More than two years into the pandemic, hospitals and public health agencies are still struggling with widespread staffing shortages, impacting their ability to care for patients and respond to new Covid-19 surges.

Hospitals continue to struggle with staff shortages

Hospitals nationwide are combating widespread staffing shortages as they prepare for a potential surge in hospitalizations and deaths from the highly contagious BA.5 subvariant. Covid-19 hospitalization rates have increased by more than 40% in the last month, reaching a seven-day average of more than 6,400.

As of July 22, hospitals in almost 40 states are reporting critical staffing shortages, and hospitals in all 50 states said they expect to reach that threshold within a week.

"While we have previously experienced staffing shortages, we're keenly aware of the staffing shortages at virtually every kind of position within the hospital right now," said Nancy Foster, VP for quality and patient safety policy at the American Hospital Association. "If we have a large influx of Covid patients, it will be much more challenging to surge to meet those demands than ever before."

At UNC Health, the shortfall of staffers has led to difficulties providing certain labor-intensive treatments, such as monoclonal antibodies. To meet rising demand, the hospital has had to borrow staff from other departments.

"We have to rob Peter to pay Paul," said David Wohl, an infectious disease expert who leads the Covid-19 response at UNC Health. "If you have people working in an infusion center doing this, what was their day job before Covid? Some of them were working in the emergency room. Some of them were working in the operating room. You just can't pull people from these other critical functions and have them always working elsewhere."

Some hospitals, including the Medical University of South Carolina (MUSC), have stopped testing inpatients for Covid-19 to avoid overwhelming their short-staffed medical labs.

"We're all trying to figure out what does our lab look like now, and what we can do to help prepare ourselves for another surge, knowing that we won't have the same staffing that we had in other surges," said Julie Hirschhorn, director of molecular pathology at MUSC. "We're flying blind."

In addition to staffing shortages, many hospitals are also running out of federal funding for their pandemic response. In March, a $15.6 billion Covid-19 funding deal stalled in Congress after Democrats objected to repurposing unspent pandemic funds and Republicans requested a full accounting of the $6 trillion in funds that had already been appropriated.

"There is growing concern that this money has run out," Foster said. "It's not really getting sufficient attention."

An exodus of public health workers

Hospitals are not the only organizations struggling with staff shortages. Both local and state public health agencies are also facing significant staff shortages as more workers leave the profession altogether, according to a 2021 survey recently published in CDC's Morbidity and Mortality Weekly Report.

For the survey, research from the de Beaumont Foundation and the University of Minnesota collected responses from state and local governmental public agency workers in the 2021 Public Health Workforce Interests and Needs Survey between September 2021 and January 2022.

Overall, the survey included 41,890 public health workers from 47 state health agency central offices, 190 large local health departments, and 249 medium-sized local health departments. Most respondents were white (53.7%), women (78.6%), and older than 40 (52.7%). Around half had worked at their current agency for less than five years, and 72.1% said they worked partially or fully in a Covid-19 response role.

When asked what was needed to respond to the pandemic, aside from funding, 50.7% said more staff was needed, followed by more support from the community (30.4%) and from elected leaders (25.6%)

In addition, the survey found that many respondents are planning on leaving their jobs in the future. In total, 26.9% said they were thinking of leaving within the next year, and 44.2% said they were thinking about leaving, including to retire, in the next five years. Of the workers who are considering leaving, 76.3% said they began doing so when the pandemic began.

"This finding is concerning, given a recent report that found approximately 80,000 additional full-time staff members are needed throughout the nation's public health agencies to provide foundational public health services," the study's authors wrote. "Purposeful succession planning and focused attention on recruitment and retention that promotes diversity will be critical as the workforce rebuilds while the COVID-19 pandemic evolves." (Mahr, Politico, 7/25; Bork et al., Morbidity and Mortality Weekly Report, 7/22; CIDRAP News, 7/22)