Planning in the Calm Before the Storm: Staffing in a Pandemic Crisis

Update: On March 11, 2020, the World Health Organization officially declared COVID-19 a pandemic.

The evolving public healthcare crisis surrounding the spread of coronavirus disease 2019 (COVID-19) raises many questions about the capacity of healthcare organizations to maintain staffing levels to provide appropriate care.

Any healthcare providers who come into direct contact with patients or clients must take precautions to ensure that they protect themselves. With demand for healthcare services surging amid concerns over the spread of the virus, provider health and safety are vital to ensuring adequate staffing to care for those affected by COVID-19.

The effects of this public health concern are far reaching, as anyone providing direct care already knows. Primary care providers and hospitals are facing increasing questions from those who are ill or suspect they might be ill. Behavioral health concerns are exacerbated by the anxiety associated with the spread of this disease as well.

And naturally, infection prevention and control is a concern in every facet of healthcare as organizations strive to keep their staff and clients healthy.

Although the distribution of COVID-19 has not been classified as a pandemic at this point, healthcare organizations are taking serious steps to respond to the global spread of this disease.

In fact, the Centers for Disease Control and Prevention (CDC) has stated, “Current global circumstances suggest it is likely that this virus will cause a pandemic.“ The CDC cautions that healthcare providers and hospitals could become overwhelmed if we have widespread transmission of COVID-19.

Contingency Planning To Ensure Adequate Care

An influenza pandemic has been expected by health officials for years, and one of the top concerns has been healthcare staffing.

“The threat of pandemic infectious disease lurks quietly beneath the surface of everyday hospital operations and society at large,” an article in Emergency Medicine Reports notes. “In an infectious disease pandemic, the hospital resource most at risk for inadequate supply is staff.” In fact, all healthcare staffing is at risk when a pandemic occurs.

For hospitals, nursing shortages pose a clear risk for pandemic preparedness. “A robust nursing workforce is needed for a hospital to effectively respond to a public health emergency (PHE) such as a terrorist attack, infectious disease epidemic, or natural disaster,” an article in Public Health Nursing notes.

Physicians at the Johns Hopkins Center for Health Security advise hospitals to focus on the following priorities to maintain appropriate staffing and care capabilities during an infectious disease outbreak in general and the COVID-19 crisis in particular:

• Planning for surge capacity based on CDC projections for individual hospitals and the region.
• Limiting the spread of COVID-19 within the hospital to protect healthcare workers and patients.
• Finding ways to maintain, augment, and stretch the hospital workforce.
• Allocating healthcare resources in a rational, ethical, and organized way to do the greatest good for the greatest number of people.

Of course, staffing concerns amid PHEs go beyond hospital needs, as healthcare workers in many settings may work longer hours, be exposed to ill clients, and become infected themselves. Many of the above strategies can benefit other healthcare organizations as well.

Planning for Unknown Public Health Emergencies

When a real crisis develops, the planning process itself is what pays off, epidemiologist Stephen Weber, MD, notes in Hospital Infection Control and Prevention. The process a team goes through to develop an emergency plan can promote collaboration, flexibility, and adaptability, he observes.

In recent years, U.S. and global healthcare leaders have strongly emphasized pandemic preparedness planning. The U.S. National Strategy for Pandemic Influenza relies on three pillars:

• Preparedness and communication
• Surveillance and detection
• Response and containment

A brief from the Institute of Medicine of the National Academies emphasizes that crisis standards of care must be employed when a public health emergency requires a substantial change in healthcare operations. The brief focuses on preparations for providing care amid a catastrophic disaster.

“Medical care delivered during disasters shifts beyond focusing on individuals to promoting the thoughtful stewardship of limited resources intended to result in the best possible health outcomes for the population as a whole,” the researchers note in the brief.

Finding Creative Solutions to Staffing as Demand Surges

Pandemic preparedness plans must include strategies for expanding and adapting the healthcare team as demand surges and illness circulates among staff members. “Nurse staffing and supporting systems are weak links in the preparedness chain,” the Public Health Nursing article notes.

Strategies to expand staffing in the event of a PHE include mutual aid agreements, temporary professionals, volunteers with experience, help from the American Red Cross and other relief agencies, retired professionals, and national disaster resource teams from outside the locality.

However, if a widespread event such as a viral pandemic develops, localities may not be able to rely on external support because the resources will be needed across the country. Other complicating factors include healthcare workers becoming ill themselves, being absent because of family illness, or experiencing emotional distress that might reduce their capacity to care for clients.

Preventing Healthcare Worker Infections

History provides cautionary tales for contingency planning to ensure adequate staffing. In the 2003 outbreak of severe acute respiratory syndrome (SARS), many exposed healthcare workers, patients, and visitors became infected and transmitted infection to others in the healthcare facilities. The cause of that SARS outbreak was later identified as a coronavirus, named SARS-CoV. The virus causing COVID-19 has been named SARS-CoV-2.

To minimize the risk of exposure to COVID-19, the CDC advises healthcare personnel to follow infection prevention and control guidelines and use recommended personal protective equipment (PPE).

However, shortages of PPE are a global concern, according to a March 3 World Health Organization (WHO) news release. PPE supply shortages are leaving frontline healthcare workers “dangerously ill-equipped to care for COVID-19 patients,” the WHO release says, noting that they rely on PPE “to protect themselves and their patients from being infected and infecting others.”

In a February WHO briefing, Director-General Tedros Adhanom Ghebreyesus, PhD, MS, observes, “This situation has been exacerbated by widespread, inappropriate use of PPE outside patient care.” His top priority is for PPE to go to healthcare workers. Next in line are those who are sick or caring for someone who is sick.

Keeping Healthcare Workers on the Front Lines Informed

Naturally, public health guidance on preparedness and prevention evolves along with the actual diseases encountered, the development of new resources, and real-life experiences. The CDC is providing regular updates on COVID-19 and investigators’ understanding of the virus.

As the situation is changing rapidly, the CDC has designated a section of its COVID-19 website to keep healthcare professionals up to date.

In any pandemic situation, infection prevention and control procedures are vital to protect healthcare workers and patients. Online education from reliable sources can provide easily accessible information to ensure all healthcare workers understand the necessary precautions and procedures.

In order to maximize the ability of healthcare workers and others to fight the spread of COVID-19, WHO has provided free access to an online course on emerging respiratory viruses, including COVID-19, and an introductory video.

Relias also has made resources available for free to help healthcare organizations prepare for infectious diseases and stop the transmission of COVID-19.