Why did they not extend capacity with field hospitals weeks ago? They’ve been telling us it was going to get bad, then it did and they’re not prepared for it? What is going on here?
They...did. There is a limit to the ability to magic up staffed medical facilities on short notice ex nihilo, however.
> They’ve been telling us it was going to get bad, then it did and they’re not prepared for it?
Had it not been predicted that it would exceed the potential to boost capacity, they would not have implemented the capacity-cobtingent statewide stay at home order (which is undermined by county sheriffs widespread and public non-enforcement stance.)
And, since the Federal government never stepped up to fund anything, no one is going to bother training personnel that they'll just get rid of in 12 months.
I'm not sure where this idea came from, but I really wish people would start arguing about what Congress actually did rather than making it up, because Congress did step up to fund medical care. The CARES act appropriated $130B for health care providers, including hospitals. The followup appropriations bill allocates $69B for vaccines, testing, health care providers, and mental health.
One might argue that that's not enough money, but at least make the argument that they should have spent more rather than falsely claiming they spent nothing. Congress' direct payments to the healthcare providers in these two bills totaled $199B. Broken down by department, only two agencies are allocated more than $199B next year, the DOD ($695B) and the VA ($243B). And that's just looking at direct payments to medical providers, I didn't even mention the remaining $2.1T from the CARES act.
Training these people requires multi-year funding and commitment to their hiring as well.
There is a lot to blame the federal government for in this pandemic, but the lack of nurses just isn't one. The federal government has very little leverage to increase the supply available, since the vast majority of nurses are employed by the private sector or state systems. Congress could provide more money to underwrite training and nurse salaries, but they'd just be setting up for mass layoffs once the demand for that form of labor returns to historical norms. And there is very little chance that these new nurses would be trained in time to make a difference.
Maybe the federal government could undo the residency program that constrains the supply of doctors, but at best they could flush out all the doctors waiting for residency to complete right now. That would provide a small boost, but at most they could add 3 extra years worth of new doctors at once. Nothing the federal government could do would drastically increase the supply of doctors other than relaxing immigration requirements for foreign trained doctors, but that still takes time and is uncertain.
If there's any aspect of this pandemic that I'd lay right at the feet of the federal government, it would be the lack of PPE. Both Congress and the executive branch have all of the tools at hand to goose the production of PPE domestically should they have decided to do so, and yet our medical personnel continue to reuse N95 masks nine months into this pandemic. An extra supply of N95 masks would have also reduced the attrition of medical personnel, as actual sickness and perceived risk has been a big drag on the supply of properly trained personnel to fight this pandemic.
No, they mostly weren't.
> Why were they dismantled?
They have largely been activated, including ones which while prepared stood empty in the initial, far lower, peak, and many additional ones were set up for this surge.
Santa Clara's hospitalization growth rate is running at 2-3 weeks.
This isn't something the health system can grow to solve.
While California is worse off, the US has a national problem and no region to ship surplus from, even leaving aside the political problems which would add friction if the capacity existed.
The hospital growth thing is a red herring. Gaining +2000 hospital beds (or 20% growth for a lot of areas) means jack diddly squat against a Virus that replicates into the millions.
Its far easier to stay home for Thanksgiving and cut down on the spread, rather than grow hospitals. But of course, we're growing hospitals where we can (moving Navy Hospital Ships, hiring student nurses before they graduate, etc. etc.) But the USA already had a nurse shortage BEFORE COVID19 came around.
There comes a point where there's no point building Hospital beds: we simply don't have enough nurses / doctors in this country to staff them. Even if we include student nurses / doctors.
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In either case: China has the right idea. You stop the spread before it becomes a million cases. You can't just magically grow hospitals and create expert nurses out of thin air.
Free Liberal countries like New Zealand got to stop the exponential growth because their society was more unified and rational about things. Authoritarian wasn't necessary, but its clearly a good cudgel to use in this situation.