Updated on: August 26, 2020

Hospitals without ICU Beds: The State of COVID-19 and the SDoH

Original story posted on: August 25, 2020

As scary as it seems, COVID-19 continues to exacerbate the stark realities imposed by the social determinants of health (SDoH), racism, and health disparities. The story I’m reporting on this week is about as hard to fathom as the pandemic itself. Hospitals across the country are reporting that ICU beds are now so scarce in low-income communities that patient care can barely be rendered.

As the pandemic worsens, so do the numbers, with Penn Medicine spearheading this vital study:

  • The sample consisted of the total ICU bed capacity for 4,518 short-term and critical access hospitals (CAHs) in the 50 states and Washington, D.C.; data was obtained from the Centers for Medicare & Medicaid Services (CMS) Healthcare Provider Cost Reporting Information System. 
  • Forty-nine percent of the lowest-income communities (annual income below $35,000) have no ICU beds, as opposed to 3 percent of the highest-income communities.
  • Over 35 percent of U.S. communities have no ICU beds.
  • Half of hospital service areas in the Midwest and 34 percent in the West have zero ICU beds per thousand residents age 50 or older. This compares to 52 percent of hospital service areas in the Northeast and 54 percent in the South.

New York City released over 1.46 million coronavirus antibody test results last week, providing validation of virus infiltration for lower-income communities:

  • In East Elmhurst, Queens (among the first virus hotspots), 45 percent of people tested positive, while the rate was over 51 percent in Corona, Queens. These excessively high rates were also found in parts of Brooklyn. No ZIP code south of 96th Street in Manhattan had a positive rate of over 20 percent.
  • The Bronx had the highest overall rate, at 33 percent, where close to 30 percent of the population lives below the poverty level.

Rural communities are equally struggling. This reality is due to lack of testing or available health services from facility closures, and population shifts. Along with the 170 hospital closures over the past decade, another 18 hospitals closed last year, mostly across the southern states, which include those most impacted by COVID-19, including Alabama, Georgia, South Carolina, Texas, and Florida.

The immigrant workforce employed across the food supply chain is particularly heavily impacted. They’re unable to shelter in home and vulnerable to virus transmission courtesy of vast occupational hazards, especially substandard living and working conditions.

Over 300,000 reported cases of the virus and almost 8,000 associated deaths have been reported among this population, accounting for 9 percent of all COVID-19 cases and 6 percent of associated deaths.

This topic and the data will continue to be a focus of researchers everywhere, and we will have our eyes on them. For this week’s Monitor Mondays Listeners Survey, we asked our listeners how their organizations are managing amid the pandemic. The results of the survey can be viewed here.

Programming Note: Ellen Fink-Samnick, a member of the RACmonitor editorial board, is a permanent panelist on Monitor Mondays. Listen to her live reporting on SDoH every Monday at 10 a.m. EST.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management,  Social Determinants of Health: Case Management’s Next Frontier (with Foreword by Dr. Ronald Hirsch), and End of Life Care for Case Management are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk-Ten-Tuesdays, and member of the Editorial Advisory Boards of Professional Case Management, Case Management Monthly, and RAC Monitor. Ellen also serves as the Lead for Rise Association’s Social Determinants of Health Community.

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