‘Too many lives are at stake to do otherwise’: Shifting resources during COVID-19 pandemic

Ali Khan

Leaders of states and cities with the highest burden of COVID-19 early in the pandemic have called for resources — from ventilators to medical personnel — to be shifted to these areas.

Due to the burden of disease in New York City, New York Gov. Andrew Cuomo signed an executive order allowing the state government to redistribute ventilators and personal protective equipment (PPE) from hospitals and institutions that are not currently in need of them to those with the highest need due to the burden of COVID-19 in their communities.

“I'm not going to get into a situation where we're running out of ventilators and people are dying because there are no ventilators but there are hospitals in other parts of the state that have ventilators that they're not using,” Cuomo said during a press briefing. “I'm just not going to allow us to go there. I think it would be wholly irresponsible.”

The executive order noted that institutions will have the supplies returned or have the cost of the equipment reimbursed at a later date.

Previously, both Cuomo and Michigan Gov. Gretchen Whitmer had previously called for health care workers to come to New York and Michigan to mitigate the strain to the health care system caused by the pandemic.

To learn more about the implications of shifting resources and how to ensure low-burden areas are not left vulnerable, Healio Primary Care spoke with Ali Khan, MD, MPP, FACP, executive medical director at Oak Street Health and faculty member in the department of medicine at the University of Chicago’s Pritzker School of Medicine, and Harriet Booker, chief operating officer of Option Care Health, the largest independent provider of home and alternate site infusion services in the United States.

Benefits of shifting

“The primary benefit of any resource reallocation is pretty straightforward,” Khan told Healio Primary Care. “It gets crucial supplies to the front lines of COVID-19 hot zones and communities that desperately need that help.”

Before shifting resources, he noted it is essential to ensure that all health care workers and communities are prepared to care for patients with COVID-19. However, he said many communities with a low burden of COVID-19 are practicing social distancing, meaning that fewer people are going to the hospital, which frees up medical supplies.

“In those areas, there may be excess resource capacity that can be shared with those who are in more dire straits,” Khan said.

Booker noted that Option Care Health has sent nurses from low-burden to high-burden areas — including from upstate New York to New York City — to allow them to treat more patients at home during the pandemic, and potentially prevent patients from requiring hospitalization and using resources needed for those with COVID-19.

She explained that the company “is very well positioned during this pandemic to work with primary care physicians and health care workers to either prevent hospital admission or discharge safely into the home so that the health care system — whether it’s a hospital or physician office — can use its capacity to care for people who must be hospitalized [during the pandemic].”

Preventing vulnerability in low-burden areas

Before sending health care workers to areas heavily impacted by COVID-19, Booker said “we look at the whole ecosystem of our health care team, and we don’t feel in any shape or form that we would be leaving other areas vulnerable.”

“In fact, we would only shift resources physically if our capacity allows for that,” she continued. “One of the positive impacts of Governors Cuomo’s and Whitmer’s executive orders was to allow licensed medical professionals from other states to deliver care across state lines.”

Khan explained the success of shifting resources like PPE and ventilators to high-burden areas depends on whether those making redistribution decisions at state and institutions are using the best scientific evidence to determine the amount of equipment needed in multiple scenarios.

“If leaders, clinicians and scientists are working together, hand-in-hand, to shape that strategic planning and prioritizing safety for their patients and their care teams, then we're likely in a really good place — and we can share what extra resources may be available,” Khan said.

“Communities that have been decisive and thoughtful about day-to-day, hour-to-hour assimilation of new information on COVID-19, and that have anchored in social distancing policy, have really helped us to create some extra hands to help other locales,” he added. “We may not have that forever as states start to reopen, but for as long as we do have it, we should take advantage of it — too many lives are at stake to do otherwise.” – by Erin Michael

References:
Amid ongoing COVID-19 pandemic, Governor Cuomo announces executive order allowing state to redistribute ventilators & personal protective equipment to hospitals with highest need. https://www.governor.ny.gov/news/amid-ongoing-covid-19-pandemic-governor-cuomo-announces-executive-order-allowing-state. Accessed Apr. 27, 2020.

Governor NY. Video, audio, photos & rush transcript: Amid ongoing COVID-19 pandemic, Governor Cuomo announces executive order allowing state to redistribute ventilators & personal protective equipment to hospitals with highest need. https://www.governor.ny.gov/news/video-audio-photos-rush-transcript-amid-ongoing-covid-19-pandemic-governor-cuomo-announces-7. Accessed Apr. 27, 2020.

Gretchen Whitmer. Twitter. https://twitter.com/GovWhitmer/status/1244777864974733313. Accessed Apr. 28, 2020.

Disclosures: Booker reports she is a shareholder, officer and current employee of Option Care Health. Khan reports he is a shareholder and current employee of Oak Street Health, a shareholder and former employee of Iora Health and Anthem Inc., and an incoming member of the American Board of Internal Medicine.