Institutional readiness to provide critical care to patients with viral hemorrhagic fever (VHF) in the United States after the COVID-19 pandemic.

Objective: A follow-up survey of Special Pathogen Treatment Centers (SPTCs) was conducted to assess their readiness to provide critical care interventions to confirmed and suspected viral hemorrhagic fever (VHF) patients after the COVID-19 pandemic. Methods: An electronic survey with 54 multiple-choice and free-response questions assessing VHF critical care capabilities was sent to 74 US SPTCs in April 2023. Results: Fourteen SPTCs (19%) completed the survey. Most respondents were prepared to provide intubation/mechanical ventilation (79%), pharmacologic cardioversion (79%), renal replacement therapy (71%), and defibrillation (71%) to suspected and confirmed VHF patients. Few were ready to provide cricothyrotomy (36%), extracorporeal membranous oxygenation (ECMO) (29%), or code status (14%). Factors impacting institutions' ability to provide critical care to a VHF patient included staff safety (71%) and clinical futility (50%). Less than half (36%) reported that the COVID-19 pandemic positively affected their facility's ability to care for VHF patients, while 21% indicated the pandemic prompted their facility to be better prepared to care for a VHF patient. Conclusions: Most responding SPTCs reported capability for critical care interventions, although fewer had policies governing code status, ECMO, and cricothyrotomy. Institutions were less prepared to manage a VHF patient after the COVID-19 pandemic, highlighting challenges such as staff turnover and less support for training and equipment maintenance. Given that special pathogen outbreaks continue to occur globally, governments and healthcare institutions should institute measures to recruit, support, and retain staff to ensure critical care readiness for special pathogen patients.