Will North Texas Health Care System Recover After Four COVID-19 Blasts?

The coronavirus pandemic has dealt the US healthcare system one hit after another with four major COVID-19 outbreaks. And hospitals are dealing with two years of navigating equipment shortages, increased patient numbers and staff burnout with little to no respite.

While the recent omicron wave appears to be waning, the potential for another COVID-19 surge is ever-present. In north Texas, hospitals only had a few weeks to recover from the delta rise before the Omicron variant was first spotted in the area.

As part of an ongoing conversation with COVID-19 experts, The Dallas Morning News spoke to a panel of four healthcare providers and researchers to learn more about the current state of North Texas’ healthcare system and its possible future. The experts are:

  • dr Alejandro “Alex” Arroliga, chief medical officer at Baylor Scott & White Health
  • Erin Carlson, associate clinical professor and director of graduate public health programs at the University of Texas at Arlington College of Nursing and Health Innovation
  • dr Joseph Chang, chief medical officer at Parkland Health
  • Meagan Rogers, associate professor of undergraduate nursing at the University of Texas at Arlington’s College of Nursing and Health Innovation

What was the biggest blow to North Texas’ healthcare system during COVID-19?

For Chang, who oversees medical care at Dallas County’s only public hospital, the pandemic’s most challenging wave came with the Delta variant, which caused more severe illness in unvaccinated patients than any of its predecessors.

Although the Omicron variant is more contagious, breaking all case records in both North Texas and the United States, an analysis of Houston Methodist patients found far fewer patients with the strain needing to be hospitalized compared to the Delta variant.

Patients with Delta also had the longest median hospital stay — 5.4 days — compared to patients with Omicron and Alpha infections. These patients had a mean length of stay of 2.8 and 5.1 days, respectively.

“These patients were sicker than other variants and stayed longer in the hospital,” Chang said.

Staffing during the Delta was particularly difficult in Parkland because of the need for so many ICU-level staff, he said.

Hospitals also have to deal with uncompensated hospital expenses, Carlson said.

Data on the cost of all COVID-19 hospitalizations is not publicly available, but the Peterson-Kaiser Family Foundation Health System Tracker estimates the average COVID-19 hospitalization cost is approximately $20,000. (The Chaser is operated as part of a partnership between the Peterson Center on Healthcare and the Kaiser Family Foundation.)

Without insurance, that’s a steep price. According to data from the Texas Comptroller of Public Accounts, Texas has both the highest number and percentage of uninsured residents in the country.

“There was a high level of complex care provided in large volumes, compounded by Texas’ high uninsurance rate,” Carlson said. “This mixture inevitably leads to a significantly higher burden on hospitals due to unpaid care.”

The longest-lasting toll of the pandemic will likely be the loss of burned-out frontline workers.

Staff shortages have been a constant concern for hospitals throughout the pandemic, putting additional strain on already exhausted healthcare providers. For example, during the Omicron wave, many nurses and other workers contracted the variant, preventing them from coming to work for several days.

“The biggest health care impacts are not measured in dollars and cents,” Arroliga said. “It’s measured by the emotional and physical toll it takes on our workforce.”

Will our healthcare system recover from the pandemic?

All four experts believe the US healthcare system will recover from the hardships caused by the pandemic.

“We’re nothing if not resilient,” Carlson said. “The resilience of the human spirit is remarkable, especially in people as passionate as those you find in public health and healthcare.”

While the healthcare industry is under immense stress, the system has adapted to care for patients during a pandemic, Chang said. The biggest remaining hurdle is solving the shortage of medical staff.

“The main difficulty before the pandemic, and now only magnified, is the lack of care across the country,” he said. “Until nursing becomes a desirable and desirable profession overall, we will continue to struggle with it.”

There is no quick or easy fix for post-pandemic recovery, Rogers said. Even before COVID-19, Texas was experiencing a nursing shortage, and there aren’t enough nurses to keep up with the number of nurses who need training to fill the gap.

“Even though nursing programs have been able to increase the supply of registered nurses in the state, it takes at least five years to train a nurse, so this is not a short-term solution,” she said.

What will the healthcare industry look like after the pandemic?

The COVID-19 pandemic will bring some positive changes, Carlson said. The use of telemedicine, which can expand access to care for those with busy schedules or those living in remote areas, is likely to continue even after the pandemic has passed.

Psychiatric care could also be given more attention. “We will see increased delivery of mental health care via telemedicine and an adjustment in reimbursement strategies to support remote delivery of services,” Carlson said.

The industry could also see an increased awareness of the need for mental health care for healthcare providers. More than three-quarters of healthcare workers reported fatigue and burnout in a 2020 study by Mental Health America. More than 67% said they were sad.

“Hopefully this will be accompanied by a reduction in stigma in the healthcare industry towards providers who seek mental health care,” Carlson said.

What changes need to be made to maintain the healthcare system as we know it today?

Managing chronic health conditions like diabetes, high blood pressure and asthma should be of paramount importance post-pandemic, Chang said.

Preventive measures that prevent chronic diseases from reaching severe levels will reduce hospital visits and better prepare the healthcare system for acute events like the pandemic, he said. But to improve preventive care, the system must remove barriers to accessing primary care.

Perhaps the most critical and urgent need to sustain the US healthcare system is the labor shortage. That requires prioritizing the health and well-being of critical care workers like nurses, Rogers said.

“Admins used to buy pizza for staff during a tough shift, but nurses are now sending them a clear message to trade the pizza for real solutions to fix staffing problems,” she said. “We must take care of the health of both patients and the professionals treating them to sustain the healthcare system post-pandemic.”

Barbara Davis, immunizations supervisor and registered nurse, administered an unidentified 18-year-old Monday, May 13.

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