The emergency room at Thomas Memorial Hospital in South Charleston, WV. West Virginia's Department of Health and Human Resources received a CDC grant to study firearm injuries through collecting emergency room data from center's like this one. Photo by Quenton King.

For two months, the Delta variant of the COVID-19 virus has been surging throughout West Virginia, where the rate of people getting sick and dying is among the highest in the country. As hospitalizations and deaths climb, hospitals have been understaffed and health care workers have been overworked. 

“Hospital staff are used to preparing and training for an emergency. But they usually think that an emergency will last a few days, not 20 months,” said West Virginia Hospital Association President Jim Kaufman. 

Now, they’re “emotionally, physically and spiritually exhausted,” he added.

Medical experts say the way out of the pandemic is by getting more West Virginians vaccinated. But the state’s vaccination rate is the lowest in the nation

“It’s been frustrating to see so much suffering and death, when there’s an incredibly effective preventative vaccine readily available and free to the public,” said Dr. Robert Hayes, medical director at St. Mary’s Medical Center in Huntington.

But instead of instituting vaccine mandates or reviving a mask mandate, Gov. Jim Justice has focused on incentives, such as the largely ineffective “Do it for Babydog” vaccine lottery. His latest effort to address the pandemic and its fall out is “Saving Our Care,” an initiative announced last month aimed at giving financial aid to hospitals. 

“We’ve got to move, and we’ve got to move right now,” Justice said.

But more than two weeks later, hospital leaders are still in the dark, waiting for more information about the program, while COVID-19 hospitalizations remain higher than the state’s previous record in the winter surge.

Even when it does finally arrive, assistance from Saving Our Care may only be enough to get some hospitals past the current surge. While the program may protect hospital and nursing home finances for the next few months, Daniel Lauffer, president and CEO of Thomas Health System, said a lot more help is needed. 

“[Saving Our Care] is just a finger in the dike for what hospitals need for the future,” he said.

Hospital needs

Justice’s promise of hospital funding came at the peak of the latest COVID-19 surge, one that placed significant pressure on hospitals’ bottom lines and their staff.  

“Saving our care is our hospitals and our nursing homes… they are absolutely getting ready or at the peak of this, and being tasked to the limit,” the governor said at the press briefing announcing the program. “And in many situations, maybe nowhere to turn. Financially if they eliminate elective surgeries… they are really going to destroy the economics of the hospital.”

According to the governor, the program will shore up the finances of hospitals as they incur COVID-19 related expenses and delay profitable, elective procedures in an attempt to free up hospital beds and staff to treat patients with COVID-19.

Dr. Clay Marsh, West Virginia’s coronavirus czar, said right now one of the main needs of hospitals is money to bring in additional staff. 

“In the first part of the pandemic, the real issue was that we had the capacity to enhance the number of beds,” he said. “But now that limitation is really not beds, it’s staff.”

The past year has been stressful for medical workers. While many nurses and other clinical staff have quit or retired over the last year, due in part to burnout, others have found more lucrative jobs in travel nursing and other contract nursing jobs, according to Lauffer.

Many of the state’s hospital systems are having to rely on short-term, contract staff to deal with the influx of COVID-19 patients. And this adds up: Kaufman estimates that West Virginia’s hospitals spent $35 million on travel nurses in the month of August alone. Lauffer says that while a typical, staffed nurse may cost a hospital $35 to $38 per hour, a travel nurse may cost $140 to $200 per hour. 

Marsh says that in some instances, travel nursing agencies have poached nurses from hospital systems, and then contracted those nurses back to the same system. 

The increased demand for personal protective equipment (PPE) has been another hit to hospitals’ bottom lines since the start of the pandemic. While at the beginning of the pandemic there was a shortage of PPE due to the immediate, unexpected demand, supply lines have since adjusted. But Kaufman says PPE costs are still 15% to 20% higher than they were pre-pandemic.

All these extra expenses are coming when a key stream of hospital revenue is being cut: elective procedures. While West Virginia hasn’t required hospitals to postpone these non-essential, non-emergency procedures, some have done so anyway to save space and resources for sick patients, preventing them from relying on a traditional source of income.

Systemic issues

But none of these problems is new, and most won’t disappear after this wave of the pandemic. COVID-19 has exposed the vulnerabilities in our state’s public health and health care infrastructure, according to several people interviewed for this story. 

Even before the pandemic, there was a shortage of qualified medical professionals in West Virginia and the rest of the country, particularly nurses. And with an aging population, more health care workers will be needed.

“Staff have gotten sick, burned out, or left the workforce,” Marsh said. “We’re seeing that rebound impact of COVID-19, not only the acute nature of the current spread, but the chronicity and the stress we’ve placed on health care workers and health care entities. I do think we’ll see a bit of a lasting effect of COVID-19 in this way.”

And hospital finances will continue to be under stress in the future. One reason is that West Virginia has one of the highest percentages of residents who are on public insurance — either the state’s Public Employees Insurance Agency, Medicaid or Medicare. About three-quarters of hospital patients in the state are people covered under one of those three insurances, which reimburse at lower rates than private insurance. 

David Goldberg, president and CEO of Mon Health System, said the state should invest in public health infrastructure to improve health outcomes across the state. To Goldberg, this includes broadband, which can be used for telemedicine to better serve people in rural areas of the state.

In the meantime, hospitals are still waiting for more details about Justice’s Saving Our Care program, even as they continue to spend money on testing, monoclonal antibodies, staffing and incentives, and PPE, while voluntarily delaying elective procedures. At the press conference announcing Saving Our Care, the governor said federal relief dollars will be allocated to the program. A spokesman for Justice didn’t return requests for more details about the program. The state Department of Health and Human Resources, which also didn’t respond to emailed questions, will create the guidelines for the initiative and review hospitals’ applications for reimbursement. 

But leaders say the money is needed now.

“I applaud the governor and his team and the Legislature for saying that they’re going to put money into the system to help us with costs,” Goldberg said. “But it’s been weeks. Where is it?”

Quenton King is a native West Virginian, born and raised in Charles Town in the Eastern Panhandle. He previously worked as a policy analyst for the West Virginia Center on Budget and Policy and the National...