As I write this, I have just finished my ninth consecutive overnight shift as an emergency medicine physician here. At the end of each shift I go to an Airbnb, where I have been living alone for two and a half months, away from my wife and 10-year-old daughter so that I am less likely to pass the coronavirus on to them.
In a medical crisis, my job is to manage a clinical team, problem-solve and be in control. It is hard to admit that I feel vulnerable and scared when I think of the COVID-19 surge we are facing now and the combined COVID-19 and influenza tsunami expected later this year. But I am admitting it because you need to know how close health care workers are to breaking.
My colleagues and I watched what happened this spring in New York with horror and hoped we could avoid the same from happening in our state. But our federal and state governments abandoned their duty and let the virus terrorize our vulnerable communities, spreading rampantly. Now we are beginning to experience what hospitals in the Northeast went through months ago.
When Arizona and other states started to open back up in May, public health experts predicted a surge of COVID-19 cases. That surge is just beginning. We see a steady increase in patients arriving at the emergency department with COVID-19 symptoms. Every day, Arizona sets a record high for daily cases. As of today, over twice as many Arizonans are hospitalized for COVID-19 symptoms as were on June 1.
Patients are evaluated, stabilized and admitted to an inpatient medical team. But many admitted patients remain in the emergency department, “boarding” while awaiting transfer to the hospital wards because there are no more intensive-care beds available in the hospital or there is insufficient staff to care for them in the beds that are available.
Because of that, far fewer emergency department beds are available for people with non-COVID-19 health conditions and medical emergencies. So sick people wait for an emergency department bed to become available. The surge in cases night after night shows no sign of slowing, and it is terrifying.
The media has reported how few hospital beds are available in the state. But even if we had enough beds, it wouldn’t matter if our staff wasn’t physically and emotionally well enough to attend to the people occupying those beds. Many hospital systems have chosen to furlough staff and tighten belts even as health care teams were beginning to feel the psychological strain of the pandemic. Physicians are a small part of our clinical care teams. We are profoundly limited in what we can do without the support of nurses, paramedics, emergency and intensive-care technicians, respiratory therapists, radiology technicians, environmental services workers, social workers, case managers, unit coordinators, clinical pharmacists and others.
Health care workers are exhausted. Staffing shortages and increasing fatigue are the new normal for emergency departments, intensive-care units and COVID-19 units, and across hospital wards. Staffing levels are being set with an emphasis on “productivity” as determined by financial calculations rather than clinical severity or the complex needs of our patients and the community we serve.
Staff members call in sick or feel so emotionally drained that they need a mental health day to face another shift on the front lines. Staffing shortages are being made even worse by the furloughs of some of our most experienced team members. Inexperienced new nurses remain and plunge into caring for increasingly ill patients with less mentorship and support.
Emergency medical and critical-care team members are canaries in the coal mine. When we are understaffed and overworked, when there is no staff to triage patients, when more and more patients are piling up at the emergency department door, the system breaks down, then people break down. You can borrow ventilators (until you can’t) and make more personal protective equipment (we hope). You cannot magically produce more nurses, respiratory therapists, physicians or other professionals.
My colleagues and I witnessed the physical and emotional devastation of the health care work force in Wuhan, China; in Italy; in New York. Health care workers were catching the coronavirus on the front lines, getting sick, getting their families sick, dying. We saw them suffer the lasting scars of feeling helpless in the face of this new coronavirus, unable to save their patients or themselves. We did what we could to prepare ourselves for when the pandemic would hit our community, knowing it was just a matter of time.
A group of us from a variety of backgrounds began building a coalition called HCW Hosted to help local health care workers find quarantine housing to isolate from our families. We have since added other services: health-status monitoring, emotional-health support and psychological first aid. These support services have helped fill some of the gaps our employers and government infrastructure have failed to address. But even if every city and town had an organization like HCW Hosted, that would still be only part of what is needed to mitigate the impact of COVID-19.
I get angry when I see people refuse to wear a mask or physically distance from others or stay home when they could because it is inconvenient — or as a political statement. If you do not wear a mask and physically distance, you are putting yourself and others in harm’s way. You are putting us in harm’s way. Then you will expect us to risk our lives to save you. And it’s not just we whom you ask to risk our lives, but our families as well. What you are saying to people like me and my team is, “Your life and the lives of your loved ones do not matter to us; you are disposable.”
I am willing to sacrifice for the greater good of the public. I took an oath to that effect when I became a physician. But the public has to sacrifice some too if we want to get through this as safely as possible — social scientists call this “health citizenship.” It means contacting your elected representatives and imploring them to follow public health science when they set policy — and voting out those who won’t. It means demanding the health care systems protect the well-being of staffs. And yes, it means wearing a mask, staying home when possible and practicing physical distancing so that our hospitals and care facilities are not swamped and we are not overwhelmed.
Your sacrifices of comfort and convenience make a difference — for your family, your neighbors, your health care workers and your access to quality health care in the future if you need it. I hope you don’t visit me or my team in the hospital anytime soon, but should you need to come see us, we want to be available and able to provide you the best possible care.
To do that, we need you to be part of our team.
Bradley A. Dreifuss is an assistant professor of emergency medicine and director of rural and global emergency medicine programs at the University of Arizona College of Medicine at Tucson. This column was originally printed in The New York Times.