proficient hospitals. They fear the loss of revenue and autonomy. Organizational morale and prestige take a hit, too. https://www.wbez.org/stories/one-chicago-hospital-called-for-8-hours-to-transfer-covid-19-patients-thats-problematic-for-future-outbreaks/1ecd60f3-f185-4deb-ae65-3e3ca25f0063 (5/n)
COVID patients experience markedly lower mortality rates in ICUs with the low patient-staff ratios, resources and equipment to provide proper care. (6/n)
This isn’t so much about high-tech COVID therapeutics. COVID patients face many of the same risks faced by others w/acute respiratory distress syndrome. The most concerning disparities+poor incentives arising in COVID arise for these patients too https://www.healthaffairs.org/do/10.1377/hblog20201023.55778/full/ (7/n)
Outmoded regulations+protocols worsen the situation. Many COVID patents stuck in wrong hospitals are taken there by ambulance, under questionable regulations that require transport to the nearest hospital rather than to more-proficient ones often only another mile/two away. (8/n)
What to do: (9/n)
States and the federal government must raise Medicaid funding and hospital reimbursement, to ensure that hospitals are able to cover their costs and provide high-quality care to all people, and to reduce toxic incentives to avoid Medicaid patients. (10/n)
States should designate respiratory centers of excellence, building a system similar to stroke+trauma. This would improve incentives for both sending+receiving centers to transferring critically ill patients w/respiratory failure to hospitals best equipped to treat them. (11/n)
Hospital transfers are just the tip of the iceberg in addressing these challenges. COVID provides a critical opportunity to redesign our respiratory care system to address the current crisis, prepare for future pandemics+ improve everyday care for many other patients.(12/n)
We must seize this opportunity to reduce disparities, and save lives.(13/13)
