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Honestly these past few weeks have been the scariest ever for practicing physicians not just in the United States but across the globe.
Taking a chapter right out of The Art Of War by Sun Tzu, medical practitioners are being laid siege to on two fronts by a microscopic combatant that is proving to be quite the formidable enemy.
Front 1: Physical Safety/Health.
As physicians, we know that there is always some risk to our health and safety every time we don our white coats and enter the workplace.
Sure precautions can be taken, but one can only do so much.
I hearken back to my days as a surgical resident (before I switched to radiology) and found myself in the trauma bay attempting to get a femoral central line in a patient who started writhing as the needle entered her groin.
In her thrashing, the needle came out and promptly pierced my glove drawing blood.
Thoughts of all sorts of potential diseases I could contract from this needle stick rushed through my head.
Fortunately blood samples from the patient that are routinely drawn for needlestick cases came back with no worrying results.
However that was pure luck.
The patient could have easily had some easily transmissible bloodborne pathogen that could have impacted my life, such as HIV or Hepatitis.
Fortunately a lot of these higher risk situations are typically only encountered in specific locations such as the trauma bay, giving the physician a chance to increase his or her guard in these “hot zones.”
What makes the current medical climate so taxing on a physician is that this particular microbe, the COVID-19 virus, has two powerful factors helping its spread:
- Ease of transmission.
- The COVID-19 virus has an RO value of around 2-2.5.
- An RO value over 2 accounts for its exponential spread as 1 infected person will pass it along to 2 or more individuals who then each infect 2 more and so on.
- The COVID-19 virus has an RO value of around 2-2.5.
- The ability to survive outside a host for extended periods.
No longer are there safe havens in the hospital/medical practice.
The entire place is now a “hot zone.”
An infected patient can, unknowingly, be leaving viral loads on previously innocuous places.
A doorknob, a keyboard, a phone, a counter top can now all harbor COVID-19 and then help it spread like wildfire throughout the entire healthcare staff.
The mental psyche ramifications:
It is appropriate that the media has been referring to healthcare workers involved in this battle against COVID-19 as being on the frontline.
In war, the soldiers on the frontline witnessed first hand the atrocities taking place around them.
Although there are no actual bullets flying around them, healthcare workers on the front line are faced with an invisible weapon that can have just as deadly a result.
What is worse is, unlike a soldier that is struck by a bullet and killed on the battlefield, the healthcare worker has the potential to take this invisible bullet home and have friends and loved ones struck by it as well.
It tugs at my heartstrings when I read about some of my friends and colleagues on Facebook whom, for the safety of their family, have imposed self-isolation, and are now living in a separate residence.
One of my online physician friends has posted pictures of her husband on the other side of a window placing his hand on the glass as the only way to interact with his young children who do not understand why their dad does not come inside to give them hugs.
I can’t even begin to imagine the additional mental toll it is taking on this household because of this living situation during this already trying time.
My own situation:
As a radiologist I am not going to pretend to be on the frontlines fighting COVID-19.
[No it is my remarkable colleagues like those who work the Emergency Department that are truly the rockstars in this battle.]
A lot of people would not even consider my specialty to be in the second wave/line.
I personally view myself in the 3rd wave, far more protected in my relatively isolated reading room.
However I will tell you that I still have a mental toll dealing with the current pandemic.
I could not forgive myself if I happened to pick up the virus at work and transmit it to my daughter who has been following social distancing remarkably well.
I like to think of my reading room as a “protected space” but is it really?
I still have people entering my room to discuss cases, techs coming in to keep me up to date on current issues with studies, etc.
Heck even the cleaning crew may inadvertently leave a viral load that I could pick up even if I personally have taken all the appropriate countermeasures.
All it takes is one break in the chain and my whole local environment could be harboring deadly pathogens just waiting to inoculate me and put my family at risk.
It is impossible to stay in my office the entire workday and every time I do leave, I have increased my odds of being exposed to COVID-19.
Guess what happens when you get COVID-19?
You get sick.
And guess where sick people go to seek treatment?
A medical building can thus truly be a hotspot for virus transmission as there is a far higher chance of carriers congregating within its four walls compared to the baseline neighborhood structures.
The appalling lack of personal protective equipment.
The most glaring difference between military personnel and healthcare workers is how each group is equipped to fight its enemy.
The United States is renowned the world over for its military prowess.
Our military has at its disposal some of the most technological advanced and expensive equipment in the world.
A soldier is given every chance to best his or her enemy because of this equipment/supply advantage.
And what about the healthcare worker’s situation in his or her fight against COVID-19?
It honestly feels like we are bringing knives to a gunfight (or perhaps even more appropriate, knives to a nuclear war).
The COVID-19 virus requires medical personnel to have personal protective equipment that is designed to eliminate particles 0.3 microns or less from entering your body.
Anything less efficient than that puts the wearer at risk for contracting the disease.
One of the most vital pieces of protective equipment a healthcare worker can have against the COVID-19 fight is the N95 mask, which is designed to trap 95% of particles less than 0.3 microns.
Sadly, the N95 mask is now so coveted, it is increasingly hard to find one.
Physicians have been forced to compromise and re-use what little supply they have despite these masks originally intended for one time use only.
I am considered fortunate that I was given an N95 mask and have been using the same one for over 2 weeks.
Already the re-use of these N95 masks has been implicated in the death of at least one emergency physician.
That article certainly does not give me a warm and fuzzy feeling as I too am also going off-label from its intended use.
Shortages in appropriate equipment to treat afflicted patients is also putting mental stressors on healthcare workers.
The ventilator is one of the most vital pieces of medical equipment that can help save a critically ill patient afflicted with COVID-19.
As many of you already know, the limited supply of ventilators is creating a bottleneck in the treatment algorithm.
Many physicians will have to make difficult choices and play God, deciding who will get this life-saving equipment, and who will not.
Sure it is easy for bureaucrats to create an algorithm with exclusionary criteria to help with this emotionally difficult process, but they are not on the front lines and do not have to look into the eyes of the patient and the patient’s family members and say that a ventilator is not available because they are too old or have another medical condition.
Front 2: Attack on Financial Well-Being.
I elaborated on this particular topic on a previous post, “The White Coat Is Not A Shield,” and thus will only mention this again in passing.
COVID-19 has placed financial stressors on physicians the likes of which have never before been seen.
A profession that in the past could always be counted on for highly compensating its practitioners is now quite tenuous/precarious in nature.
A lot of medical practices, private and academic, have seen patient volumes drop precipitously.
In order to keep the lights on, administrators have been forced to furlough healthcare workers, enforce dramatic pay cuts, or even worse, initiate termination proceedings.
Running a medical practice has an exorbitantly high operating cost, and these costs are fixed and carry on with no care of whether money is coming in or not.
Some of the hardest hit specialties are in the surgical domain as there are bans for performing elective surgeries, often the bread and butter of a physician’s livelihood, during this pandemic.
One of the memes floating around in my Facebook newsfeed sums up what is happening quite eloquently:
“They call us essential workers…..Because sacrificial would be too blunt.”
Sadly many healthcare workers who put their own lives at risk helping others will indeed not make it through alive.
When this crisis is finally averted, it will not shock me in the least to find out that many of my medical colleagues will have some form of PTSD.
Medicine was already a profession where a lot of us were already feeling burnt out prior to the pandemic.
I can only imagine what adding the above stressors to an already volatile situation is going to do for our profession:
- COVID-19 could certainly be the ignition source that sets the whole medical field ablaze with burnout rates dramatically increasing.
- Will those who had been debating retiring early from medicine now be pushed to retirement after enduring this pandemic?
- How will physicians make up for the dramatic losses in income during this pandemic?
- Do they have to now see more patients and work longer hours to make ends meet (since fixed expenses have continued to pile on despite drastic income drops?)
- Will this only accelerate the path to burnout?
- How about the next generation of medical practitioners?
- Will they now be dissuaded from pursuing medicine after seeing the above atrocities to current physicians?
What are your thoughts on some of the long-term effects the COVID-19 pandemic will have on our healthcare workers? Please comment below.
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Thanks for sharing. These are all issues worthy of deep discussion. We have yet to see how all this will work out. I have a slightly more optimistic take that I wrote about elsewhere (https://wealthydoc.org/portfolio-panic/). I won’t rehash those points, but make a few comments. I have had similar thoughts about going into battle without a helmet. No U.S. military would do that. We are not fodder to sacrifice. We are altruistic workers. Some of that altruism has been used against us. When the CDC said it was okay to just wear a bandana and my hospital asked for homemade… Read more »
Thanks WD for the excellent discussion. I actually have the article you referenced highlighted for this Thursday’s Grand Rounds).
Excellent point about grocery stores etc being even worse hot spots because of less precautions taken.
I do hope the new normal is something that has a semblance of things going back to where it was. It would be a shame if wearing a mask out in public is how we have to live life from now on.
I agree that we are very fortunate that we are set up to survive this crisis because of the fire philosophy.
It is easy to get down and see no light at the end of the tunnel. I have been there. But, it won’t be an endlessly open “from now on” either. Herd immunity will develop. The virus will tend to become more benign. Treatments will improve (proning, plasma donations, and remdesivir have already helped). And a vaccine will be developed (likely within a year from now).
Hang in there. It’s tough for all medical workers right now. I’m worried about my brother, but he said it’s not too bad right now. He’s an ER physician. It looks like most areas avoided the overload. The curve flattened just in time.
It’s appalling about the lack of PPE. I hope the situation improves soon. We really need to bring some of these critical manufacturing back to the US.
Glad your brother is doing alright in these scary times. Shelter at home orders really did have an impact. I’m worried about a 2nd or more wave cropping up when it starts getting relaxed again.
I agree that critical manufacturing of some products should have at least a base in the US to deal with issues like this. This was an eye-opener for sure.
Some days you go to work wearing nothing but the flimsy codpiece you are given. It’s not sufficient, and it comes with great risk, but you show up because someday it’ll be you on that gurney.
Everything you say is spot on, my friend. But in the end we still show up, because someone has to, and because others depend on you – a variant of the greater fool theory of finance applied to health care.
Stay safe and healthy,
Well spoken CD. I agree it is in our nature to put the health of our patients over our own. Most of the time that means sacrificing time and sleep which can be unhealthy in its own right. This takes it up a notch with actual potential for death