A health care draft could help unemployment and front line burden in response to COVID-19

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As COVID-19 diagnoses surpasses 400,000 cases, U.S. hospitals are concerned about capacity. There are not enough ventilators, beds or frontline clinical staff to handle the impending tsunami of intensive care unit patients. Meanwhile, U.S. unemployment counts have continued to multiply, exceeding 10 million in the past 30 days

Many are worried about each of these scenarios and we are already seeing responses. New York Gov. Andrew CuomoAndrew CuomoOvernight Health Care: Trump calls report on hospital shortages ‘another fake dossier’ | Trump weighs freezing funding to WHO | NY sees another 731 deaths | States battle for supplies | McConnell, Schumer headed for clash Overnight Defense: Navy chief resigns over aircraft carrier controversy | Trump replaces Pentagon IG | Hospital ship crew member tests positive for coronavirus NRA reportedly lays off dozens of employees amid coronavirus MORE, for instance, is enlisting graduating medical students to the frontlines.

Nonetheless, how do we further increase health care capacity? What do we do about the growing unemployment as companies, shops and restaurants remain closed in most states and major cities around the country? 

As the White House has clearly indicated, we are in a time of war. In war, countries take drastic measures to handle impending threats. But for the first time in modern U.S. history, the enemy cannot be fought off with guns, troops and diplomacy. This enemy requires stethoscopes, compassion for one another and a determination to increase health care capacity.

We would like to propose a voluntary draft of health care workers for the nation’s consideration. Such a move would put most unemployed people back to work in the next 90 days, ensure that they have adequate health care coverage and prevent avoidable deaths caused by COVID-19.

Our analysis of the Johns Hopkins Coronavirus Resource Center data combined with World Health Organization (WHO) data on nursing concentrations indicates that every additional nurse per 1,000 in the population is associated with a -2.0 reduction in COVID-19 deaths per million. This implies that nurses — physicians and therapists, for that matter — on the frontlines are able to address patient needs adequately to prevent many COVID-19 deaths. But our capacity in terms of frontline staff are only proportional to the number of ICU beds currently in the U.S. 


If the number of patients with COVID-19 ventilators exceeds our current 100,000 ICU bed capacity in the U.S., we will definitely be in need of not only more beds and ventilators but more frontline staff.

Putting unemployed individuals back to work on the frontlines of health care is not out of reach. 

We could increase nursing capacity in the U.S. within 90 days by putting individuals through a 12-week certified nurse assistant (CNA) training online. The U.S. has almost 4 million nurses. If we trained 2.5 million of the unemployed in this skillset as a course of “basic training,” it would increase our total nursing capacity by nearly 50 percent nationwide. This would enable yet another pathway to adequately address the needs of patients.

To be clear, the intention is to add skilled labor to the frontline workforce, while allowing for experienced nurses to work at the top of their licenses. Specific tasks such as taking vital signs, triaging acuity and managing documentation can be the focus of a CNA short course. 

This is a long-game proposal that will decrease the burden of burnout as diagnostic surges continue across the country.

The cost for this proposal? The U.S. could train CNAs for about $3 billion, considering an individual certification costs about $1,200. If the U.S. paid for this cost, making it free for volunteers, then we would be insulating individuals whose jobs are threatened with an alternative set of technical skills that remain useful past this viral economy.

Equally important to this measure will be a solution to fluctuating rates of under-insurance and un-insurance. As individuals lose their jobs, they also lose their healthcare coverage. This presents a major threat to any remaining economic stability, as those who may contract COVID-19, or face other health dilemmas, fail to maintain adequate coverage. Should the U.S. military consider the opportunity of drafting volunteers from the growing unemployed population who are capable of gaining skills to serve capacities as frontline staff, then the U.S. could quickly and sufficiently extend healthcare coverage through TRICARE. TRICARE is the military branch’s form of health insurance, which provides coverage for almost 10 million Americans. It would adequately serve the temporary influx of healthcare needs for workers who transition to frontline staff. 

Ultimately, if this is a possible solution, what are we waiting for? If COVID-19 rates and unemployment continue to grow across the nation, the time is now to train health care workers to relieve the current strain on the system and put individuals back to work for adequate pay. 

Even if we are able to flatten the curve for the time being, it may be wise to develop a reliable contingency plan to quickly respond to American needs for both healthcare capacity and employment.

William Padula, Ph.D., is an assistant professor of pharmaceutical and health economics in the School of Pharmacy at University of Southern California and a Leonard D. Schaeffer Center Fellow for Health Policy & Economics in Los Angeles. Manish Mishra, MD, MPH, is the director of professional education at the Dartmouth Institute for Health Policy & Clinical Practice, and an assistant professor in the Geisel School of Medicine at Dartmouth, Hanover, NH.

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