As the United States faces enormous issues regarding the COVID-19 outbreak which has now impacted all 50 states, I would like to refer to a quote from Franklin D. Roosevelt: “Let me assert my firm belief that the only thing we have to fear is fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.” This quote epitomizes a message that should also hold true today both nationally and within the health care system in the upcoming months.
As a hospitalist physician, I see an ever-increasing amount of fear not only among U.S. citizens, but also within our health care system. I believe that “fear paralysis” is a problem that is equal in scope to universally available testing, social distancing, and vaccine trials. Although testing and vaccine trials are a vital solution, they take time and don’t protect the health care system from being overloaded at its peak occupancy in-real time. Resolving fear paralysis and promoting social distancing can expedite relief on our already overstretched health care system and improve mortality rates. As a hospital doctor, I’m only a small part of the larger medical system which already had existing problems. Now is the time for all medical staff, politicians, and patients to work together to avoid medical travesties from occurring awhile desperately waiting for more supplies, staff, and solutions.
Fear paralysis can be described as the action of being incapable of doing anything due to the fear invoked by an observed stimulus. Although this is a generalized explanation of the term, fear paralysis can also be defined in the current COVID-19 pandemic as the inability to perform appropriate actions or delays in actions within our health care system due to social fears. As COVID-19 continues to be a very elusive diagnosis without universal testing, social fears are abundant. The proof is easily represented through irrational toilet paper buying, people hoarding medical supplies to price-gouge a community, and the obvious fall within the U.S. stock market. A form of social fear is expressed by those who believe the current situation is under-control and denying the COVID-19 problems exists in the first place, which can have a devastating effect. The fear and irrational thoughts don’t stop with the general public; they are quite evident in the medical health care system.
Evaluating COVID-19 has placed a taboo unto patients who are not yet even confirmed to have the disease. As hospital supplies become more limited for physicians, nurses, and respiratory therapists, fear is starting to accumulate within the health care community that is both appropriate and inappropriate. It is appropriate for medical staff to prevent exposure in any way possible to maximize the systems efforts to combat the disease. It is inappropriate, though, to limit the care of patients who do-not have confirmed COVID-19 or to ignore the problems regarding access to appropriately assess patients with confirmed COVID-19. As fear paralysis increases patient-demand in the health care system, there is an equal amount of fear paralysis developing within the medical community regarding exposure. The combination of these two issues added with limited supplies is a recipe for disaster that will potentially increase the mortality of all patients hospitalized (not just individuals with COVID-19).
Multiple systems have provided different recommendations regarding isolating, testing, and triaging patients coming into clinics or emergency room departments. Given no uniform consensus due to different hospital limitations, I am offering a few objectives/goals to help mitigate fear paralysis within the health care system.
Suggestions to combat fear paralysis:
- The public or community needs to be informed daily by reliable community members, not just state and federal level
- People need to come together to demand action (in a way that also conforms to social distancing)
- We must all critically think and look to expert opinion and limit opinions that are promoting denial to the situation or mistrust
- We must find avenues to ensure the social stigma of pending COVID-19 evaluations does not inhibit patient care
- We must find methods of support to establish ways to unify the community with its local health care systems
- Health care systems need to unify protocols to reduce confusion and fear
- We must protect all our health care workers with appropriate personal protective equipment to limit fears that can inhibit appropriate care, diagnosis, assessment, and treatment
I leave my thoughts to a community greater than I am for innovative and appropriate solutions to one of the greatest health care challenges in the past century. Thus just like the fear invoked in times of peril from past travesties, please take heart to FDR’s famous inaugural quote and let us unite to ensure action, limit fear, and diminish the effect of COVID-19.
Carter W. English is an internal medicine physician.
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