GAO calls for COVID-19 medical supplies, testing guidance

COVID-19 lab testing
COVID-19 lab testing

IAEA Imagebank, Hospital Claudio Vicuña / Flickr cc

The US Government Accountability Office (GAO) yesterday published a report calling for actions such as increasing transparency in COVID-19 vaccine and treatment development and meeting states' needs for scarce medical supplies.

In its fourth report on the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the GAO also recommended improved COVID-19 testing guidance, more accurate estimates of the number of people relying on unemployment benefits, better oversight of Veterans Affairs nursing homes, and more information on the status of economic impact payments to individuals.

The 11 new recommendations come on top of the 19 previous recommendations the GAO has already issued in regards to the CARES Act.

Tests, gloves, other supply shortages

The GAO said that shortages of certain medical supplies persist, despite efforts by the Department of Health and Human Services (HHS) and the Federal Emergency Management Agency to mitigate them. In particular, about a third to a half of states have reported a lack of testing supplies such as rapid point-of-care tests and chemicals and instruments used in testing.

Certain types of personal protective equipment (PPE), such as nitrile gloves, are in short supply, although most states reported that they were able to fulfill most requests for PPE. And about a third of states said they were "greatly" or "completely" worried that they won't have enough supplies to administer COVID-19 vaccines; another 21 states said they were "moderately" concerned.

The report noted that HHS and the Department of Homeland Security had taken issue with GAO's previous recommendation to create a plan to fill critical supply gaps and work with states to ensure adequate supplies for the duration of the pandemic.

Call for vaccine, testing transparency

The GAO had previously asked the federal government to uniformly disclose information from the Food and Drug Administration's (FDA's) scientific review of safety and effectiveness data when issuing emergency use authorizations for vaccines and treatments, which are being developed with unprecedented swiftness under Operation Warp Speed.

The report said that transparency is the key to strengthening public trust in those decisions, which could be viewed as hasty. The FDA concurred with the recommendation.

The GAO called for HHS to ensure that the Centers for Disease Control and Prevention (CDC) publicizes the scientific reasons for any future changes to testing guidelines in a timely manner. In the past, the report noted, HHS and its agencies, such as the CDC, have not always openly communicated their testing-related guidance, which increases the risk of confusion and weakens trust in the government.

This is particularly important when evolving knowledge about an emerging pathogen such as the novel coronavirus necessitates frequent changes to CDC testing guidelines, the report said. HHS agreed with this perspective.

Uneven unemployment estimates

The GAO commented that weekly Department of Labor (DOL) press releases don't accurately estimate total unemployment claims because they potentially both overestimate and underestimate actual numbers. This is because the DOL uses state-reported data that equates the total count of weeks claimed nationwide with the number of people claiming benefits.

While the DOL's method has worked in the past, backlogs on state claims and other data issues amid the pandemic have led to inaccurate estimates, the report said. "For example, state backlogs in processing claims led to individuals submitting claims for multiple weeks of retroactive benefits during single reporting periods," the report said. "So, by using claims counts to represent the number of people, many individuals are counted more than once in DOL's estimate."

In addition, because of inconsistencies in the states reporting Pandemic Unemployment Assistance (PUA) data each period, the DOL has inaccurately represented changes in claims week over week, the GAO said. For instance, on Jul 23, the DOL reported that claims for continuing unemployment in the week ending Jul 4 decreased by about 200,000 from the week before.

"However, Arizona did not report PUA data for that week, after reporting almost 2.3 million claims the previous week," the report said. "Had Arizona submitted data, DOL likely would have reported a significant increase in claims from the prior week instead of a decrease."

Reliable information on both the weekly number of new unemployment claims and claimants who continue to file for benefits are needed to understand the role of unemployment in the pandemic economy.

"DOL should revise its weekly news releases to clarify that in the current unemployment environment, the numbers it reports for weeks of unemployment claimed do not accurately estimate the number of unique individuals claiming benefits," the authors wrote. The DOL agreed with the recommendation.

Poor tracking of stimulus payments, nursing homes

By the end of September, the Department of the Treasury and the Internal Revenue Service had distributed $274.7 billion in economic relief payments to individuals. Because some people didn't receive their payments, the IRS then notified nearly 9 million people that they were eligible for a payment.

The agencies, however, did not plan to follow up on the results of these notifications until 2021. The GAO report recommends that they track and analyze their efforts as soon as possible and release the results to the public.

The GAO report also recommended that the Centers for Medicare & Medicaid Services rapidly create a plan to fully explain how it will respond to and implement the Coronavirus Commission on Safety and Quality in Nursing Homes' 27 recommendations issued in September on such topics as testing, PPE, and visitation policies.

It also advised the Departments of Veterans Affairs to develop a plan to restart inspections of state veterans' homes after it stopped in-person inspections in March over concerns about COVID-19 infections.

"As of September 2020, these inspections had not resumed, leaving veterans at risk of receiving poor quality care," the authors wrote. "Additionally, VA does not collect timely data on the number of COVID-19 cases and deaths occurring at each state veterans home, hindering its ability to monitor and take steps to mitigate the spread of COVID-19 in these homes."

The VA plan, the GAO said, could include in-person, fully virtual, or mixed-type inspections. HHS neither agreed nor disagreed with this suggestion.

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