We Need More Transparency and More Action From the Department of Veterans Affairs
The VA is designed to be one of our country’s safety nets in the fight against Covid-19
The Department of Veterans Affairs (VA) is designed to be the safety net system when hospitals overflow in the US. Before fitting out convention centers and tents, we have the VA’s taxpayer funded hospitals. In recognition of that role, and to ensure our Veterans get the best care, Congress recently granted them $20 billion. Today I wanted to find out what’s happened to the $20 billion. I got some answers, but they are not good ones.
US hospitals have long been unable to give remdesivir to patients once Gilead stopped compassionate use as demand outstripped supply. Remdesivir has demonstrated promise in shortening illness and potentially saving lives. But that shortage isn’t everywhere. The VA has a stockpile.
A friend of a friend’s father has been on a ventilator for three weeks, unable to get the drug. There are 9,500 people in ICU’s right now. Would it save their lives? No one knows. And likely no one will. Does the VA need it? That’s wrapped up in another bigger question.
Unlike community hospitals that need revenue from elective procedures to pay the bills, the VA doesn’t. They don’t bill revenue. Unlike other hospitals granted congressionally appropriated money, if the VA’s volumes drop, no one loses their jobs. The VA has ~8% of US hospital beds. In the CARES Act they got between 15–20% of the money for all health care providers (including non-hospitals). So one would think that they would be playing a massive role as a safety net for other hospitals, right?
The last report showed that the VA was treating 135 civilians. Maybe that’s because hospitals don’t need the capacity? Yet in New York and Michigan, ventilators, nurses, and ICU beds were brought in and the outreach to the VA reportedly didn’t work.
And remdesivir is still in short supply and being denied to patients. Does the VA have some? How much? Enough for all 9,500 people? With Gilead claiming they are making enough to more than replenish, could the VA with their stockpiles (not to mention $20 billion) save some civilian lives?
What else are they doing with the $20 billion? According to the VA, they are treating 5,000 COVID veterans at last count. With 2 million veterans, that’s one quarter of 1%. Either Veterans are not inclined to get COVID, they are being seen in civilian hospitals, or more likely, there are 50,000 to 100,000 Veterans with Covid-19. If the VA doesn’t play their safety net role, then they should be spending this giant pile of money doing outreach to Veterans to treat them for Covid-19 and for the mental health needs they likely face.
There seems to be more than enough money to do all of those things — be a safety net, proactively reach Veterans with Covid-19, and proactively reach out to Veterans on mental health issues. And transparently share what their medication supply is.
I am not interested in waiting 2 years for the inevitable Inspector General’s report on what happened with this $20 billion. I’d like the VA to publicly share it now and do whatever they can to actively help.
500 veteran hospital patients + 4,500 non-hospital Covid-19 Veterans + 135 civilian cases + unknown levels outreach does not equal $20 billion. Please, please can we try to save the lives of some of the 9,500 ICU cases? If remdesivir makes a three point improvement in mortality, that’s almost 300 lives. Are we too busy taking premature victory laps to move heaven and earth for 300 people?
There is this story from David Kocieniewski in Bloomberg which has even more data.
The VA could also be spending money providing veterans care with community providers, which is a big initiative they were funded for, but apparently that suspended (likely for safety reasons). Now I’m not even sure the VA asked for this $20 billion or in the haste of throwing around a package, it looked like a politically popular thing for Congress to do. Would also be worth it for staff to release their analysis on that. If someone from the VA offers a sensible explanation tomorrow or questions these numbers or demonstrates their actions, I will gratefully apologize. As long as they give up their remdesivir to those who need it.
I could get into the hype over Rem, but I’m trying to avoid it. There is still way more we don’t know here and there will be a lot of highs and lows in drug development. 2 steps forward, 1 step back. It will feel that way when searching for an answer in the middle of the maze. But for about 300 people it may be an answer.
Simple enough to say it’s a potential tool in what will need to be a larger arsenal. Doesn’t sound like a silver bullet. And it’s early. Look to Peter Bach as someone who can give you reliable assessments and ask the right questions:
We keep hearing of an “all of government” response. An “all of America” response is what we need. The VA is not alone in sitting on the sidelines. There should be no such thing as “not my crisis.”
Pulled from my daily COVID-19 updates on Twitter
