The astonishing toll of COVID-19 in the United States is not limited to the number of cases and deaths.
The pandemic has also led to record unemployment among an unlikely group: nurses and health care workers, as the American for-profit health care system is strained by both the virus and an economic crisis.
“I was ready to put on my boots and go out into it,” said Dayna James, an emergency room nurse in Miami, recalling the early days of the pandemic in March.
Back then, the entire country was bracing for the worst. Her hospital cleared the emergency room to make room for COVID-19 patients — only to see South Florida spared the initial arrival of the virus.
“There was no patient volume. The patients were not coming in,” she explained.
With the E.R. less than 50 per cent full, her hours were cut. James went from preparing to help others, to needing help herself.
“Grocery money was tight,” she said. “It doesn’t bring me shame, but I went through food donation lines.”
The U.S. Bureau of Labor Statistics reports that at least 1.4 million healthcare workers, many of them nurses, were laid off or furloughed by April.
“A lot of hospitals are kind of quiet about cutting nurses’ hours,” said Mike Hastings of the Emergency Nurses Association. “Who wants to say during a worldwide pandemic that you’re cutting nurses’ hours?”
Those jobs have been slow to come back.
“It’s turned around somewhat, but it hasn’t returned to pre-COVID levels,” said Alison Cuellar, a professor of health policy at George Mason University.
Experts lay the blame squarely on the private, for-profit network of hospitals and clinics in the U.S., where healthcare is a business transaction, and where patients are actually considered customers.
Like any other business caught up in the pandemic, a loss of revenue has led to a decision to cut staff.
The reality is that hospitals and outpatient clinics rely on elective surgeries and non-emergency procedures as a large source of their income. Many elective procedures were cancelled to free up resources when the virus first emerged.
Then emergency room visits, unrelated to COVID-19, all but dried up. As people stayed at home, the normal rate of injuries plummeted.
“What we’re seeing is hospitals really having much, much less care going on than normally would be going on,” explained Dr. David Shulkin, who served as Secretary of Veterans Affairs under President Donald Trump.
According to the American Hospital Association, hospital revenues in the U.S. decreased by an average of $50 billion per month, between March and June of this year (all dollars U.S.). The federal government’s relief bill, known as the CARES act, set aside just $30 billion in funds for eligible health care providers.
At the same time, the cost of procuring supplies and meeting demand for COVID-19 care totalled an extra $36.6 billion during that same time period. The cost of acquiring extra PPE alone is estimated at $600 million per month.
The financial pain isn’t limited to hospitals.
Doctors’ offices, dental practices and other clinics have seen a severe decline in business, after being ordered to shut their doors during stay-at-home orders.
“Even when you reopen, patients are reluctant to continue at the pace that they had before,” Cuellar said.
In the face of declining revenues, the costs of delivering health care keep rising.
As the virus moves around the country, hospitals have had to rent hotel rooms for their staff, to keep them from exposing family members to COVID-19. They’ve spent millions of dollars adding beds and converting spaces to accept the new surge in patients.
“We’re seeing a system of care that really doesn’t act as a system,” Shulkin said. “These are individual hospitals, individual doctors, individual insurance companies and suppliers, all acting in their own best interests,” he said.
Little about the pandemic has unfolded as expected.
The virus eventually arrived in South Florida like a tsunami, delivering more cases per day in that state than had been recorded anywhere else in the country. The rate of hospitalization and death surged to new daily records.
After initially being laid off, Dayna James was called back to work.
“Right now, it’s ugly. It’s like nothing I’ve seen before,” said James of her long days in the emergency room.
The stress of unemployment has been replaced with the fear of the virus itself.
“This is an eyeopener to see how our country has dealt with this, compared to other countries and how we’re developing, comparing us to the rest of the world,” she said.
Jackson Proskow is Washington Bureau Chief for Global National.