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Pandemic Response -- by the Numbers

Earlier this week, the Government Accountability Office (GAO) released its latest bimonthly report to Congress on the status of the Federal Response to the COVID-19 pandemic. The GAO reviewed data from multiple sources including USAspending.gov, data obtained directly from agencies, Bloomberg, and other economic research groups. The GAO also developed health indicators that may be useful in continued measurement of response to this and future pandemics.

The GAO found that over $2.2 trillion has been allocated for pandemic relief, of which agencies had obligated $1.5 trillion and recorded spending $1.3 trillion. Additionally, GAO found that more can be done to monitor the health care system's response to the pandemic, and they recommended four healthcare metrics that could be used to measure the system's ability to handle and react to emergencies. Finally, the GAO found that the economy is still weak, but appears to be improving with the help of the Federal Pandemic Response. There is quite a bit to unpack in the 44 page report so I made this infographic. Read on for more...

Click to see full size image on venngage.com


According to their website, the Government Accountability Office (GAO) "is an independent, nonpartisan agency that works for Congress" and "examines how taxpayer dollars are spent and provides Congress and federal agencies with objective, reliable information to help the government save money and work more efficiently." With this mission in mind, the GAO is responsible for submitting to Congress bimonthly reports outlining the status of the Federal Government's response to the COVID-19 pandemic.

The report reviews federal spending, oversight activities and the economy overall to gauge how effective efforts have been at addressing the challenges presented by the pandemic.

Federal Spending

Through a series of loan programs, emergency funding and payments, unemployment assistance, and emergency Public Health funds, over $2.6 trillion dollars has been appropriated to federal agencies. Almost two thirds of that total appropriation -- $1.5 trillion has been allocated by agencies; of which $1.3 trillion has been spent.

By far the largest beneficiary of these funds has been the Small Business Administration's various business loan programs. Reflecting funds for the Paycheck Protection Program and various other SBA loan program subsidies, the SBA was allocated $687 billion -- about 26 percent of the total allocation, of which nearly $538 billion has already been obligated. 

The Department of Treasure was also appropriated $500 billion to support lending facilities, fund emergency lending programs through the CARES Act, and to support the aviation industry. Unemployment insurance obligations; direct payments to individuals; emergency payments to healthcare providers; and other assistance payments to state-, local-, and tribal governments round out the remainder.

Put into a different context, the President's initial budget reflected a total outlays greater than $4.7 trillion. The added spending on pandemic response reflects nearly half of the total original budget amount for the entire government!

Oversight

The GAO identified four metrics that they recommend as ways to enhance monitoring of the healthcare system's ability to respond to this, and future pandemics.

1. Positivity Rate for Testing

The GAO recommends that public health officials should monitor the overall positivity rate of COVID-19 test results to help measure whether testing resources are being deployed effectively. The GAO report suggests that high rates of positive test results may be an indicator that tests are being performed in a way that misses asymptomatic patients and that is failing to test patients who aren't seeking testing. 

As testing and related contact tracing increase in scope and quality, the GAO claims more uninfected patients will be tested and the positivity rate will decrease.

2. Contact Tracing

The GAO recommends a robust model of contact tracing. Effective and timely contact tracing can limit the community spread of pathogens and ultimate negate the need for additional community lock-downs. While a robust workforce is necessary to effectively implement contact tracing protocols, the GAO found that there is no reliable source of contract tracing employment numbers. While funds have been awarded to local health departments to hire and train contact tracers, the GAO is unable to determine if a sufficient number of contract tracers have been hired to meet current and anticipated needs.

3. ICU Beds

The GAO suggests that tracking the proportion of available ICU beds over time can provide a reliable metric of hospitals' ability to treat critical ill patients. The GAO notes there is no single metric that is widely agreed upon, but suggests that a threshold of 30 percent availability of ICU beds (that is 30 out of 100 beds are staffed but unoccupied at a given time) is a firm reflection of a facility's ability to treat acutely ill patients.

4. Higher than Expected Deaths

Finally, GAO urges public health officials to measure the number of deaths that exceed the typical mortality rate in a given timeframe. Suggesting that mortality rates are relatively constant over time, measuring increases in mortality can provide a sense of the impacts -- both direct and indirect, of the pandemic. Higher than expected death rates indicate that the healthcare system is unable to adequately address the critical medical needs of the population.

The Economy

Finally, the GAO reviewed nine broad indicators of economic health, finding an economy that remains weak, but is showing signs of recovery.

With respect to employment, the GAO found that initial jobless claims have decreased by half since March 2020, while the employment to population ratio has increased 10 percent. Employment in state and local governments has increased significantly since March. While employment in the healthcare sector continues to grow, adding over 780,000 jobs since May, the rate of growth appears to be slowing.  

Spreads on bonds (a measure of perceived risk) for both investment grade corporate and municipal bonds are falling, indicating that investors see less risk in bonds. Consumer loan defaults have fallen overall while one measure of small business health appears flat.

While overall, many measures of the economic health appear to be improving, the economy has still not recovered from the initial shock of the pandemic in March.

The full GAO report is available online here (will open in a new window).

John Warren is the Owner and Principal Consultant at Gettysburg Healthcare Consulting in Hanover, Pennsylvania. He worked at CMS for 22 years and he directed divisions responsible for rate setting and payment policy development as well as program integrity and medical review. He has consulted with numerous clients in the Medicare space interested in navigating Medicare coverage, coding and reimbursement. Visit http://www.policypros.net for information about GHC and it's services


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