Will post-omicron mean down time or prep time for hospitals?

New omicron cases are declining nationwide, with most states predicted to see this surge peak by mid-February. If the omicron surge ends as quickly as it started — as it has in South Africa and the U.K. — some health experts predict the U.S. will experience a "quiet period" where infection levels will remain low due to high levels of population immunity. This period will give hospitals time to recuperate from a COVID-19 wave filled with record hospitalization levels, extreme staffing shortages and a scant supply of available tests and treatments. 

That leaves hospitals with a simple question that's hard to answer: what comes next? Some experts are hopeful the pandemic's emergency phase is coming to a close and that the world is entering a time where COVID-19 will prove less disruptive to everyday life. However, uncertainty remains, especially as high levels of viral transmission increase the risk for new variants to emerge.

"This pandemic, like all other pandemics before it, will end, but it is far too early to relax," Dr. Hans Henri Kluge, the World Health Organization's regional director for Europe, said Jan. 24.  "With the millions of infections occurring in the world in recent and coming weeks, coupled with waning immunity and winter seasonality, it is almost a given that new COVID-19 variants will emerge and return."

Whether the pandemic evolves into regional, controlled COVID-19 outbreaks or another national surge occurs, the U.S. healthcare system must use the months ahead strategically to reflect on the past surge's challenges and prepare for the uncertainty ahead, Ashish Jha, MD, dean of Brown University's School of Public Health in Providence, R.I. wrote in a Jan. 24 op-ed for The Washington Post. 

Five areas preparations should focus on:

COVID-19 vaccinations. Healthcare providers must focus on vaccinating the tens of millions of Americans who are still unvaccinated, many of whom are children. An even larger proportion of Americans have not received booster shots. As of Jan. 28, 75.1 percent of Americans had received at least one dose, 63.7 percent were fully vaccinated, and 41.1 percent received a booster dose, CDC data shows. 

Vaccinations are a key strategy in slowing down the COVID-19 virus's spread and limiting the risk of new, potentially more dangerous variants emerging. Vaccinations will also be crucial to mitigating the burden on hospitals if another major surge occurs. Dr. Jha said the U.S. needs "Operation Warp Speed 2.0" to study and create new variant-specific vaccines.

Shereef Elnahal, MD, CEO of Newark, N.J.-based University Hospital, said the hospital is working closely with the state on a mobile van vaccinations initiative in which clinicians canvas door-to-door to emphasize the importance of vaccinations. 

Testing. Testing production decreased after last year's delta surge, meaning the U.S. had to ramp back — almost from scratch — to meet demands in the omicron surge, according to Dr. Jha. "We can't make that mistake again," he said. As demand for testing slows in line with the omicron wave's deceleration, test manufacturers will be left with a glut of tests. "If no one buys them, manufacturers will stop making them," Dr. Jha said in a Jan. 24 Twitter thread. The U.S. must commit to buying and storing these tests for future surges.

Dr. Elnahal said manufacturers will also need more notice to increase manufacturing capacity before another surge.

"Stockpiling tests makes sense to a degree, but recently, during omicron, the tests that were stockpiled didn't come anywhere near to what the need was," Dr. Elnahal said. "So the realistic move is anticipating and predicting when surges will happen and then ramping up testing production."

Therapeutics. Shortages of COVID-19 therapeutics have affected health systems nationwide, forcing some to ration treatments to accommodate patients. Dr. Elnahal said health systems are at the "behest" of state and federal governments on the matter. 

"We're given what we are allocated, and so we are making our voice heard as much as possible to the state health department's State Office of Emergency Management … that Newark as a community should be prioritized that was so disproportionately impacted by the pandemic," Dr. Elnahal said.

Before another variant emerges, the U.S. must ensure every American can access COVID-19 antiviral treatments as soon as they test positive by expanding available supplies and ensuring clear clinical pathways, Dr. Jha said. 

Capacity. Not all hospitals or systems will have the benefit of "down time" when the current COVID-19 surge recedes. 

"We really haven't had any down time nor do we expect to have down time from our regular work of providing that complex tertiary and quaternary care," said Johnese Spisso, RN,  president of UCLA Health and CEO of UCLA Hospital System in Los Angeles. 

Even pre-omicron, the health system was consistently operating at 100 percent capacity, she told Becker's. In between each of the four COVID-19 surges since the start of the pandemic, UCLA Health has seen "a flurry of activity" among patients who may have deferred care during the surge period and then came in once it receded. "We end up being even busier in between surges [when] we're trying to make up a lot of care that was deferred," Ms. Spisso said. 

Armed with this knowledge from earlier surges, UCLA Health is now focused on "creating alternative places for care," Ms. Spisso said. This includes further building out hospital-at-home concepts, expanding outpatient areas to bolster primary and secondary care, and moving most oncology infusion services into community sites "so that we can really have a workforce in those areas that's a little less resource intensive," enabling the system to direct more focus to hospitalized patients requiring complex care. UCLA Health is also planning to add 125 mental health beds on a new campus to convert existing beds at another campus into additional medical surgical beds.  

Staffing. Hospitals entered the omicron wave already facing workforce shortages because of pandemic-related stressors. These shortages were magnified as employees had COVID-19 infections or exposures. As these employee absences fall, hospitals will still face staffing shortages in the wake of omicron. A big focus for University Hospitals this spring will be fortifying contingency staffing plans.

"Science would predict that any future variant would likely be even more transmissible, and in that scenario, we can always expect more staffing shortages," Dr. Elnahal said. "So [we're] fortifying our agency contracts, making sure we're doing everything we can to recruit and retain with competitive salaries. We're going to be doing a holistic effort on that to protect us in the event of a future wave."

With continuously high patient volumes and extra strain from omicron-driven staff outages, UCLA Health's greatest challenge has been trying to maintain a resilient and revitalized workforce, Ms. Spisso said. The system has offered extra shift incentives such as monetary rewards and meals, as well as providing wellness offerings "but people really just wanted time off," she said. "That has been the hardest thing to do when we're so short-staffed." 

To bolster staffing and reduce the strain on current employees, UCLA Health is looking to expand its medical assistant training program and continues to work with its school of nursing to expand student slots. 

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