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Tears for the Warriors Without Armor in the Fight Against COVID-19

It is difficult to put into words the level of frustration and despair that I have felt over the last few days watching the schizophrenic national response to this COVID-19 crisis and its detrimental effects on the work conditions of my colleagues.

As an internal medicine physician working in Utah, it feels like it is the calm before the storm as emergency room and urgent care volumes are down as people try to socially distance to correct the spread of this virus. Other areas of the country are not so lucky.

While I wait, I am sickened by what I’m seeing in the more harder hit areas of the country.

I feel myself becoming physically ill as I read about health care providers in New York City who have resorted to using trash bags because the hospital has run out of protective gowns.

I cry as I read the account of one of New York City’s first health care worker deaths: a 48-year-old emergency room nurse, Kious Kelly, who caught the virus, as coworkers angrily note, from an embarrassing and dangerous lack personal protective equipment (PPE). His last words to his sister when he texted her while on a ventilator: “I’m okay. Don’t tell Mom and Dad. They’ll worry.”

My heart breaks for frontline coworkers who are being given only one single-use protective mask and being told to use it for days to weeks at a time, a breach in infection protocol so egregious that just several weeks ago it would have been grounds for dismissal from the hospital.

As of March 26, the United States has now surpassed China as the country with the most cases of COVID-19 in the entire world.

Meanwhile our president continues to downplay the seriousness of this outbreak and pats himself on the back for the delusional reality he lives in where he is “doing a really good job in terms of running this whole situation.”

This is just a reflection of what his responses been all along. In the early stages of the outbreak, when cases started to reach our shores, he tried to magically wish it away saying that we only had a few cases and we would soon be down to 0. Besides admitting he was wrong when the exact opposite happened, he fell back on the inaccurate claim that this is “no worse than the flu” a claim he is repeated despite overwhelming evidence suggesting otherwise.

As the crisis escalated rapidly, his administration finally realized the gravity of the situation and declared a national emergency, putting into place travel bans to affected areas of the world — effective measures to prevent further spread of the virus, but too late to prevent it from reaching our shores.

He called himself a “wartime president” when he signed a Defense Production Act (DPA) — a 1950’s law that would give him much needed authority to require corporations to “accept and prioritize contracts for services and materials deemed necessary to aid U.S. national defense.” But bafflingly, he did not use it, saying that he would not use it unless we reach a “worst case scenario.”

Last week, my wife helped create a petition on Change.org to urge President Trump to actually use the DPA to provide the protective equipment needed for frontline medical personnel who were dangerously close to running out. I just received word that President Trump said he would finally use the DPA to address shortages. Unfortunately, I made the mistake of believing him and we shut down the petition. Since then, he has backpedaled on his promise, falling back on flimsy excuses like saying that private companies will solely be able to step up production, insisting that it is the governors’ responsibilities to address these shortages, and lashing out at governors who plead for help from the national level.

Some have tried to defend Trump, arguing the private companies that produce PPE (which are facing the worst economic downturn since 2008) are somehow going to be able to keep ramping up production to meet demand with no financial incentive or direction from the federal government.

This argument doesn’t hold water. Companies which are facing devastating financial losses and a dwindling workforce are being expected to muster the money and staff to become more productive than ever during a time of crisis, and all out of the kindness of their hearts. While it truly has been heartwarming to see companies step up, this is not sustainable for anyone in a state of emergency.

Even if private companies were able to keep up with demand on their own, the distribution has become a nightmare. “The problem is, that the private sector supply chain has broken down. It has just simply broken down,” [Senator Chris] Murphy said on a call with reporters. “It is a ‘Lord of the Flies’ scenario today in which supply is not heading to areas of need, but is instead heading to places where the money is or where the political connections exist.”

During the worst public health emergency in a decade, in the absence of national leadership, the States of America are anything but United.

Meanwhile, pleas from all over the nation keep pouring in asking for the federal government to use the Defense Production Act. Here’s a short list of people who have pleaded for the President to act:

I don’t bring this up to be political. I bring this up because I’m scared. I see colleagues, young colleagues, talk about making sure their partners and family know their end of life wishes if they don’t make it through this fight. I see nurses and doctors kiss their families goodbye to live in isolation for the forseeable future when they finish their hospital shift to prevent their families from getting sick. I see colleagues openly debate the gut-wrenching dilemma of deciding whether to follow their Hippocratic Oath to take care of the sick or choose to protect themselves by refusing to work in dangerous conditions.

To be clear, Trump did not create this virus. He is not responsible for it. But he and his administration, with the exception of Anthony Fauci, have fumbled their response to this crisis again and again, and, bafflingly, continue to hold back from exercising the full authority of the federal government in protecting our front line warriors in the onslaught that will come in the following weeks.

You could argue that this is an unprecedented public health crisis that has never been seen before, so we can’t be so hard on our leaders. Indeed, this is part of Trump’s argument. I would buy it if I lived in Italy or China, as they were the first wealthy nations to experience a major outbreak, but we have had weeks to watch the pandemic unfold there. It is delusional and irresponsible to watch two major nations brought to their knees because of this epidemic and then refuse to make preparations because we somehow magically think that we would not face anything near what they did.

Here in Utah, I pray that our social distancing measures now will pay off and that we don’t follow the path of Italy and New York and Washington State. But the nightmare has set in for my colleagues on the front lines in those areas. It would be a traumatizing situation to manage even if they had the protective equipment they needed, but the reality is that they don’t. They are fighting this war without the tools they need to care for their patients and keep themselves safe. And until our “wartime president” actually starts acting like one, I’m afraid we’ll continue to lose many more of our patients and our fellow brothers and sisters in health care.

Author’s note: There is now a petition to demand that President Trump use the Defense Production Act to accelerate production and coordinate distribution of PPE. Please consider signing it. While he did use the act to direct GM and others to produce more ventilators, we need protective gear. Otherwise who will run the ventilators when health care workers start getting sick in large numbers?

Image credit: New York Post Front Page from 3/26/2020

Justin Jones, MD Justin Jones, MD (5 Posts)

Attending Physician Guest Author and Contributing Writer Emeritus

Intermountain Healthcare

Justin Jones is an outpatient primary care physician in Utah. He completed his residency in 2018 in Colorado and wrote for in-House during residency. He blogs at Residency Hacker.