COVID-19 Scan for Aug 21, 2020

Nursing home PPE shortages
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COVID-19 hospital use and deaths

Report: 1 in 5 nursing homes face serious lack of PPE, staff shortages

A comprehensive review of data submitted by more than 15,000 US nursing homes revealed that about 20% faced a staff shortage or severe shortage of personal protective equipment (PPE) in early July, months into the COVID-19 pandemic, according to a study in Health Affairs yesterday.

US researchers analyzed staff and PPE shortage data submitted by 15,035 nursing homes (98% of the total) into the Medicare and Medicaid Services (CMS) COVID-19 Nursing Home Database. They looked at data submitted from May 18 to Jun 14 and compared it to information submitted from Jun 24 to Jul 19. PPE included N95 respirators, masks, gowns, and gloves.

At the end of the first study period, 20.7% of nursing homes reported a severe PPE shortage with 1 week or less of available supply, with shortages of N95s and gowns being the most common (13.4% and 12.6% of all nursing homes, respectively). Similarly, 20.8% of facilities reported a staff shortage, with 15.1%, 17.2%, and 9.2% indicating a shortage of nurses, nursing aides, and other staff, respectively.

The rate of both staff and PPE shortages did not meaningfully improve from May to July, the authors noted. The facilities most likely to report shortages were those with COVID-19 cases among residents and staff, those serving a high proportion of Medicaid recipients, and those scoring lower on CMS's five-star quality rating system.

The authors of the study write, "As in most crises, the most vulnerable nursing homes are at the highest risk for shortages that put the health of their residents and staff at risk…. Unless these shortages are prioritized by policymakers, long-term care residents will continue to be at a great disadvantage in the pandemic."

"Twenty percent is a lot, given where we are in the course of this pandemic," said lead author Brian E. McGarry, PhD, of the University of Rochester Medical Center (URMC), in a URMC news release. "While there has been some shifting in which nursing homes have been reporting these problems, from a national level, we're still not on the right trajectory."
Aug 20 Health Aff study
Aug 20 URMC news release

 

COVID-19 hospital bed occupancy tied to death rates in US states

Using hospital data from 23 states, researchers at the University of Minnesota (UMN) and University of Washington found a correlation between the number of hospital beds occupied by COVID-19 patients in a state and reported death rates in that state, according to a study yesterday in the Journal of General Internal Medicine.

The investigators used the UMN's COVID-19 Hospitalization Tracking Project to examine data from 23 states that reported daily percentages of intensive care unit (ICU) and non-ICU bed use by COVID patients.

They found that COVID-19 patients occupied nearly 20% of all ICU bed use in all states examined and about 5% of non-ICU beds. A 1% increase in ICU bed use (17 beds on average) was associated with 2.8 more COVID-19 deaths over the next 7 days, and a 1% increase in non-ICU bed use (130 beds on average) was associated with 17.8 more COVID-19 deaths.

"These estimates provide a better understanding of the projections of the COVID-19 pandemic in the U.S., especially when states are monitoring economic activities, and provide important practice insights for hospitals in terms of assessment of hospital bed and ICU bed capacity and preparedness," said study lead Pinar Karaca-Mandic, PhD, with the UMN's Carlson School of Management, in a UMN news release.

Co-author Soumya Sen, PhD, also with the Carlson School, said the findings will be helpful with mathematical modeling estimates in determining how not to overwhelm hospitals during the pandemic.
Aug 20 J Gen Intern Med study
Aug 20 UMN news release

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