Veterans Affairs' staffing shortage raises concerns amid coronavirus outbreak

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, discusses why he would think twice about getting on a plane in the midst of the coronavirus pandemic.

Posted: Mar 13, 2020 9:29 AM
Updated: Mar 14, 2020 11:53 AM


A chronic staffing shortage across the Department of Veterans Affairs is fueling new concerns that lives could be put at risk as the country's largest integrated health care system confronts the growing coronavirus pandemic.

Data released in August revealed 49,000 vacant positions across the department, which employs more than 390,000 people. While the agency's budget has since increased, tens of thousands of jobs remain unfilled.

'It could end up killing people,' one VA official who works for a regional system said, referring to the likelihood that medical personnel at its 1,243 health care facilities across the country will be overwhelmed by a significant rise in patients.

Earlier this month, the VA confirmed the first case in its system. That veteran is currently being treated for coronavirus at a VA facility in Palo Alto, California.

Fifteen other cases, either confirmed or presumed to be positive, have since surfaced at VA facilities in Nevada, Louisiana, Washington state, Georgia, South Dakota and Colorado.

As of Friday, the VA says it has administered 140 tests nationwide, up from 70 just two days prior. That means roughly 9% of those tests have registered indications of coronavirus, a staggering result considering the VA provides care for millions of veterans.

The VA has 3,000 test kits available,1,000 of which were provided by the CDC and will be used first. An additional 2,000 VA-developed tests will only be used if necessary, VA spokesperson Christina Mandreucci told CNN.

In an interview with CNN this week, President Donald Trump's former VA secretary, David Shulkin, agreed that staffing shortages could result in avoidable patient deaths and said it could also limit the VA's ability to proactively test patients.

'When there's time to look back upon the situation and we dissect the response, I think the big deficiency is going to be the fact that we were not prepared for testing,' said Shulkin, noting that it was clear back in December that coronavirus was becoming a significant infectious outbreak.

Older veterans at risk

Most concerning are staffing shortages at facilities that serve a high number of older veterans, a patient population that is among the most vulnerable to infection.

'What demographic uses VA the most and who is most at risk? Elderly people,' a former VA official told CNN. 'Where are those people located? The same places where the system is already overwhelmed.'

On March 10, more than 134 nursing homes operated by the VA adopted a 'no visitors' policy in an effort to lower the risk of exposure to the coronavirus among older veterans.

While Mandreucci told CNN that 'no staffing issues are impacting its response to COVID-19,' the department has been grappling with a well-known staffing problem for some time. Lawmakers and VA officials have sought to address the situation for several years with little to show for it. Mandreucci maintains the VA's workforce continues to grow, citing a turnover rate that 'compares favorably to other cabinet level agencies.'

Yet, the Trump administration's struggle to address the coronavirus outbreak has renewed concerns over VA's failure to fill key positions at medical facilities across the country. Congressional aides familiar with the staffing shortages who spoke to CNN this week acknowledged it's a serious problem that could get exacerbated as the virus spreads.

Open to civilians?

Should the coronavirus continue to worsen, the VA could be called on to open its doors to civilians in case of a national health emergency -- a directive that has been triggered during previous crises. In 2016, the department authorized VA grief counselors and emergency responders to provide assistance to victims following the Pulse nightclub shooting in Orlando, Florida.

Shulkin told CNN that were he still running the VA, he would have already issued the directive in response to the coronavirus. 'I believe the necessary authorities are already in place. I do believe that one should coordinate all their decisions with both Congress and the executive branch,' he said.

As of now, VA Secretary Robert Wilkie has not taken that step, but the option remains on the table amid warnings that the outbreak is expected to spread. The VA has deployed some resources to help other federal agencies conduct screening of repatriated Americans.

One VA official working at a facility outside Washington, DC, told CNN that they believe VA resources would only be offered to the civilian population in a worst case scenario and that they were not aware of any discussions at the local level about that happening.

Some VA medical facilities are uniquely equipped to treat patients with respiratory symptoms that have been associated with coronavirus, offering so-called negative pressure isolation rooms that contain air flow to help prevent cross-contamination.

The VA has 1,000 of those rooms throughout its system, according to Shulkin, more than any other health care system in the country. But they're only effective if properly staffed, he said.

Emergency preparations

The VA has taken some steps to address the coronavirus outbreak in recent weeks and remains more flexible than most health care systems in its ability to deploy staff to areas in need of additional assistance, maintaining a longstanding plan to deploy clinical and non-clinical staff in emergency situations

'VA's emergency preparedness exercises began weeks before COVID-19 was confirmed in the US. These exercises are an essential part of VA's ability to meet the specialized healthcare needs of veterans across this widespread challenge,' Mandreucci said when asked if facilities were properly equipped.

Still, veterans must meet very specific criteria in order to be prioritized for testing, placing similar restrictions on those who have access to tests similar to civilian patients.

In order to meet the current standard for testing, individuals must have demonstrated symptoms and had exposure to someone who has tested positive or traveled to one of the regions the administration has designated as 'high risk,' Mandreucci confirmed, adding that the department is implementing the same guidance issued by the Department of Health and Human Services.

Additionally, some veterans who are tested have to wait days before receiving their results.

While VA facilities across the country are able to administer COVID-19 tests, they must be sent to the department's Public Health Reference Laboratory in Palo Alto, California, for processing, according to the department. VA Medical Centers are also using local or state public health departments for test processing, according to Mandreucci.

Wilkie has insisted that the VA is prepared to handle coronavirus and is taking the necessary steps to protect veterans.

'We rehearse all the time, for epidemics and natural disasters — we are constantly rehearsing and just change the name on whatever we are dealing with ... if it's Ebola, if it's H1N1, that's how we deal with it,' Wilkie told CNN on March 4.

Several VA officials at facilities across the US told CNN this week that they have not noticed any changes in their daily routine or any added pressure on the staff.

However, multiple officials also made it clear that they were hesitant to say anything beyond the limited public guidance issued from VA headquarters in Washington.

'We're just following the same guidance as everyone else,' a VA official in Portland, Oregon, said. 'We are following the best guidance from national. Everything else, you need to talk to the people in DC.'

Indiana Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 112626

Reported Deaths: 3520
CountyConfirmedDeaths
Marion20832759
Lake10292318
Elkhart6415109
St. Joseph6156102
Allen6029200
Hamilton4724109
Vanderburgh344530
Hendricks2673122
Monroe247436
Tippecanoe226913
Johnson2268123
Clark215056
Porter207845
Cass19329
Delaware188261
Vigo178123
Madison159575
LaPorte137739
Floyd131461
Howard128563
Kosciusko120217
Warrick119936
Bartholomew115357
Marshall98924
Dubois95418
Boone95146
Hancock91143
Grant89133
Noble89132
Henry77024
Wayne74414
Jackson7409
Morgan70038
Shelby66529
Daviess64427
Dearborn63228
LaGrange63111
Clinton59212
Harrison56024
Putnam53710
Lawrence50528
Montgomery50521
Knox5019
Gibson4854
White48114
DeKalb45611
Decatur45439
Miami4263
Fayette41813
Greene41835
Jasper3862
Steuben3707
Scott35610
Sullivan33012
Jennings31212
Posey3060
Franklin29925
Clay2935
Orange28524
Ripley2838
Carroll27013
Wabash2618
Washington2611
Starke2537
Whitley2526
Wells2482
Adams2453
Jefferson2443
Fulton2342
Huntington2223
Tipton21722
Spencer2153
Perry21413
Randolph2087
Jay1730
Newton17111
Owen1651
Martin1640
Rush1524
Pike1401
Vermillion1260
Fountain1182
Pulaski1151
Blackford1133
Crawford1030
Brown1023
Parke941
Benton880
Union770
Ohio767
Switzerland700
Warren391
Unassigned0225

Ohio Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 145850

Reported Deaths: 4635
CountyConfirmedDeaths
Franklin26242603
Cuyahoga17196644
Hamilton12850309
Montgomery7583152
Lucas7187358
Butler5727102
Summit5172249
Marion307247
Mahoning3002279
Warren294748
Stark2771168
Pickaway263444
Lorain227786
Delaware216620
Fairfield203850
Columbiana192180
Licking187562
Trumbull1852131
Clark175938
Wood173772
Clermont165520
Lake158649
Medina143939
Allen138869
Miami138049
Greene137632
Portage109466
Mercer107717
Tuscarawas91620
Erie91244
Wayne90866
Ross86123
Richland80819
Madison78712
Darke76839
Belmont71227
Geauga70547
Hancock67410
Ashtabula65148
Athens6292
Lawrence61618
Shelby5909
Auglaize5709
Putnam55823
Sandusky55520
Huron5337
Union5002
Scioto4746
Ottawa46630
Seneca45314
Preble42213
Muskingum3802
Holmes3777
Jefferson3284
Logan3013
Henry30012
Champaign2943
Perry2889
Defiance28710
Clinton28213
Brown2812
Knox28015
Morrow2522
Washington25123
Hardin25013
Fulton2371
Jackson2344
Coshocton23111
Crawford2276
Fayette2266
Ashland2244
Highland2203
Wyandot20212
Williams2013
Gallia18612
Meigs17210
Pike1670
Hocking1619
Guernsey1578
Carroll1517
Adams1234
Van Wert1143
Monroe10918
Paulding1050
Harrison622
Morgan470
Vinton453
Noble270
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