As cases of COVID-19 sore around the nation, the days of New York as the epicenter of the pandemic have become a distant memory for this emergency room doctor. Did the government really once send us refrigerated trucks for our dead and a naval ship for our sick? Did we really sit masked, goggled, and wrapped in plastic while sweating out shift after shift surrounded by coughing, gasping coronavirus infected patients? Did the rapid response and hospital distress alarms overhead fall on us non-stop like the sounds of artillery shells in a trench? Did they tell us to conserve oxygen because the hospital compressors could no longer keep up with the demand being pulled from the wall sockets for damaged, desperate lungs? Even as we lived this bad dream, a part of me knew we had been lucky. COVID-19 had come to American shores at the end of the influenza season. A fact which blunted the impact of the new virus on our hospital systems. As we approach winter, when influenza returns and COVID-19 cases continue to increase, I contemplate what lies ahead.
To understand the true horror of COVID-19 in the American health care system, you must realize that hospitals operate at 130 percent capacity during an average flu season and still need space. Every winter, when influenza—the 100-year-old king of human viruses—returns with his army (human metapneumovirus, rhinovirus, enterovirus, and the mischievous old coronavirus) for his annual reign of destruction, our hospitals overflow to the brink, and the health care system hangs on by its fingernails to get through another season. During this time, the hospitals reach capacity, and patients can spend some or even all of their hospitalization in the hallway. Yes, that’s right; it is normal practice in America for people to spend an entire hospitalization in a hallway because we have run out of rooms.
Let me describe what this is like. You do not rest in a comfy adjustable hospital bed but rather you spend your time on a stretcher, which is the equivalent of a park bench with a flimsy pad on it. Most human bodies cannot tolerate a stretcher for more than a few hours, let alone days. You will lay in the open without privacy. The fluorescent lights will burn your eyes, stretchers will slam into you as they are wheeled by, and the noise of the hospital will fill your ears. Sleep deprivation is your only option. Food service is sparse, so you will be hungry. If you need to use the bathroom and cannot get up on your own, you will have to go on yourself until someone can clean you. All the above describe how we normally operate in America—on a shoestring in squalid conditions. The veil has been removed from America’s little health care secret in 2020. Not enough of x, y, or z? There never was.
On the eve of winter, we sit here in New York like a skittish pack of deer, knowing an apex predator stalks us. Soon, influenza will retire from his summer hibernation. He will explode into hospitals in his usual flash-bang style, making noses run, lungs cough, and bodies feel like they have been run through a trash compactor. This winter, he will meet the new menace in town—COVID-19, the destroyer of lungs. Will he be angry that this young usurper has stolen all his ventilators or will COVID-19 and his majesty, influenza, make an alliance to double their terror on humanity? Will widespread use of masks (you always wear yours, right?) and increased influenza vaccination compliance (you got yours, right?) foil the duo’s plan? Will hospitals be prepared this time with adequate PPE for their front-line heroes? The long months of winter will be filled with novel challenges to our health care system. As a nation, I hope we learned enough in the Spring test run to survive the cold months ahead. For now, we brace for impact.
Katarzyna Falkowska is an emergency physician.
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