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 8:29 AM
Updated: Mar 14, 2020 9:00 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.'

Minnesota Coronavirus Cases

Data is updated nightly.

Cases: 604687

Reported Deaths: 7643
CountyCasesDeaths
Hennepin1250161780
Ramsey52519898
Dakota46852471
Anoka42789458
Washington27436291
Stearns22561225
St. Louis18146313
Scott17553137
Wright16383149
Olmsted13406102
Sherburne1202795
Carver1067448
Clay826592
Rice8204110
Blue Earth762744
Crow Wing681895
Kandiyohi668185
Chisago620152
Otter Tail586284
Benton582998
Goodhue484074
Douglas475781
Mower470533
Winona461451
Itasca460163
Isanti440364
McLeod430961
Morrison424962
Beltrami407962
Nobles407750
Steele397816
Polk389072
Becker386755
Lyon363853
Carlton353056
Freeborn347133
Pine334923
Nicollet331345
Mille Lacs311854
Brown308040
Le Sueur297326
Cass286332
Todd285633
Meeker263543
Waseca238023
Martin235333
Roseau211221
Wabasha20793
Hubbard196641
Dodge18783
Renville182846
Redwood176539
Houston174616
Cottonwood167124
Wadena163423
Fillmore157610
Faribault155219
Chippewa154038
Pennington153820
Kanabec146828
Sibley146810
Aitkin138937
Watonwan13579
Rock128719
Jackson122812
Pipestone116726
Yellow Medicine115020
Pope11306
Murray107110
Swift106918
Koochiching95518
Stevens92411
Clearwater89016
Marshall88817
Lake83220
Wilkin83213
Lac qui Parle75622
Big Stone6044
Grant5948
Lincoln5853
Mahnomen5669
Norman5479
Kittson49022
Unassigned48393
Red Lake4017
Traverse3775
Lake of the Woods3453
Cook1720

Iowa Coronavirus Cases

Data is updated nightly.

Cases: 371226

Reported Deaths: 6056
CountyCasesDeaths
Polk58274641
Linn21241339
Scott20311248
Black Hawk16180312
Woodbury15241230
Johnson1462285
Dubuque13515211
Dallas1129499
Pottawattamie11233174
Story1072048
Warren583891
Clinton561593
Cerro Gordo554196
Sioux517674
Webster516094
Muscatine4884106
Marshall487176
Des Moines467672
Wapello4337122
Buena Vista427040
Jasper421172
Plymouth403181
Lee382556
Marion366176
Jones301057
Henry294537
Bremer288761
Carroll287252
Boone268534
Crawford268340
Benton260355
Washington257551
Dickinson249344
Mahaska232751
Jackson225242
Clay216727
Kossuth216166
Tama212271
Delaware211143
Winneshiek198935
Page194522
Buchanan194133
Cedar192323
Hardin187544
Fayette186943
Wright186140
Hamilton182051
Harrison179973
Clayton171157
Butler166535
Madison164519
Mills163924
Floyd163542
Cherokee159338
Lyon158941
Poweshiek157136
Allamakee152852
Hancock150334
Iowa149724
Winnebago144531
Cass139255
Calhoun138813
Grundy137433
Emmet135841
Jefferson133335
Shelby131637
Sac130920
Union130035
Louisa129849
Appanoose129049
Mitchell126743
Chickasaw124917
Franklin123523
Guthrie123332
Humboldt119626
Palo Alto113523
Howard105022
Montgomery103638
Clarke101124
Keokuk96832
Monroe96431
Unassigned9550
Ida91635
Adair87432
Pocahontas85822
Davis85325
Monona83431
Osceola78917
Greene78011
Lucas77923
Worth7628
Taylor66812
Fremont6279
Decatur6169
Ringgold56424
Van Buren56418
Wayne54423
Audubon53411
Adams3444
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