In the wake of BA.5, a COVID subvariant of Omicron, hospitalizations are on the rise once again. Add the growing cases of monkeypox, alongside the day-to-day emergencies that bring people to the hospital, and it spells potential trouble for
According to the CDC, as hospitals reached 100% capacity between July 2020 and June 2021, 80,000 excess deaths would be expected two weeks later. The pandemic has made it clear that the U.S. public health infrastructure is not prepared to manage capacity issues, and people may pay with their lives. With every new COVID wave, there's additional proof that this problem is not going anywhere anytime soon, says Regina E. Herzlinger, the Nancy R. McPherson professor of business administration at Harvard University.
"COVID is a very smart virus, and it wants to survive just like the rest of us," says Herzlinger. "COVID is like the flu, which is a polite way of saying that COVID mutates, and it's not going away."
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Faced with a deadly pattern in the U.S. health system, Herzlinger and Dr. Richard J. Boxer, a clinical professor of urology at the University of California, Los Angeles, composed a solution: hospitals could alleviate capacity problems by coordinating with other facilities in their community, referring patients to other hospitals with more availability.
"As a physician, I think about how thousands of people died in one month because they couldn't get into a hospital bed," says Dr. Boxer. "Something is especially wrong when there are hospital beds in one part of the city and not in another. So why can't there be coordination of care?"
Herzliner and Dr. Boxer point out how two of the largest hospitals in Spokane County, Washington, had a wide disparity in capacity in 2020, with one hospital being 30% occupied with 583 beds, while the other was 92% occupied with 536 beds. In an ideal world, once a hospital reaches a capacity of around 80%, they would immediately transition people to another facility — or better yet, patients would have access to an app or platform that shows them where they can be redirected to receive care, explains Dr. Boxer.
However, as Dr. Boxer and Herzlinger underline, hospitals are in competition with each other as businesses, and likely would not pursue this solution on their own.
"If somebody said, let's have two steel manufacturers set up a network and share capacity with one of their arrivals, people would say that's crazy," says Herzlinger. "But this is a public health issue. The solution is to require hospitals to disclose their plan for dealing with another epidemic."
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Herzlinger and Dr. Boxer propose that the U.S. Financial Accountings Standards Board, which is empowered by the Securities and Exchange Commission, require a new accounting standard for hospitals. The standard would demand that hospitals divulge their plans for capacity surges in their financial disclosures, most likely as accounts called "contingent liabilities," which are events that are likely to cause expenses in the future.
However, in order for this to happen, Dr. Boxer believes it would have to be an executive decision by the president, and has little faith a policy like this would make it through Congress.
"[Politicans] get money to run from captains of industry in their district, and what is the biggest employer in every congressional district and country? It's the health system," says Dr. Boxer. "These captains of industry are sitting on the hospital board, saying that they want their hospital to stay on top. That's what they tell the politician. It's highly incestuous in how it works."
The U.S. is already at a disadvantage when it comes to its hospital capacity. According to the Organisation for Economic Co-operation and Development, the U.S. only has 2.8 hospital beds per 1,000, people compared to eight beds per 1,000 people in Germany or 12.6 beds in Japan. The U.S. may not be able to afford to leave hospitals to their own devices, says Dr. Boxer.
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"It's a blood sport for hospitals to make sure that their hospital beds are filled," he says. "People die because [hospitals] are not sharing data. Someone has to knock some heads together for the sake of the community."
Alongside a policy change, Herzlinger and Dr. Boxer both agree that external pressure from the public could push hospitals to coordinate with each other. If patients and even employers exclusively work with health systems that have capacity contingency plans for their community, then more hospitals (and their board of directors) may consider better adhering to this new policy. "They can use it as a marketing plan — we will take care of you when the next crisis occurs," says Dr. Boxer.
Herzlinger notes that this issue should also be a major concern for employers who have lost employees to chronic health conditions and even death because hospitals could not treat them.
"From an employer's point of view, I would be worried for my employees," she says. "In the past year, we didn't have enough hospital capacity to deal with COVID and also to deal with heart attacks, cancer, births or joint replacements. Who knows how many employees needlessly had to stay out of work and were in great pain and suffering because they couldn't get a hospital bed."
While only time will tell if a policy like this could be introduced into the U.S. healthcare system, COVID has already proved that something has to change, or people will continue to needlessly die every time a public health emergency strikes.
"Only a fool would think it's not going to happen again," says Dr. Boxer. "People deserve quality care contingency liability planning so that when the next surge happens, it will be handled by the community, and every hospital will participate in the care of the individuals."
