(AP) — The global coronavirus pandemic has created a huge need for health care in the U.S., but it also is delivering a devastating financial blow to that sector.

COVID-19 worries have kept patients away from doctors’ offices and forced the postponement and cancellation of non-urgent surgeries. The pandemic also has shut down large portions of the American economy, leaving many would-be patients without insurance or in a financial pinch that makes them curb spending.

All of this has forced hospitals, health systems and doctors to lay off staff, cut costs and hope a return to normal arrives soon.

“You couldn’t ask for a worse situation, really,” said Joe Antos, an economist with the American Enterprise Institute.

Health care provided the biggest drag on the U.S. economy in the first quarter. Spending on care fell at an annual rate of 18%, the largest drop for that sector among records going back to 1959.

Economists point to hospital systems, a key driver of the sector’s performance, as a big reason behind the drag from COVID-19, which initially hit some parts of the sector more intensely than others.

The nation’s largest hospital chain, HCA Healthcare, said its hospital-based outpatient surgery totals for last month were down about 70% through late April.

In many cases, hospitals that lose those profitable surgeries are gaining COVID-19 patients — and losing money on them. Those patients may require hospitals to expand intensive care units, spend more on infection control and stock up on gowns and masks, among other items.

The American Hospital Association estimated in a recent report that the nation’s hospitals and health systems will collectively lose more than $36 billion from March to June treating hospitalized COVID-19 patients.

When adding factors like lost revenue from postponed surgeries, the total balloons to more than $200 billion, said the association. Congress has set aside about $175 billion so far to help hospitals and other care providers, but the hospital association says more assistance is needed.

“We’re facing perhaps the biggest financial crisis in our history,” association CEO and president Rick Pollack said.

From the doctor’s office, the view also is bleak.

Dr. Seemal Desai said patient visits for his Dallas-area dermatology practice plunged about 85% after COVID-19 hit.

He started seeing patients over the internet with help from smartphone or tablet cameras. But that created fresh problems. Desai said some patients don’t have the technology to do online visits. Others hesitate because they aren’t sure their insurance will cover them.

Only about half the patients who were offered a telemedicine visit actually did one.