The Trump Administration’s Absurd Response to At-Risk Front-Line Healthcare Workers
In the wake of this onerous COVID-19 crisis, it seems the Trump administration can’t resist employing its typical disregard for actual workers — in this case, healthcare workers — in its approach to frontline doctors, nurses, and other healthcare staff. Despite repeated warnings that doctors and other workers are running out of supplies which keep them safe — a bare minimum of expectation under any context — the administration has refused to utilize the emergency defend act or to otherwise marshall any sort of significant help for front line workers. The administration just agreed to employ the much-needed Defense Production Act despite desperate calls for equipment and dire warnings for weeks.
Repeated warnings from physicians such as those working in heavily-hit ER’s — warnings which underline the importance of protective gear and the fact that these are specialized — have gone largely unheeded as the Trump administration recommends reusing gear which does not work properly when reutilized and offers his recommendation: ‘use bandannas.’ This ‘let them eat cake’ approach to necessary — and limited — human beings who have the education and experience to deliver aid in this context is appalling, to say the least. This suggestion is so absurd that it rivals the most mediocre of off-off-Broadway plays.
Treating health care workers as if they are dispensable is not only immoral, it is also extremely unwise even from a purely pragmatic standpoint. There are fewer than a million doctors in the US at any particular time, and the onerous changes in healthcare which have inflicted corporate ideals on physician oaths have resulted in a rapid exit from this profession. Doctors report that the profession no longer offers any sort of reprieve — little time with patients; no control over rules or even over medical decisions, in some cases; antiquated testing that exists to line the pockets of greedy CEO’s with no attendant value to either physicians or patients (see: Richard Baron and the ABIM). Thus, doctors have left medicine at increasingly higher rates, often retiring earlier than expected and leaving for corporate positions which offer a significant improvement in professional quality. Similarly, nurses are often burned out by a profession in which they are frequently under appreciated and underpaid, and often leave the front lines for administrative positions or other careers altogether.
In addition to the administration’s attitude towards doctors and other front line workers — one which conveys that they are largely dispensable and that risking their lives and that of their families is acceptable — the administration and other politicians feel as if the antidote to this is to request that retired doctors and nurses volunteer to fill in gaps where younger, more fit doctors and nurses are falling ill and unable to keep up.
The multi-layered absurdity of this suggestion must be clear: we already know, after several months of COVID-19, that older people are particularly at risk. And who is most likely to be retired? Yes. Older doctors and nurses. What more ridiculous suggestion could there be — when other emergency options are available — than to call to the front lines more vulnerable doctors when even the younger ones are unable to tolerate the stress? How is it possible that politicians, whose families are protected through isolation, have no problem whatsoever asking older people to sacrifice themselves?
Telehealth: Establish Immediately at All Hospitals and Clinics
The need for front-line workers, exposure of multiple healthcare workers, and the need for protective equipment can be significantly reduced by instituting large-scale measures of telehealth/telemedicine care. Most hospitals are already equipped with these mobile monitors, which are taken from patient room to room as needed when a doctor needs to be consulted but is not available in person. These monitors — and this approach to care — could significantly decrease infectious potential and increase the number of doctors and nursing leaders willing to come back to medicine, if only for this COVID-19 emergency. Any healthcare staff not required at the front lines should not be there; this approach would minimize contact. All health care workers should be performing at the highest level of their education such that the fewest number of people are potentially infected.
Most doctors and nursing/team leaders are NOT needed at the front lines: typically in many hospitals, a respiratory therapist/nurse anesthetist can intubate the patient in the ICU and assistants under nursing tutelage do much of the nuts-and-bolts physical care. The ICU doctor makes the decisions — for example, adjusting the vent or making choices about medication — and should be operating at this level: he/she/they are not typically required on the front lines. This approach preserves the number of doctors available and increases the likelihood that more will volunteer to help. The same may be done with nursing leaders and other healthcare leaders not required at the bedside such that only a few people are required on a physical basis. Some hospitals have robots which can deliver medications and other supplies, and these should be utilized maximally for obvious reasons.
Those who are required at the front lines should have definitively reliably protective gear. As a result of reducing the number of people on the front lines, lesser amounts of protective gear — already in very short supply — will be needed. It is appalling and utterly unacceptable that front line workers are being asked to jeopardize not only their own lives but also the lives of patients to whom they might spread the virus through improperly utilized masks, as only one of many examples. The president of the American Medical Association, Patrice Harris, MD, MA, has called for an aggressive, ‘all levers’ approach to this disaster, as she lends her insight on a recent video:
The AMA calls on Trump to use 'all levers' to get medical supplies
American Medical Association President, Dr. Patrice Harris, joins Morning Joe to discuss critical supply shortages at…
The Trump administration’s response has been sluggish at best. They just instituted the Defense Production Act, a move that should have been undertaken at least weeks ago. Now that they have finally made this important decision, they must aggressively and proactively institute it.
The lives of all peoples are at risk without the vigorous support of the government during these types of national/international disasters.