HPH systems play a vital role in maintaining national health security. However, shortages of HPH workers, insufficient surge capacity, and availability of training, especially in the nursing field, remain challenges. Public health emergencies and disasters exacerbate these challenges, which affects overall resiliency of HPH systems. The HPH workforce is susceptible to staffing shortages due to high turnover and burnout. During COVID-19, the public health and medical workforce also faced heightened personal security concerns, which worsened burnout. Insufficient supply of personal protective equipment (PPE) for essential workers can impede response operations and pose a health risk for emergency, health care, and public health personnel. Workforce shortages, coupled with inequitable patient access to telehealth technologies and limited provider services offered through telehealth, result in deficiencies in critical expertise and disruptions in continuity of care for chronic disease patients, people with disabilities, and underserved communities.
Effective health care delivery and hospital management during times of disaster is a challenge. The volume of patients can overwhelm the number of beds available in a hospital and managing patients’ acute- and long-term care needs can strain hospital operations as demand for PPE, hospital beds, and other supplies surges during a disaster. Rural hospitals often face disproportionate operational challenges during public health emergencies and disasters due to pre-existing limited bed capacity, lack of specialty care, and financial constraints.
Containment and/or mitigation of a novel disease requires rapid pathogen testing combined with immediate availability of PPE and laboratory supplies. High testing demand, coupled with staffing shortages, challenges with data availability, and regulatory requirements strains public health laboratories and can lead to delays in response.
Additionally, aging data infrastructure and inconsistent capacity to manage data limits information sharing between the federal government and SLTT authorities. The lack of interoperable datasets and surveillance systems and technology bottlenecks, including the inadequate linking of electronic health record data and other significant data sources with national syndromic surveillance systems, is a significant challenge that limits situational awareness, delays detection times, and negatively impacts patient care. This challenge leads to an incomplete national picture and slows response activities during public health emergencies and disasters that impact multiple geographic areas.
An NIH study demonstrated that nearly 1 in 4 COVID-19 deaths was potentially attributable to hospitals strained by surging caseload. Despite improvements in COVID-19 survival between March and August 2020, surges in hospital COVID-19 caseload remained detrimental to overall patient survival and potentially eroded benefits gained from emerging treatments.
Association Between Caseload Surge and COVID-19 Survival in 558 U.S. Hospitals, March to August 2020