On Friday, the U.S. Department of Veterans Affairs released its COVID-19 response plan and gave us a glimpse at the kind of comprehensive military approach this crisis has needed for weeks. The 257-page document describes a dramatic mobilization of the nation’s largest health care system to augment civilian hospitals in the event that they are overwhelmed by the crisis. That is the fourth mission of the VA: “to improve the nation’s preparedness for response to war, terrorism, national emergencies and natural disasters.”
The VA has supported civilian responses to local emergencies in recent years like Hurricane Maria in Puerto Rico in 2017, the mass shooting at the Pulse nightclub in Orlando in 2016, and the Ebola outbreak in 2014. But since a fourth mission was added to the VA’s mandate in 1982, the department has never had to deploy for such a broad role as the one facing it in a global pandemic.
It has been planning, however. Following the attacks of Sept. 11, 2001, the VA ramped up its role as the health care system of last resort. It drafted contingency plans for natural disasters, military attacks and pandemics. Until Friday, only one of those contingency plans had been made public — one for an outbreak of the flu, last updated in 2006.
The VA’s COVID-19 plan unfolds in four phases.
Phase 1: Contingency planning and training. The department says it has been running drills for COVID-19 response since January. And while it was only made public Friday, the response plan has been in place for months.
Phase 2: Initial response. This is where the department finds itself now: prioritizing care for veterans with COVID-19 and shifting resources to make room for more. The department has postponed some elective and non-emergency procedures and has shifted some outpatient care to telehealth. And it is creating quarantine zones in all its inpatient units.
Phase 3: Establishing alternative sites of care. This is the phase in which the VA could surge its capacities to backstop civilian health care systems. It also calls for setting up temporary sites. This is the section of the plan that uses language like “field hospital” and “worst-case scenario.”
Phase 4: Sustainment operations and recovery. This phase is triggered when the supply of medical services catches up with demand, and public health officials announce that the crisis is beginning to wane.
All of this may seem too neatly packed for a rapidly advancing global foe. As the old trope goes, no battle plan survives first contact with the enemy. And there are serious questions about the VA’s ability to execute its plan. The department is already stretched thin. U.S. Rep. Colin Allred, who serves on the House Committee on Veterans’ Affairs, said he’s worried about the VA’s capacity issues.
“They already have far more demand than bed space,” Allred told us Friday.
According to reporting by The New York Times, about 60% of the department’s medical staff have affiliations with other medical centers, which might lead to staff shortages in Phase 3. The Dallas VA hospital is already using temporary buildings for some operations. Allred has been leading a push to open a separate VA hospital in Garland to increase capacity. If the VA is struggling to meet its first three missions, how can it hope to succeed at a fourth?
But if it faces challenges, it also has advantages. The department is about to receive $4.5 billion as part of the federal stimulus package. It is the nation’s largest health care system and the only one with the comprehensive scope and centralized command needed to spin up a national health care response.
Nationwide, the VA operates 172 hospitals and 1,074 outpatient sites with 13,000 acute care beds, including 1,800 intensive care beds. The VA system in North Texas is the second-largest in the nation, with 853 beds, almost as large as Parkland Hospital, which has 882.
The VA has extensive experience caring for the elderly and medically vulnerable populations most threatened by COVID-19. The VA’s response won’t be held back by political squabbles the way the congressional stimulus was. And it won’t be a patchwork of overlapping jurisdictions like the decrees issued by state, county and city leaders in recent days.
We would have liked to see the VA’s COVID-19 plan sooner, before the country found itself on the threshold of Phase 3. But now that it’s out, we’re encouraged by it. As Allred told us, “Having an enormous and well-trained professional staff should make everybody feel better. I’m confident they will be able to provide help despite their capacity issues.”
In the absence of other coherent, national leadership to address this crisis, that kind of decisive, organized plan is reassuring.
