symptoms to help relieve the pressure on emergency departments, and the use of telehealth services when possible to help protect both patients and staff through social distancing measures. In addition, to help triage patient flow into the hospitals, hospital administrators described efforts to educate community members about COVID-19 screening or testing processes to avoid patients entering the hospital if not advised under guidelines. To address potential bed and facilities shortages, some hospitals reported converting or creating space to house a surge of additional patients. This included expanding their intensive care units, repurposing existing space, using tents, and utilizing other network facilities to separate COVID-19 patients when possible. One hospital administrator explained their strategy: “I’ve emptied the hospital and I’m waiting for it to come. Which it may or may not.” Some hospital administrators described plans to make use of other facilities, such as local fairgrounds, vacant college dorms, and closed correctional facilities as additional space for patient care in the event of a surge. With an uncertain supply of standard, full-feature ventilators, hospitals sought new sources and turned to alternative equipment to support patients In anticipation of increased needs for ventilators, hospitals tried to obtain additional machines by renting ventilators, buying single-use emergency transport ventilators, or getting ventilators through an affiliated facility. Hospitals also discussed sharing supplies of ventilators between hospitals. Where these options were not available, some hospitals planned to transfer patients in need of a ventilator to a nearby hospital. Some hospitals reported converting other equipment to use as ventilators. For example, adapting anesthesia machines and bilevel positive airway pressure machines. One hospital reported considering “doubling up on ventilators – that is, adding another hose to the ventilator so that it can push oxygen to two patients from a single machine.” Another hospital detailed its staff’s efforts at both converting anesthesia machines and using them to support more than one patient: “Our staff had figured out that we could transition some anesthesia machines using t-connectors and viral filters to turn them into ventilators. You jerry-rig the anesthesia machine by using a t-connector, you can support four patients off one of these.” Hospitals reported pressing needs for government assistance to meet COVID-19 challenges Faced with the magnitude and diversity of challenges described above, hospital officials identified a range of government assistance that could support their COVID-19 response. One common theme was Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020 OEI-06-20-00300 12 the need for swift action to respond to the COVID-19 crisis. Broadly, the actions they described fall into five categories: 1) assistance with testing, supplies, and equipment (e.g., PPE); 2) assistance with workforce allocation; 3) assistance with capacity of facilities; 4) financial assistance; and 5) communication and public information. The hospital input and suggestions reflect a specific point in time—March 23–27, 2020. We recognize that the Department of Health and Human Services (HHS) is also getting input from hospitals and other frontline responders and has already taken and continues to take action to alleviate many hospital challenges and implement suggestions. The Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law on March 27, 2020, and provides HHS with additional funding and authorities to combat and respond to the COVID-19 pandemic, including in ways that address challenges and suggestions raised by the hospitals we surveyed. 1, 2 We present the following hospital suggestions on ways that the government could assist them for HHS’s and other decision-makers’ consideration as they continue to respond to COVID-19. Assistance with testing, supplies, and equipment In discussing potential government assistance related to testing, supplies, and equipment, hospitals often stated that they were in competition with other providers for limited supplies, and that government intervention and coordination could help reconcile this problem at the national level to provide equitable distribution of supplies throughout the country. Hospitals wanted the government to: • provide test kits and swabs, or for the government to take steps to ensure that supply chains can provide hospitals with a sufficient supply of tests; • make testing faster by allowing more entities to produce tests and related supplies or to conduct tests; • help in obtaining a range of supplies, such as N95 masks, surgical masks, gloves, and other protective gear; • provide equipment such as ventilators, triage tents, and beds, among others, or take steps to bolster supply chains to provide needed equipment; and, • loosen restrictions around the transfer or gifting of equipment and supplies (e.g., when providers want to send supplies necessary for treatment with patients when transferring them to another facility). Assistance with workforce allocation Given their concerns about staffing shortages, hospitals reported that they needed the government to enable maximum flexibility among their care-giving