Funding is needed now for hospitals to prepare for the coronavirus

Funding is needed now for hospitals to prepare for the coronavirus
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We could be on the brink of another pandemic. This time the culprit organism is a novel coronavirus rather than influenza.

In many ways, what we face today is a very similar scenario to what health care facilities and especially hospitals were bracing for in 2003 when SARS-CoV emerged in China. Though SARS raced around China and quickly spread to several other countries, it was eventually contained in five months.

The reason behind SARS containment was that it was not very contagious outside of the health care environment, and consequently, there was relatively little community spread. Therefore, the application of strict infection control measures in hospitals was sufficient to stop the chain of transmission. 

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Unfortunately, however, with this new 2019 coronavirus, there appears to be widespread community transmission in China. Most cases appear to be clinically mild, essentially like the common cold or influenza, but contagious. On the one hand, this is good news; the case fatality ratio is certainly much less than with SARS, which was approximately 10 percent. 

On the other hand, the fact that it is spreading efficiently in the community means that it will be very difficult, if not impossible, to stop. At this point, this virus resembles influenza in its epidemiology. We can anticipate many mild infections but also some severe and even fatal cases that could further stress our already over-stressed emergency departments and intensive care units.

So, what does this mean for U.S. health care facilities now? The answer is: Get ready. To be adequately prepared, hospitals need to undertake a myriad of activities now that will take considerable time and effort. To do this, hospitals will require additional funding. Congress should appropriate additional funding soon to the Department of Health and Human Services’s Hospital Preparedness Program. 

What would this funding be used for? A good place to start is implementing the hospital’s existing pandemic influenza plan. If these plans have not been revised or updated since 2009, now is the time. Also, hospitals will need to re-educate staff and update training on infection control procedures and personal protection equipment. Plans should include emergency department screening and triage protocols and procedures, diagnostic testing algorithms, respiratory etiquette policies, infection control procedures using airborne precautions, cohorting, surge planning including alternate sites of care, contingency standards of care, supply stockpiling and supply chain plans, and policies related to workforce and employee health. 

Doing all of this will require intense work by a multidisciplinary team, the members of which all have other day-to-day responsibilities. Hospitals leaders must recognize the risk a coronavirus pandemic poses to their institutions and prioritize and adequately resource these efforts. Hospitals should be working now in close collaboration with their local health care coalitions and health departments. 

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Many hospitals are dealing now with a fairly intense influenza season, and it is possible that they could experience a widespread and equally severe coronavirus epidemic before the flu season ends. And it’s not just the hospitals — clinics, medical offices, urgent care centers, and nursing homes should also be preparing and may require funding support.  

The military talks about the strategic and tactical warning. We have had a strategic warning of the risk of a pandemic for years. Now we have a tactical warning that it is coming and perhaps, just perhaps, in time to react effectively and proactively. Pandemic readiness for health care facilities is too hard and complex to invent on the fly. Facilities that do not prepare in advance will suffer more than those that do. Congress has the opportunity now to give them a fighting chance through additional funding to improve hospital readiness for this current outbreak.

Eric Toner, M.D., is a senior associate at the Johns Hopkins Center for Health Security in the Johns Hopkins Bloomberg School of Public Health.