Published on April 14, 2020 by Regina Rodman
Covid19 is a novel coronavirus that had not previously been seen in humans. The lack of immunity to a novel virus has now caused a global pandemic. The possibility of a pandemic has been discussed for many years by top officials including the World Health Organization. Considering global trade, international travel, and our shrinking world, it was almost inevitable that this would happen someday. It is inevitable that new diseases arise and spread occurs. This is a natural phenomenon that has occurred throughout human evolution. It is inevitable that disease comes to the United States and deaths occurs. However, the alarming spread and increasing deaths in the United States were largely caused by systematic failures. The crisis that has fallen on the US comes from disorganization throughout the system. The inability to make scientific data-based decisions, the inability to protect health care workers, the lack of PPE, lack of tests, and subsequent closing of the economy has resulted in a humanitarian crisis. Much of this was preventable.
This case of disease versus disaster is comparable to drought versus famine. A drought is a natural disaster. A drought can cause crop failure, food shortages and production deficits. However, with mechanisms such as stocks, imports or external aid, the effects of drought can be mitigated. While even a mitigated drought may lead to shortages, climate alone does not lead to widespread famine. A famine may occur when a drought takes place in the midst of socio-economic processes that prevent the most vulnerable and marginal groups from accessing food. In the past, we have witnessed this in the horn of Africa; political instability leaves a vulnerable population, and changes in climate have the potential to cause a total collapse. Instability makes it difficult for any remedies to be effective. Armed conflicts prohibit humanitarian aid to certain areas in need. Lack of infrastructure creates difficulty distributing imported goods to offset a production deficit. A weak central government cannot manage this type of shock effectively. We have seen this in countries that seem far away but we never thought this could happen in the US.
Covid19 is our version of this humanitarian crisis. The same phenomenon are happening here. This calamity will be a case study for decades to come. A weak central government was unable to recognize the risk and failed to prepare. Lack of infrastructure and centralized leadership led to a disorganized supply chain to support needs. Recruitment efforts that failed to protect workers also prevented aid from reaching the areas in need. As a result, the most vulnerable and marginal groups suffered the most; our healthcare workers, our elderly, and ethnic minorities.
Warnings to the United States were heard as early as January 3. The voice that usually would have been monitoring the situation and sounding the alarm, the National Security Council Global Directorate, had been dissolved in 2018. The warnings from China about a new disease causing significant morbidity and mortality merely bounced off an arrogance so thick scientific knowledge could not penetrate. The notion that America was somehow “above” the disease and could limit spread by travel restrictions was arrogant and proved fatal. A weak central government failed to plan or prepare. This left the country without adequate infrastructure to cope with the crisis. The millions of test kits needed to assess and track spread were never ordered. The public health departments who would help with contact tracing and control quarantine had already been defunded. The massive amount of PPE needed to protect healthcare workers was never produced.
Disorganization at the federal level led to chaos between states. States had to bid against other states, and against the US government, for personal protective equipment. Failure to evoke the Defense Production Act to its full extent led to huge delays in developing the needed equipment. Without a competent Supply Chain Commander In Chief, supplies still lack in many places. Weeks were wasted between the first warning on January 3 and March 21, the day that the Department of Health and Human services placed its first large-scale order of N95 masks. These unjustified delays resulted in the deaths of multiple healthcare workers. These deaths should never have happened.
The lack of transparency by hospital administrators is equally fatal. The administrators and their staffing agencies, often owned by private equity firms, are more concerned about their reputations than addressing the problem. Healthcare administrators have perpetuated the crisis by silencing their staff and threatening the jobs of those who speak out. The lack of transparency and attempts to keep a positive appearance is killing us. Let the doctors on the frontline share their experiences. We are told that these restrictions are to “prevent spreading fear.” This is a completely paternalistic view. Let health care workers speak. Let them tell about the suffering they are seeing and the overwhelming numbers of patients in comparison to the number of hospital beds available. Let them speak about the lack of protection provided for physicians and the fears they face daily. Let these stories be heard by the public, and then let the public react as they will. With an accurate and factual understanding of what is happening in the hospitals, many Americans will react in sympathy and solidarity with healthcare workers. It may be easier to enforce stay at home orders if the average American could truly see or hear what healthcare workers see.
Finally, failing to respect the lives and contributions of physicians is what is causing a shortage of doctors in critical areas. Numerically, there is not a shortage of physicians willing to help. Multiple calls for “volunteer physicians in NYC” have been publicized. As an out of work surgical subspecialist who holds a recently expired license in NY, I signed up immediately upon hearing the need. I was also contacted by Texas Disaster Volunteer registry, which I also applied to in full. I was quickly informed that in both cases, this was strictly volunteer. There would be no compensation. There would be no hazard pay. There would be no malpractice or liability coverage, no assistance with lodging or travel, and no type of health insurance should I fall ill. They also noted that PPE was not guaranteed. Physicians are the most valuable asset a hospital can have right now, yet hospitals are not treating them this way. There are many doctors out of work. Many are looking for ways to pay their own bills. While we are not all trained as intensivists, we all have medical degrees and can serve as extenders to those who do have the training. For areas with critical numbers and overwhelmed health systems, there are many more physicians available to help. But they will not come without some kind of effort to show that they will be compensated for their sacrifice. More importantly, they deserve to be protected as they work.
Even the most altruistic doctor will not sign up for this arrangement. When we became physicians, we took the Hippocratic oath. This oath is centered on care for patients. It does not demand self-sacrifice. We agreed to care for the public, but we also took an oath to “do no harm.” We are not just sacrificing our own lives. When healthcare workers serve without proper protection, they risk exposing their families and all the patients they treat. This is a divergence from the physician’s intended purpose: to heal. Instead it results in physicians feeling powerless to protect patients. It creates moral injury. Leaders are sending healthcare workers to the frontlines, knowing that many will be sacrificed. Physicians feel powerless trying to protect their patients. The moral injury felt by physicians today will have effects for years to come.
What has happened thus far in the United States is a tragedy. The collision of an arrogant central government and a healthcare system run by administrators created this explosive disaster. The alignment of these two failings has exposed a void so great it can no longer be ignored.
I can only hope that in the recovery phase we are able to rebuild a new and improved health system. One that sees medicine as more than a highly leveraged balance sheet. I hope that it is one that regards doctors as more than data points, and the care we provide as more than a revenue figure. I hope that physicians and scientists can have their expert knowledge heard. Finally, I hope that we can work with government and healthcare administrations in a spirit of transparency and collaboration. It’s time that patient care becomes the focus of healthcare.
After any devastating event, lessons can be learned. The lesson here is WE NEED HEALTHCARE REFORM. Our broken system has to change. Our lives depend on it.
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