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The final days of this calamitous year are strange ones. “Hope is here,” reads a flashing road sign on the highway in New Mexico, 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 secured an additional 100m doses from Pfizer, to be delivered by July. If all goes well, enough people may be vaccinated to enable a return to something like normal by the end of the summer. It’s tempting to focus our attention on the future, as the end of the pandemic begins to come just barely into view.
After “Hope is here,” the next message that cycles through on the highway road sign says “Keep wearing your mask.” Even as the vaccine rolls out, the virus’s most frightening surge yet continues to gather astonishing power and momentum. More than 2,600 people are dying every day in the United States from Covid-19. That’s about a death every 30 seconds. More than 200,000 people are testing positive each day – a million new infections every five days. One in every 17 people in the US have now contracted the virus since the pandemic began. The scale of this latest wave exceeds our ability to readily comprehend it. It’s a mega-thing, like climate change or planetary mass. The virus is moving at light speed; its daily incidence is making for the moon on a very steep curve.
All across the country, hospitals are beyond capacity and ICU beds are full. Hospital gift shops are being turned into makeshift patient rooms. But making room for new beds isn’t enough; you need nurses, environmental service workers, physicians and techs to staff those beds. And right now, all of those people are bone-tired and stretched thin. You can buy new beds, but training personnel takes time. We’re edging up to a hard limit on the number of patients we can take care of nationwide, and the virus is still finding thousands upon thousands of new hosts every day.
Some of those patients will get sick enough to need treatment in the hospital. Will we have room for them? Or will some people die simply for want of space and providers to tend them? Los Angeles county is preparing to enact crisis standards of care, to direct the allocation of scarce resources like 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’ve seen among my frontline colleagues has been extraordinary, but I worry about the moral injury of fighting this pandemic in the face of fragmented leadership, petty politicization and a simple lack of critical equipment and supplies. “There are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us,” wrote an Italian physician 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 gap left by poor planning and leadership.
It’s tempting to look only to the future, to the vaccine’s promise, but we have to stay grounded 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 dark still. Adherence to public health guidelines – wearing masks, washing hands, staying home, limiting contact – are more important now than at any other point in the pandemic. We can’t afford to let the relief of the vaccine’s arrival erode our vigilance.
And what about what has passed? As eager as we are to move beyond this pandemic year, we cannot forget what has happened. There is far too much to learn. During the first months of the pandemic, I began keeping notes during each shift in the ER. Reading them now illustrates the systemic failures that allowed the virus to spread much more aggressively than anywhere else, and the institutionalized inequity and injustice that brought the heaviest toll upon those already marginalized and exploited in our society.
In March, I saw a patient with HIV who had just returned from abroad with fever, cough and shortness of breath. The state department of health refused our request for Covid testing. CNN later reported that the CDC had conducted zero tests that day, and state labs had performed only eight. We were so hopelessly unprepared to meet 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 made the leap from animals to humans. While other countries rapidly scaled up testing capacity to track the virus’s spread, we were blind as it took root in communities all across the country. Without adequate testing, there never was any hope of containment.
Later that month, I took care of an elderly patient we thought had severe Covid (our tests were still taking hours or days to result). The possibility of running out of ventilators seemed very real, and the patient agreed to be terminally extubated if his Covid test returned positive, to free up his ventilator for another patient. It was an incredibly selfless act. As it happened, we never did run out of ventilators in Boston, where I was working, because the community came together to successfully flatten the curve. In New York, hospitals desperate for additional ventilators received dusty, outdated models from the strategic national stockpile that sometimes didn’t work, and heard from the president and his advisers that they were lucky to receive anything at all.
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 constituted 40% of admitted Covid patients in our hospital. The poverty and medical disenfranchisement that had robbed these communities of their health and longevity for generations were also, hideously, causing them to bear the brunt of the pandemic’s devastation.
In early April, the hospital where I worked granted permission to nurses and doctors to use their personal cellphones to record the final words, messages or wishes of patients we were about to intubate. We knew that some of them wouldn’t 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 their wedding song for him over her phone as he passed. I’m thankful for what these devices have enabled, but the pandemic has given lie to the idea that digital connection is a worthy replacement for actual human engagement.
On 11 April, when the United States had just shy of half a million infections and 18,000 deaths, I wrote in my notes that I was “so ready to return to normalcy, although I hope we won’t go back to the normalcy we knew”. We are all ready to ditch the masks and hug our loved ones, to share a meal with friends, to travel and gather again. We’re so ready for this to finally end. But the pandemic has exposed some critical truths, and if we want to derive any goodness at all from this awful time then we would do well to pay them heed. Racial inequity is embedded deeply within our society, and there is much work still to be done to the end of justice and real equality. The integrity of our leadership matters greatly; it can fracture the nation just as potently as it can unite it. And real human connection requires more than a screen or a few hundred characters.
The changing climate will bring untold crises in the years to come. Covid was a stress test, and we didn’t do especially well. I hope we can learn from the mistakes of this year as we face what lies ahead. “I so dearly hope we rise to this challenge,” I wrote in my notes that day, “and be better for it.”
Source: The Guardian
Keyword: This Covid wave has trapped healthcare workers in a nightmare. I see it every day | Coronavirus