How will Michigan staff field hospitals if they reach capacity?
On Thursday, Governor Gretchen Whitmer announced that the TCF Center would begin accepting its first 25 COVID-19 patients.
The announcement also stated that Henry Ford Health System, Beaumont Health, McLaren Health and Detroit Medical Center would be stepping in to provide administrative support, and that a FEMA strike team would provide initial staffing.
Still unclear, however, is where other workers will come from if the facility swells toward its 1,000-patient capacity. The state has not explained in detail a comprehensive plan to staff the field hospital, nor has FEMA, which is leading the operation.
Meanwhile, the Army Corps of Engineers has begun construction at Michigan's second alternate care site, the Suburban Collection Showplace in Novi. The team in charge there—like at the TCF Center, a collection of state, federal and private organizations—will also have to figure out how to staff the 1,000-bed facility.
Based on a FEMA procedure document that estimates staffing needs for field hospitals housing infectious patients, the TCF Center alone could require over 600 medical staff members, such as doctors, nurses, respiratory specialists and pharmacists.
So, where will they all come from?
Based on what we've heard from Michigan's health department, FEMA and other federal agencies, staffing will flow from three main sources: local volunteers, workers recruited by private staffing agencies, and federal medical units.
Local workers: volunteers, students and staffing agencies
According to a health department spokesperson, as of April 8th, 16,400 volunteer medical workers—retired or otherwise free to commit time—had responded to the call for assistance Gov. Whitmer put out on Saturday, March 28th.
In an executive order, the governor eased licensing and certification requirements in a bid to attract as many skilled volunteers as possible. Its terms allow out-of-state medical practitioners to practice without a Michigan license, and medical students to volunteer in the facilities.
About a third of those volunteers are medical workers, such as doctors, nurses and respiratory therapists; another third are public health professionals; and the final third have volunteered to support community service efforts.
16,400 sounds like a lot, but the health department spokesperson didn't indicate the extent of volunteers' commitment (the volunteer form asks for workers who can commit anywhere from four to 12 hours a day).
The health department also said it has hired private staffing agencies to help with recruitment. Some advertisements for positions at the field hospital are offering almost double what a nurse might normally make. For example, a registered nurse with one year of experience could make $65 an hour.
One nurse at a Beaumont hospital, whose name we're not using to protect her job, said many of her colleagues are considering picking up extra shifts at TCF; of course, extra shifts at Beaumont are available too, but as of now, they don't pay as well. (A similar dynamic is playing out across state lines, with some Michigan health care workers traveling all the way to New York.)
"Nurses will follow the money," the Beaumont nurse said.
The Department of Defense
A FEMA spokesperson explained to us that a state, having determined that its local resources are insufficient in managing a crisis, may request support from FEMA. As lead agency in the national COVID-19 response, FEMA then works through the National Response Coordination Center to assess federal options for meeting the state's needs—in this case, to staff Michigan's field hospitals.
In a pinch, staffing support can come directly from FEMA. According to Gov. Whitmer's Thursday announcement, the TCF Center will be initially staffed by a public health strike team from FEMA, which will care for TCF's first 25-50 patients.
But according to a MDHHS spokesperson, FEMA is also investigating other federal options. One is the Department of Defense.
On April 8th, MDHHS director Robert Gordon said in a tele-townhall that "we will be getting some help from DoD around staffing the TCF site," And on Saturday, an Army spokesperson notified us that 85 Army reservists, all medical officers, had arrived in Detroit to help care for the TCF Center's first patients. In such a case, the DoD selects the military branch that, based on location and the status of ongoing operations, is best fit to serve the request. On March 28th, for example, Lt. Gen. Laura Richardson, the director of U.S. Army North, activated two National Guard task forces, sweeping the typically state-controlled units under the federal wing. One of those task forces was the 46th, based out of Lansing. Now stationed in Battle Creek, the 16th is providing transportation and other logistical support to the 85-person medical team.
One of those task forces was the 46th, based out of Lansing. A spokesperson from the 46th explained to us that under the direction of the Army, National Guard medical units might be sent to the TCF Center, but couldn't confirm.
The Army has already deployed to New York City, where hundreds of medical officers are staffing the Javits Convention Center, which has been converted into a field hospital; and to Seattle, where a mobile field hospital was set up at CenturyLink Field (and then left after nine days, without seeing a single patient).
In a press conference on April 1st, commander of U.S. Northern Command General Terrence J. O’Shaughnessy said that the Defense Department would be judicious in calling for backup. "What we don’t want to do is activate a reservist that, say, is working right now in a hospital, in an infected area with a high demand for that skill set, and have her or him be deployed to another area at the expense of that [other] area," he said.
U.S. Health and Human Services
FEMA confirmed that medical teams from the U.S. Department of Health and Human Services would be assisting the FEMA strike team in caring for the TCF Center's first patients. HHS is currently working on a response to our request for details; we'll update this post when we hear back from them.
One option within HHS is the Public Health Services Commissioned Corps. The USPHS is a uniformed unit that includes physicians, public health experts, epidemiologists, nurses, engineers and other specialists. Its officers have responded to most major national disasters, including 9/11 and Hurricane Katrina.
During the COVID-19 pandemic, USPHS teams have been dispatched to the Life Care Center in Kirkland, Wash., where the virus initially hit hard in the U.S., and to Japan, where officers helped provide critically ill patients with remdesivir, an investigational antiviral treatment.
Right now, at the TCF Center alone, we're seeing collaboration among MDHHS, FEMA, HHS, the Army Corps of Engineers, the DoD, and, per Whitmer's Thursday announcement, four private health care systems. And that's not a complete tally.
Matthew Seeger, a professor at Wayne State University who studies crisis and emergency risk communication, says this swirl of stakeholders always presents challenges during disasters.
"The coordination problem in disasters is like the quintessential, defining problem of many disaster responses," he said.
According to Whitmer's announcement, those in charge of the TCF Center include Dr. Jenny Atas, who will lead medical services at the facility.
In her role as medical director of the Region 2 South health care coalition, Atas has been coordinating Michigan's medical resources for weeks in response to the pandemic. We spoke with Atas the last week of March, when she helped select the TCF Center as a field hospital.
Now she'll be responsible for ensuring it has sufficient staff and equipment to run at full capacity.
Editor's note: This article has been updated to reflect that an 85-person medical unit from the Army has been deployed to the TCF Center.