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.'

Mississippi Coronavirus Cases

Data is updated nightly.

Confirmed Cases: 115088

Reported Deaths: 3255
CountyConfirmedDeaths
Hinds7973177
DeSoto703979
Harrison522384
Jackson457884
Rankin394086
Madison383194
Lee357380
Forrest304678
Jones292484
Washington258399
Lafayette250443
Lauderdale2478135
Lamar225538
Oktibbeha202454
Bolivar201677
Neshoba1849111
Lowndes179962
Panola170040
Leflore167187
Sunflower162349
Warren154855
Monroe150673
Pontotoc147220
Marshall143129
Lincoln140157
Pike138456
Copiah137536
Scott125429
Coahoma124937
Grenada122638
Yazoo122234
Simpson121549
Union118825
Tate116839
Leake115041
Holmes114760
Itawamba113925
Pearl River113660
Adams108544
Prentiss106120
Wayne101722
Alcorn100112
George99218
Covington97527
Marion95042
Tippah90322
Newton86627
Chickasaw85526
Tallahatchie84526
Winston84121
Hancock84028
Tishomingo81241
Attala79426
Clarke75851
Clay69321
Jasper68717
Walthall63927
Calhoun62612
Noxubee59817
Smith59416
Montgomery54923
Yalobusha54514
Claiborne53716
Tunica53517
Lawrence51814
Perry49423
Carroll49312
Greene47818
Stone47514
Humphreys43816
Amite42513
Quitman4206
Jefferson Davis41011
Webster37613
Benton3416
Wilkinson33820
Kemper32615
Sharkey28514
Jefferson27610
Franklin2423
Choctaw2086
Issaquena1074
Unassigned00

Alabama Coronavirus Cases

Confirmed Cases: 155915

Reported Deaths: 2674
CountyConfirmedDeaths
Jefferson23129377
Mobile16849315
Tuscaloosa10296140
Montgomery10197197
Madison928096
Shelby733863
Baldwin663769
Lee653465
Calhoun456761
Marshall438150
Etowah426551
Houston414834
Morgan412035
DeKalb338829
Elmore320053
St. Clair292542
Limestone284230
Walker277292
Talladega265335
Cullman244024
Lauderdale226242
Jackson214915
Franklin205231
Autauga204831
Colbert200532
Russell19443
Blount192525
Chilton186932
Dallas186527
Coffee176311
Dale175151
Covington174029
Escambia172530
Chambers135044
Clarke134317
Pike133513
Tallapoosa131787
Marion107629
Barbour10319
Marengo100822
Butler100740
Winston92213
Geneva9007
Lawrence85032
Pickens84718
Bibb82814
Randolph82316
Hale76730
Washington74412
Clay74112
Cherokee73314
Lowndes70928
Henry7086
Bullock64817
Monroe64610
Crenshaw60630
Perry5896
Fayette57413
Wilcox56712
Conecuh56113
Cleburne5568
Macon53420
Lamar4905
Sumter47221
Choctaw39012
Greene34216
Coosa2033
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