The Department of Veterans Affairs cares for 9 million veterans across 141 medical centers and more than 1,000 clinics nationwide. But it's also expected to serve as a last line of defense in national medical emergencies.
VA -- the largest single healthcare provider in the United States -- is expected to play a critical role in national emergency medical response, including for pandemics. That role is one of VA’s four core missions as a federal agency. VA's large national reach and federal authority gives it the ability to respond in ways private healthcare systems can't match.
On Wednesday, the World Health Organization declared coronavirus, specifically COVID-19, a pandemic.
Beginning in 1982, VA was chosen as “a backup to the Department of Defense medical care system and the Public Health Service and the National Disaster Medical System in times of natural and technological disasters,” according to a National Health Policy Forum report in 1998.
That includes outbreaks of disease such as COVID-19. As of March 17, 38 veterans tested positive, or presumptively positive, for the virus, VA officials told Connecting Vets. One veteran died of complications from the virus in Oregon. VA locked down visitation at its 134 nursing homes and 24 spinal-cord injury/disorder centers, which care for a total of 65,000 veterans who could be vulnerable to the virus. VA said it had administered "over 322" tests nationwide as of March 17.
About half of all VA patients are older than 65, a population at elevated risk for infection, according to the CDC.
"We train for this. We train for epidemics," VA Secretary Robert Wilkie told Congress recently, adding that VA is in "constant contact with the CDC and National Institutes of Health as well as the presidential task force."
Wilkie also has a seat on that task force.
“We are a foundational response when it comes to emergencies like this. We train for them year-round … We are testing our processes as we speak … We are checking supply lines,” Wilkie said at another recent Congressional hearing.
In the event of national emergencies, VA essential functions and funding are guaranteed by the federal government -- even in a shutdown -- and VA and its medical facilities are tasked with supporting “our nation’s communities affected by nationally-declared disasters,” according to VA’s emergency management plan. That includes assisting FEMA and HHS in response to emergencies, such as epidemics.
VA is one of four federal partners in the National Disaster Medical System (NDMS), along with Homeland Security, the Defense Department and HHS. The NDMS is intended to establish a national medical response to help state and local authorities respond to public health crises, including national disasters or disease outbreaks, or to help the military medical system care for casualties of war, “from the smallest incident to the largest catastrophe.”
That responsibility includes the Disaster Emergency Medical Personnel System (DEMPS) which deploys clinical and other staff to respond to emergencies or disasters, as well as mobile medical units.
“For all intents and purposes (VA is) the federal government’s only direct response capability,” former VA Undersecretary for Health Ken Kizer said in the NHPF report. “The U.S. Public Health Services no longer has any resources with which to respond to a disaster or national emergency.”
United States law allows the secretary of the VA, in this case, Wilkie, “to provide hospital care and medical services to non-VA beneficiaries responding to, involved in or otherwise affected by a disaster or emergency.”
Wilkie and other VA leaders have told Congress multiple times recently that they have experience serving communities during emergencies such as hurricanes and other natural disasters, as well as severe outbreaks of flu, H1N1 and Ebola.
Only one of VA’s core missions is to provide care to veterans, or those “who shall have borne the battle” and their families. The other three are to train medical professionals, conduct medical research and to be a last line of defense in national health emergencies.
The extent of the help VA can offer is not clear. The most recent publicly released VA pandemic plan is 14 years old and covered how VA would respond to a flu pandemic.
The most recently updated information on the number of beds VA has at its medical centers in the event of an emergency is specifically not publicly available. According to the 2006 pandemic plan, VA had about 20,000 beds available, with more in its long-term care facilities. But that number has certainly changed in the past 14 years.
VA also has an Emergency Cache Program, which provides medical supplies and medicine nationwide until HHS supplies arrive, often as quickly as 24 hours after an emergency. Those caches are built to provide for thousands, VA told Congress previously.
VA did not immediately respond to requests for a copy of a more recent plan, or for information on how many beds it has available today. VA previously said it has updated its emergency response plans for previous outbreaks of flu, Ebola, H1N1 and other incidents.
At a recent Congressional hearing, Veterans Health Administration chief Dr. Richard Stone told lawmakers that VA has about 1,000 negative airflow rooms, designed to prevent contamination and the spread of infection using specialized ventilation and air pressure.
"The entire nation is covered with negative airflow beds," Stone said.
Stone also said VA had about 1,000 tests -- not enough -- and the department planned to design its own.
VA officials said as of March 16, VA had 3,000 tests on hand, 1,000 from CDC and 2,000 VA designed. VA had administered 100 of those tests. With 3,000 tests, VA has enough to provide about 20 to each of its major VA medical centers, not including its more than 1,000 clinics.
On Feb. 27, Wilkie told Congress VA was prepared for an outbreak of COVID-19 and declined an offer of additional resources.
But if conditions worsen to pandemic levels, Stone said things will change.
“If this develops into a pandemic, in which parts of the American health system break down, we’re going to have a different conversation,” he told lawmakers.
Congressional staff told Connecting Vets that lawmakers have had regular calls and briefings from VA leaders on their response to the virus, but so far have not been provided an updated pandemic response plan. They have also requested an updated pandemic plan, but as of March 11, had not received it.
VA has a guide for veterans on coronavirus, which includes that veterans who believe they are infected should call their local VA before they show up to the hospital.