makers’ consideration as they continue to respond to COVID-19. We note that authorities for some of the assistance sought by hospitals may reside with entities outside of HHS (e.g., other Federal agencies or States). Testing, Supplies, and Equipment Many hospitals noted that they were competing with other providers for limited supplies, and that government intervention and coordination could help reconcile this problem nationally. For example, hospitals wanted the government to ensure that they have access to test kits and swabs, make tests faster by allowing more entities to conduct and produce tests, and help hospitals obtain PPE supplies and other equipment such as ventilators. Workforce Allocation Hospitals requested that government allow reassignment of licensed professionals and realignment of duties as needed, provide flexibility with respect to licensed professionals practicing across State lines, and provide relief from regulations that may restrict using contracted staff or physicians based on business relationships. Capacity of Facilities Hospitals asked for relaxed rules around bed designations, the ability to establish surge facilities in non-traditional settings, and expanded flexibilities in telehealth, such as the types of services, caregivers, and modalities eligible to receive reimbursement. Financial Assistance All types of hospitals, and especially small rural hospitals, requested financial assistance, including faster and increased Medicare payments, and loans and grants. Communication and Information Hospitals sought centralized communication and public information, including evidence-based guidance, Hospitals reported that their most significant challenges centered on testing and caring for patients with COVID-19 and keeping staff safe Hospitals across the country reported facing similar challenges, regardless of which stage of the process they were in—treating patients with coronavirus 2019 (COVID-19), testing patients who were potentially infected, or preparing to treat COVID-19 patients in the near future. The most commonly reported challenges centered on hospitals’ efforts to confirm cases of COVID-19, to keep health care staff safe, and to provide needed services to patients requiring hospital care for a wide array of medical reasons, including COVID-19. Challenges included difficulties related to testing, lack of personal protective equipment (PPE), and staffing, including specialized staffing. Hospitals reported that severe shortages of testing supplies and extended waits for test results limited hospitals’ ability to monitor the health of patients and staff Hospitals explained that they were unable to keep up with testing demands because they lacked complete kits and/or the individual components and supplies needed to complete tests, such as nasal swabs, viral transfer media, and reagents used to detect the virus. These shortages left hospitals unable to effectively test staff, patients, and others in the community who reported that they were concerned about possible exposure. One hospital administrator said that across the industry, “millions [of tests] are needed, and we only have hundreds." Without access to needed testing materials, some hospitals described dividing the media in COVID-19 kits in half to double their capacity and resorting to using the transfer media in flu and strep kits to provide testing. Hospitals described extended waits for COVID-19 test results. Hospitals reported frequently waiting 7 days or longer for test results. According to one hospital, 24 hours would typically be considered a long turnaround time for virus testing. Hospitals’ reliance on external laboratories contributed to delays, particularly as these laboratories became overwhelmed with tests to process from around the State or country. Hospitals also reported delays related to infrequent specimen pickups, mailing delays, and labs’ restrictive business hours. Some hospitals described success getting results more quickly by using commercial labs, whereas others received more timely results from public sources. Still others experienced inconsistent turnaround times, leaving them unable to predict when results would arrive or advise patients on how long they should self-quarantine or undertake other measures while awaiting results. Testing challenges exacerbated other challenges, including bed availability, PPE supplies, and staffing shortages. Hospitals reported that to prevent the spread of the virus in the hospital and community, they were treating symptomatic patients as presumptive positive cases of COVID-19 (i.e., an individual with symptoms that strongly indicate COVID-19 and tests have ruled out Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020 OEI-06-20-00300 2 similar conditions, but without a positive COVID-19 test result). The scarcity of COVID-19 tests and length of time it took to get test results back meant presumptive positive patients greatly strained bed availability, PPE supplies, and staffing, as noted in Exhibit 1. Exhibit 1: Hospitals reported that the lack of testing supplies and delays in receiving test results caused additional challenges. Hospitals reported that some presumptive positive patients remained in the hospital for days while awaiting test results, which reduced the hospitals’ availability of beds for other patients. One hospital that was holding