Tuesday, January 19

This wave of Covid has caught healthcare workers in a nightmare. I see it every day | Coronavirus


TThe last days of this dire year are strange. “Hope is here,” reads a flashing sign on the New Mexico highway, where my wife and I live. We now have two coronavirus vaccines available in the United States that are safe and effective. I received my first dose just five days after the FDA issued an emergency approval for its use, a logistical miracle. Nearly 5 million Americans have received a dose of a Covid-19 vaccine. The government has obtained an additional 100 million doses from Pfizer, to be delivered in July. If all goes well, enough people may be vaccinated to allow a return to something close to normal at the end of the summer. It is tempting to turn our attention to the future, as the end of the pandemic is just beginning to loom.

After “Hope is here”, the next message that appears on the road sign says “Keep wearing your mask.” Even when the vaccine is released, the most terrifying wave of the virus continues to accumulate astonishing power and momentum. More than 2,600 people die every day in the United States from Covid-19. That is approximately one death every 30 seconds. More than 200,000 people test positive every day – one million new infections every five days. One in 17 people in the US has contracted the virus since the pandemic began. The scale of this latest wave exceeds our ability to easily understand it. It is a mega-thing, like climate change or planetary mass. The virus moves at the speed of light; its daily incidence is directed to the moon in a very sharp curve.

Across the country, hospitals are over capacity and ICU beds are full. Hospital gift shops are being converted into makeshift rooms for patients. But leaving space for new beds is not enough; you need nurses, environmental service workers, doctors and technicians to cover those beds. And right now, all those people are very tired and stretched out. You can buy new beds, but training staff takes time. We are reaching a strict limit on the number of patients we can see across the country, and the virus still finds thousands upon thousands of new hosts every day.

Some of these patients will get sick enough to need hospital treatment. Will we have space for them? Or will some people die simply for lack of space and providers to serve them? Los Angeles County is preparing to enact standards of crisis care, to direct the allocation of scarce resources such as ventilators, dialysis machines and ICU beds to those most likely to benefit. Other counties, cities and states are likely to follow suit in the coming weeks. The solidarity I have seen among my front-line colleagues has been extraordinary, but I am concerned about the moral damage of fighting this pandemic in the face of fragmented leadership, little politicization, and a simple lack of critical equipment and supplies. “There are no more surgeons, urologists, orthopedists, we are just doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us,” wrote an Italian doctor in March. But, as some have pointed out, celebrating healthcare workers as heroes obscures the systemic failures that demanded they step in to fill the void left by poor planning and leadership.

It is tempting to look only to the future, to the promise of the vaccine, but we must remain anchored in the present. As with the winter solstice, we have just passed the darkest day of the year, and each day brings us a little more light, a little closer to summer. But the days are still dark. Compliance with public health guidelines – wearing masks, washing hands, staying home, limiting contact – is more important now than at any other point in the pandemic. We cannot allow the relief of the arrival of the vaccine to erode our vigilance.

And what happened? As eager as we are to get through this year of pandemic, we cannot forget what has happened. There is much to learn. During the first months of the pandemic, I began taking notes during each shift in the emergency room. Reading them now illustrates the systemic failures that allowed the virus to spread far more aggressively than anywhere else, and the institutionalized inequity and injustice that brought the greatest price to the already marginalized and exploited in our society.

In March, I saw an HIV patient who had just returned from abroad with a fever, cough, and shortness of breath. The state health department declined our request for Covid testing. CNN later reported that the CDC had not conducted any tests that day and that state labs had performed only eight. We were so desperately prepared to face the threat of the new virus, even though scientists had been warning for years that it was only a matter of time before a dangerous new virus passed from animals to humans. While other countries rapidly increased testing capacity to track the spread of the virus, we were blind as it took hold in communities across the country. Without the proper testing, there was never any hope of containment.

Later that month, I cared for an elderly patient who we thought had severe Covid (our tests were still taking hours or days to produce). The possibility of running out of ventilators seemed very real, and the patient agreed to be terminally extubated if his Covid test came back positive, to release his ventilator for another patient. It was an incredibly selfless act. It turned out that we never ran out of fans in Boston, where I worked, because the community came together to successfully flatten the curve. In New York, hospitals desperate for extra ventilators received dated and dusty models from the strategic national reserve that sometimes didn’t work, and they heard from the president and his advisers that they were lucky to get anything.

Before long, I realized that a disproportionate number of the patients I was intubating for Covid were Hispanic or African American. Hispanics make up 20% of Boston’s population, but they make up 40% of Covid patients admitted to our hospital. The poverty and medical deprivation that had robbed these communities of their health and longevity for generations were also, horribly, making them bear the brunt of the devastation of the pandemic.

In early April, the hospital where I worked granted permission for nurses and doctors to use their personal cell phones to record the last words, messages, or wishes of patients we were about to intubate. We knew that some of them would not survive and the patients knew it too. The day before, CNN had interviewed a woman whose husband was dying alone in an ICU in New York. She couldn’t be with him due to visitor restrictions; The best she could do was play the wedding song for him on his phone when it happened. I am grateful for what these devices have enabled, but the pandemic has disproved the idea that the digital connection is a worthy replacement for real human engagement.

On April 11, when the United States had just half a million infections and 18,000 deaths, I wrote in my notes that I was “so willing to get back to normal, although I hope I will not do it return to the normality that we knew ”. We are all ready to ditch the masks and hug our loved ones, share a meal with friends, travel, and get together again. We are so ready for this to finally end. But the pandemic has exposed some critical truths, and if we want to draw some good out of this terrible moment, we would do well to heed them. Racial inequity is deeply ingrained in our society, and there is still much work to be done to achieve justice and real equality. The integrity of our leadership is very important; it can fracture the nation as powerfully as it can unite it. And the real human connection requires more than a screen or a few hundred characters.

The changing climate will bring untold crises for years to come. Covid was a stress test and we didn’t do particularly well. I hope that we can learn from the mistakes of this year as we face what lies ahead. “I sincerely hope that we are up to this challenge,” I wrote in my notes that day, “and we are better.”

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