David Brailer | April 6, 2020
In the early AIDS epidemic, I saw up close what is inside physicians and nurses – what they are really made of. That was a time before that disease had a name and its mechanisms weren’t understood, and when the patients – and therefore the clinicians who treated them – were stigmatized. The broad public was deeply afraid of being infected and took what now were clearly panicked and unnecessary precautions. Clinicians who took care of AIDS patients were potentially putting their lives – and those of their families – at risk.
What did America’s clinicians do then? They didn’t shy away, hold back, go on strike, call in sick or run away. They did the opposite – they ran in, they jumped in. They put all their hearts into taking care of people with this mysterious and grave illness. Some clinicians gave their lives.
Clinicians then and now display the two essential traits of caregivers: courage and empathy. They did not let fear or disgrace or risk stop them from treating patients ravaged by the plethora of things that consume a body though a failing immune system, otherwise known as AIDS. We’ve seen the same essential character of clinicians during other outbreaks – SARS, Ebola, H1N1, or even the annual flu season. We see it on airplanes, when other passengers are in distress, along roadsides and in neighborhoods, when the person down the street is ill or is traumatized. We see it in hospitals, clinics, rehab centers, nursing homes, pharmacies and in patient’s own homes.
The courage and empathy of clinicians is on full display in New York and many cities around the world during the coronavirus pandemic. Every American can see that clinicians do not have the personal protective equipment they need. Americans see them improvising and doing their best as they move into harm’s way. Many clinicians are infected and many have died – more than 14% of cases in Spain are clinicians, and 60 physicians have died in Italy so far. There is growing evidence that COVID severity is in part influenced by the degree of exposure to coronavirus, a particularly cruel challenge for clinicians with voluminous daily exposure. On top of this, clinicians are working draining schedules – often 24 hour shifts with little rest in between – and facing impossible conditions as the number of people seeking care skyrockets and hospitals are filled far beyond peak capacity. Some clinicians are facing the choice of who lives and who dies.
What Americans don’t see is clinicians running away. Far from it, clinicians today are running to the problem. Dermatologists, primary care physicians, and general nurses are retraining to take care of failing lungs and hearts. They are learning new methods of sterile technique made necessary by the startling shortages of gear. They are improvising with medications not used in years as shortages drain pharmacies. They are signing up for additional shifts, even when it means distress at home. And retired clinicians – often in the age range of elevated risk – are volunteering by the thousand, more than 80,000 clinical volunteers in New York alone.
Our clinicians are the front line in the battle of man versus virus, of DNA versus RNA. These clinicians are the same ones who have been reporting increased levels of burn-out and stress over the past few years as they have become the utility player in hospitals when EHRs are deficient, protocols don’t work and when coding is incomplete. These are the clinicians who we want to figure out how to make care more efficient while at the same time not compromising quality. These are the clinicians who have been blamed for driving expensive over-utilization and who have to spend hours on the phone with health plans to get necessary procedures and tests approved. But these clinicians are the ones who reported for duty without hesitation when the pandemic began. They saw the enormity of the outbreak and fought harder and worked longer. They will be stressed, harmed and even killed by this fight. But they won’t give up. They will keep coming to work and looking after people until the pandemic is behind us.
There will come a time when we will evaluate how all this happened and how our clinicians were left exposed, unprotected, and unsupported. Some share of the cause for this is simply nature, and how anyone could ever plan for a low-probability high-consequence event on this scale. Some of the cause will be placed on large mistakes and fumbling responses early on. Investigations will be held, and lessons will be learned. New rules and regulations will be created, and new investments will be made to fortify the health care system. Hopefully that capacity will never be needed, but if it is, we hope our successors will know at that far date in the future what we know now, just as our forebearers in 1918 would have wished we knew their lessons now.
That will all come at a time in the future, but for today we are in the fight. A generational fight. But a fight that will not break the wall made by our clinicians to protect the American public.
Please join me in giving your heartiest thanks and prayers for the courageous and empathetic clinicians who stand on our front lines.