Health Letter, April 2020
By Michael T. Abrams, M.P.H., Ph.D., Health Researcher, Public Citizen
On April 6, President Trump lashed out at a journalist who asked him about a new Department of Health and Human Services (HHS) Office of Inspector General (OIG) report that provided a snapshot of hospitals’ challenges and needs in responding to the novel coronavirus (COVID-19) pandemic. That report — which was based on a March 23-27 survey of administrators at 323 hospitals around the country — found that hospitals were overwhelmed by the pandemic, faced severe shortages of COVID-19 test kits and medical supplies, and were poorly supported by local, state, and the federal governments.
In response to questions about the report during the April 6 White House press briefing, Trump became combative and asserted that Christi Grimm, the principal deputy inspector general of HHS and author of the report, was acting against him because of political bias. Here’s an excerpt from that exchange (see transcript):
President Trump: How long has [Grimm] been in government?
Journalist John Karl ABC News: Did serve in the previous administration.
Trump: (drenched with sarcasm) OHHHHHHHHHHHHH, you didn’t tell me that! OHHHHHHHHHHHHH, I see. You didn’t tell me that John.
Karl: She was appointed for her current position in January of this year, by your government.
Trump: (continued sarcasm) You didn’t tell me that. Did serve in the previous [administration], you mean the Obama administration. Thank you for telling me that. See there’s a typical fake news deal.
Karl: Well, you asked me when she was — you asked me when she was appointed.
Trump: No look, look…
Karl: I told you when she was appointed, by your administration.
Trump: (aggressively pointing, and with a mocking tone) You’re a third-rate reporter, and what you just said is a disgrace! Okay? You asked me — you said “Sir, just got appointed.” (here the president made a distorted face reminiscent of when he mocked a disabled reporter during the 2016 campaign). Take a look at what you said. Now, I said, “When did they — when did this person — how long did this person, how long in government?
Karl: But, but —
Trump: Well, it (sic) was appointed in the Obama administration.
Karl: But her current job was in your administration, sir.
Trump: Thank you very much John. Thank you very much. You will NEVER make it.
Trump then pivoted abruptly to the next questioner. And so, once again our chief executive became unglued when tested by a journalist, choosing to attack the messenger rather than addressing the question in a constructive way.
The president was more red-faced than normal as he ranted at ABC journalist John Karl. Why was he so? Karl and at least one other journalist before him simply wanted to know how the president squared his positive assessment of the federal COVID-19 response with the concerning assessment of the OIG.
The OIG report, in fact, is a rather pedestrian 42-page document that summarized the responses of administrators from a representative sample of U.S. hospitals who were asked three simple questions about the COVID-19 crisis:
- What are your most difficult challenges responding to the pandemic?
- What strategies are you using to address or mitigate these challenges?
- How could government best support hospitals responding to the pandemic?
Because the survey was conducted from March 23 to March 27, the OIG acknowledged that the information garnered is limited to that point in time even as the pandemic and government response are changing daily. Still, here are some important lessons from that survey for those interested in problem-solving rather than polemics:
- Hospitals are facing severe shortages of critical supplies of all types, especially of COVID-19 test kits, face masks and other protective gear for health care workers, and other medical supplies needed to evaluate and treat patients.
- COVID-19 test results were often delayed, in part because of transportation issues to off-site labs.
- Personnel was in short supply; one hospital reported that 20% to 25% of its staff were presumed to be COVID-19 positive.
- Government messaging was perceived as inconsistent and contradictory.
- Facilities were concerned about bed and personnel response capacity.
- Anticipated shortages of ventilators were a major concern, and many hospitals said they lacked trained personnel who could operate them; small hospitals were especially concerned about ventilator access.
- Public misinformation about the epidemic was a problem that unnecessarily increased hospital workloads at a critical time.
- Facilities were concerned about their cash flow.
Here is how survey respondents said they were adjusting to the crisis:
- Nontraditional supply chains were being used, some good, others poor.
- Personal protective gear was being reused, sometimes after sterilization, many times not.
- Medical staff was being retrained and redeployed to address respiratory illness.
- Use of telemedicine was being expanded.
- Ventilators were being reengineered, or at least plans were being made to, for example, ‘double-up’ a ventilator.
Finally, hospital administrators made some specific requests of the federal government:
- Assist in procuring equipment, including face masks and ventilators. States expressed deep concern that they were competing against one another to obtain such vital goods.
- Ease medical practice licensing requirements to expand the functional supply of doctors and other health care professionals.
- Relax rules around bed designations so that facility needs can be met without jeopardizing reimbursement streams.
- Offer hospitals financial assistance by accelerating Medicare payments, increasing reimbursement for telehealth services, and providing loans and grants.
- Create a centralized public information platform, presumably to unify (and thus clarify) the messaging from the federal government on down.
The OIG report was distinctively anecdotal and qualitative in nature and form. Accordingly, it does not offer a complete picture of the how difficult things are for hospitals struggling with the COVID-19 pandemic in terms of measurable quantities, and numbers in this case are key — we do need precision regarding the resources that are available and anticipated to address the surge in COVID-19 cases. Still, this OIG report, described modestly by the author as a “national pulse survey,” offers essential information that governments at all levels — including, of course, the White House’s COVID-19 task force — can use to guide the response to this rapidly evolving crisis.
Instead of berating journalists for asking questions about the OIG report, a thoughtful chief executive might have said, “I will make sure we look carefully at this report and respond quickly to it.” Trump, of course, did not do that. Listening, reading, and thinking are not typically his approach. He seems to prefer denial, vitriol, and obfuscation. The enemies are those who disagree with him, without factual discrimination. Accordingly, Public Citizen and many others continue to call for his resignation.
Mr. Trump, as you do not seem to be able to control yourself or your administration during this extraordinary health crisis we now face, follow the lead of your Acting Navy Secretary: apologize and step aside.