As schools, public transport, gyms, restaurants, libraries, playgrounds shut down, and life comes to a standstill, people stay at home to prevent the spread of the novel coronavirus. Healthcare workers, however, do the reverse. They get ready every morning to go to hospitals and clinics to take care of patients, putting themselves and their families at risk. In some regions of the world, they work extra shifts, sometimes with inadequate protective gear, to handle the surge of patients with COVID-19. Retired physicians come out of retirement, and medical trainees graduate early to share the workload. On social media, health care workers share pictures of their tired and bruised faces from using protective equipment for prolonged periods of time. Physicians and nurses are doing this not due to some misplaced sense of martyrdom but quite simply because they want to improve things and feel that they have the ability to do so.
Against this backdrop, various economic and public health issues are being highlighted by policymakers, administrators, and the media. We hear about the looming recession, joblessness, impact on small businesses, as well as the impending shortage and rationing of COVID-19 diagnostic tests and therapeutic interventions. Glaringly absent is the plight of our front line workers and their selfless contribution to this fight.
The shortage of personal protective equipment and ventilators in the fight against the novel coronavirus has been persistently highlighted in the news, which is so true. Italy has had to resort to ration critical resources such as ventilators based on patients’ age, comorbidities, and other health index variables. CEOs such as Elon Musk and Tim Cook are pledging to help by making ventilators and donating masks. Although there is no doubt that these equipment and supplies are of vital importance in our fight against this pandemic, one resource which is much more valuable is our health care workers and intensivists.
Intensivists are medical specialists that have advanced training and education in the management of the sickest. In a pandemic such as we are facing now, having enough critical care beds and ventilators will not suffice. We need to have enough intensivists, critical care physicians, respiratory therapists, and ICU trained nurses to operate these machines to take care of our patients. Even at baseline, the U.S. has struggled with a chronic shortage of physicians. This will be felt even more acutely in the current medical crisis. Furthermore, contrary to medical supplies whose production can be ramped up quickly in factories, there is no way to “make” health care workers quickly. That requires a long period of training and education. And in a pandemic the scale of COVID -19, time is precisely what we do not have.
Furthermore, adding to the confusion is conflicting reports and guidelines regarding the usage of personal protective precautions by healthcare professionals as they care for patients with confirmed or suspected COVID-19. Earlier this week, the Centers for Disease Control loosened recommendations on how to use PPE in times of shortage. They stated that healthcare workers, as a last resort, could use bandanas and scarves if masks are not available. This is a ridiculous proposition! It leaves our frontline workers unprotected. Would you send a firefighter to combat fires without their bunker gear? If not, how could the country’s premier public health agency resort to such balderdash in trying times like these? Around the world, protocols are being put in place allowing reuse vs. extended usage of respirators, but how do we know such reuse preserves the structural integrity and function of these masks and respirators. Instead, we must focus on quickly securing adequate supplies of these crucial tools in our fight against the novel coronavirus. Hospitals and governments have the resources; they need to commit to these measures. And it is this commitment that I see lacking at this perilous juncture.
There are several reasons to protect our frontline workers. One, as highlighted above, is the critical training they possess of saving lives. Without them, even with an adequate number of ventilators and PPE, we would be handicapped. The other is that inadvertently, they may become vessels of transmission of disease in the community as has happened in several regions around the world. And finally, it is because in fulfilling their commitment to community and society, our physicians and nurses are putting themselves and their families at risk. It is, therefore, important not to lose sight of the fact that medical doctors, nurses, and paramedical staff are not pawns in the fight against the novel coronavirus. They are our society’s most premium resource in our fight against this pandemic, and we must protect them at all costs.
Aakanksha Asija is a hematology-oncology physician.
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