Did Hospital Protocols Make COVID Outcomes Worse?

A new Rasmussen Reports survey reveals an unsettling reality: nearly one-third of American adults say someone they know died of COVID-19 while hospitalized, and almost half believe hospital treatment protocols likely contributed to that death.

That perception warrants attention, not dismissal. During the pandemic, hospitals faced tremendous pressure, yet several systemic factors, including financial incentives, rigid therapeutic protocols, and strict visitor restrictions, may have influenced patient outcomes in ways that were never fully explored.

Under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Medicare reimbursed hospitals an extra 20% for inpatient COVID-19 diagnoses. A positive PCR test alone often triggered this classification, even if the patient was hospitalized for a different reason, such as elective surgery.

As the New York Times reported in 2020, high cycle-threshold rates in PCR testing may have detected residual viral fragments rather than active infections, potentially inflating case numbers.

Hospitals therefore had financial and procedural incentives to label and keep COVID-positive patients, which increased the risk of hospital-acquired complications. Cases involving ventilation or ICU care received even higher reimbursements.

Early in the pandemic, mechanical ventilation was used much more frequently than in comparable respiratory illnesses. One study from that period found mortality rates among ventilated COVID patients approaching 65 percent. The initial experience in New York was even more severe, showing that ventilation was often a death sentence, with only 3% of ventilated patients being discharged alive.

When the system reimburses more for sicker patients and costlier interventions, it naturally influences decision-making. Did some hospitals resort to aggressive care – such as ventilation, ICU admission, or prolonged stays – when less invasive options might have been enough? We need transparency and accountability to determine this for sure.

Remdesivir became the standard antiviral in many hospitals. Initial trials indicated it shortened recovery time by a few days but provided no clear survival benefit. The World Health Organization’s Solidarity trial also found “little or no effect” on mortality, and Johns Hopkins’ ABX Guide reported serious adverse events in up to 35 percent of patients completing a ten-day course.

Despite these concerns, hospitals continued widespread use, possibly because federal purchase agreements ensured a steady supply and protocols discouraged off-label alternatives. Hydroxychloroquine and Ivermectin, while controversial and lacking support from major trials for severely ill inpatients, were often prohibited even when physicians believed they might be helpful.

When patient-first innovation gives way to bureaucratic uniformity, personalized medicine, and physicians' ability to do their best for their patients, it inevitably suffers.

Visitor restrictions added another layer of harm. To limit infection, many hospitals completely barred family members, even for patients who were dying. A 2025 review in BMC Palliative Care found that such restrictions “negatively affected patients and families, contributing to distress and compromised decision-making.” STAT News reported that removing family advocates from the bedside eliminated essential oversight and compassion.

The absence of a familiar voice or an advocating family member may have accelerated decline or led to premature intubation. For many families, enforced separation remains the most haunting memory of the pandemic.

None of this suggests malice by healthcare workers. Front-line clinicians faced unimaginable workloads and personal risks. But systems matter. When hospital revenue incentivizes complexity, when protocols hinder flexibility, and when policy separates the sick from those who care for them, poor outcomes inevitably follow, regardless of anyone's intentions.

The Rasmussen survey indicates that many Americans feel something went wrong inside their hospitals. To rebuild trust, several crucial steps are necessary:

1.   Transparency – Provide detailed data on outcomes, reimbursements, and treatment differences across hospitals.

2.   Physician Discretion – Enable personalized, evidence-based off-label treatment when clinically reasonable.

3.   Family Presence – Ensure humane visitation rights are maintained even during public health emergencies.

4.   Payment Reform – Align reimbursement with patient well-being rather than procedural volume.

The pandemic exposed a disturbing truth: even highly developed health systems can have incentives and bureaucracy that overshadow compassion and common sense. If nearly half of those who lost loved ones believe hospital treatment contributed to the deaths, the medical community owes them honest answers, not empty words or excuses.

Brian C. Joondeph, M.D., is a physician and writer.

Follow me on Twitter @retinaldoctor

Substack Dr. Brian’s Substack

Truth Social @BrianJoondeph

LinkedIn @Brian Joondeph

Email brianjoondeph@gmail.com

See Other Commentaries by Brian C. Joondeph.

See Other Political Commentaries.