While the United States begins clamping down on international travel over concerns of the novel coronavirus' spread, the Department of Veterans Affairs has been criticized for not releasing a comprehensive emergency response to the disease, which is now classified as a pandemic.
At least six VA patients have been diagnosed with the coronavirus, formally known as COVID-19. The disease had infected a reported 1,215 people and killed 36 in the U.S. as of Thursday. The World Health Organization estimated Wednesday that there were more than 118,000 cases globally and 4,291 dead.
In response, the VA announced Tuesday that it is limiting visitors to some of its health care facilities. A VA spokeswoman said via email Thursday the department also has sent a liaison officer to the Department of Health and Human Services (HHS) secretary's operations center, as well as 16 nursing assistants to help HHS and the Centers for Disease Control screen repatriated Americans at Travis Air Force Base, California. It has also deployed five area emergency managers to assist HHS incident management teams at each repatriation site, she said.
Late Thursday, the VA announced on its blog that it will screen visitors and patients at its facilities.
"We train for this. We train not only for national disasters, but we train for epidemics," VA Secretary Robert Wilkie told the House Appropriations Committee on March 4. "We have been putting in place those courses of action that we use for Ebola and H1N1 in the past. So, we will be approaching this as we have these other issues, but it is not something that is unfamiliar to us."
The VA, the government's largest health care delivery system, has not laid out a plan to take a greater role in the public health care system in case the coronavirus spreads throughout the country.
"Unfortunately, it's just one of the many kinds of holes or gaps that seem to be in the present federal efforts for planning," former VA Under Secretary of Health Kenneth Kizer said Thursday in a telephone interview with Military.com, referring to criticism the Trump administration has received for its response to the pandemic.
"Telehealth should be an essential part of the response to this epidemic," Kizer said, "but [there's] really no mention of VA working with the private sector to try to coordinate efforts in that regard."
The federal government mandates that the VA support public health centers in case of a public health emergency but, over the years, that emergency plan has mostly been implemented during natural disasters such as Superstorm Sandy and Hurricane Katrina.
"There haven't really been any infectious diseases like this for a long time," Kizer said. "The VA's capabilities for supporting the private sector in an infectious disease epidemic has never really been played out, so it's somewhat uncharted territory."
Richard Kaslow, who held the now-vacant position of VA deputy chief and patient care services officer for public health before retiring in 2012, said the biggest question he dealt with when creating the department's Ebola emergency plan was determining how many veterans to accommodate.
"That required tailoring the planning and assembly of resources -- particularly for the highest level of isolation and personal protection -- in sufficient numbers that were not readily predictable," he said. "No one knew how widely it would spread or how 'big' the influx of patients into the U.S. would be."
The VA could open its doors to non-veteran COVID-19 patients as it's the federal government's only direct response capability; however, Kizer said it would probably take an executive order before the VA would treat civilian patients.
"Right now, the caseload is not sufficient that it would warrant that, but by any number of models of what is likely to happen with this epidemic, in a couple of months, we might be there," he said.
Meanwhile, Ed Timperlake, former VA assistant secretary for public and intergovernmental affairs, said the VA's role -- even if contained to its central mission of helping veterans -- will be vital during an infectious disease outbreak.
"If, for example, COVID-19 sweeps through the homeless population," he said in an email, "VA should be immediately allowed take those veteran patients, thus opening more beds for civilian victims of the virus."
House VA Committee Chairman Mark Takano, D-California, said he is working with the VA to waive co-payments for COVID-19 testing and medical visits for veterans, employees and even Tricare beneficiaries.
Takano also introduced legislation Wednesday that, if passed, would protect student veterans from being classified by the VA as "distance learning students" and losing their housing stipends because their college or university temporarily switched to online classes in response to COVID-19.
Timperlake said the number of vacancies in roles like Kaslow held should not be concerning to veterans.
"The great rule during a battle," he wrote, "[is] always be ready with the next person in the chain of command to be the leader. This is often known as the 'one bullet away' rule."
-- Dorothy Mills-Gregg can be reached at firstname.lastname@example.org. Follow her on Twitter at @DMillsGregg.