Research Notes on the Dire Situation Facing Medical and Health Care Workers in the U.S.

March 30, 2020 | revcom.us

 

Editors’ Note: Following are research notes on the situation with medical and health care workers in the U.S., at the frontlines of combating this pandemic. These have been compiled by readers and supporters of revcom.us, and we encourage correspondence from readers on this and related issues. As has been widely reported, there is a real shortage of PPEs (or personal protective equipment) putting health care providers at risk of infection, along with critical supplies of available hospital and ICU beds, ventilators, etc. for those infected and with severe life-threatening symptoms. The crying contradiction between the devastating effects of this pandemic and the response as shaped by this system’s functioning and rulers is finding a concentrated expression, almost a metaphorical choke hold, in the situation with health care providers, facilities and infrastructure to deal with this pandemic.

Friday, March 27, 2020

In the last few days there’ve been a raft of articles about and reports by health workers about the “apocalyptic” conditions in emergency rooms (ERs) in New York City right now. They talk of a health care system and city “on the brink of disaster” and a surge of sick people, most all with corona, with not enough hospital beds, not enough life-saving equipment, and not nearly enough protective gear. You get the sense that at the moment medical workers are battling mightily and barely able to manage the situation—even with seriously compromised means of care, and people are already needlessly dying as a result.

Given that the full force of the pandemic is just beginning to hit and efforts to speed up help nowhere near commensurate, this points to the certainty of massive, unnecessary suffering and probably death as well as the potential—even likelihood—of a major meltdown and social catastrophe unlike we’ve ever witnessed at least in our lifetimes, with the hospitals and health workers a key fault line/flashpoint. This could in turn accelerate the spread of the pandemic and the possible breakdown of the health care system overall—with all this being gravely and criminally intensified by the words, actions, and inactions of the Trump/Pence regime.

Here’s Craig Spencer’s description (he’s director of global health in emergency medicine at New York Presbyterian/Columbia University Medical Center):

Walk in for your 8 a.m. shift: Struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyone’s protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in. You take sign-out from the previous team, but nearly every patient is the same, young and old: cough, shortness of breath, fever. The staff is really worried about one patient. Very short of breath, on the maximum amount of oxygen we can give, but still breathing fast.

You immediately assess this patient. It’s clear what this is and what needs to happen. You have a long and honest discussion with the patient, and with her family over the phone. It’s best to put her on life support now, before things get much worse. You’re getting set up for that when you’re notified of another really sick patient coming in. You rush over. He’s also extremely sick, vomiting. He needs to be put on life support as well. You bring them back. Two patients, in rooms right next to each other, both getting a breathing tube. It’s not even 10 a.m.

For the rest of your 12-hour shift, nearly every hour, you get paged: Stat notification: Very sick patient, short of breath, fever. Oxygen 88 percent. Stat notification: Low blood pressure, short of breath, low oxygen. Stat notification: Low oxygen, can’t breathe. Fever. All day....” (“What it’s like being a New York ER doctor during this pandemic,” Washington Post, March 24)

The crisis for hospitals and health care workers is rapidly accelerating as COVID-19 infections are increasing geometrically, especially in the NY Metro area, the epicenter of the pandemic in the U.S. (and some say globally) with 60 percent of all the new coronavirus cases in the U.S., and half the cases nationwide. Governor Andrew Cuomo said Tuesday hospitalizations are expected to peak in the next 40 days—even as hospitals are already facing shortages of equipment needed to protect medical workers (PPE - personal protective equipment) and to keep patients alive.

Democracy Now! reported, “The virus continued its exponential growth Thursday, surging to over 85,000 U.S. cases—though the true number is certain to be far higher. Over 1,300 people across the U.S. have died from the virus, and the death rate is predicted to accelerate in the days ahead.... Here in New York City, the largest hot spot of the U.S. crisis, 84 COVID-19 patients died on Thursday, as wave after wave of critically ill people flooded intensive care units and threatened to overwhelm the health care system. Columbia and NYU medical schools said they will allow medical students to graduate early to join the fight against COVID-19, as hospitalizations surged by 40% Thursday.”

There are different layers at work here—(beyond the scope of this note)—including the necessities driving the system overall; the nature of medical care under capitalism-imperialism; the leading edge, right wing attacks on the safety/health net described by Bob Avakian in “The Truth About Right-Wing Conspiracy... And Why Clinton and the Democrats Are No Answer,” which have continued since then and taken a leap under Trump; transformations and long-term cuts in medical care, hospital facilities, and public health.

This is all being heightened by the Trump/Pence regime’s criminal—perhaps genocidal—actions and inactions: downplaying of the severity of the crisis and refusing to adopt the dire warnings, testing, and social distancing needed to slow the pandemic down—then refusing to deliver aid or enact federally-mandated production of equipment and gear, refusing to give blue states like New York and California enough equipment in government stockpiles and requisite financial aid.

Some Key Dimensions of the Crisis Facing Hospitals and Medical Workers

This system has not and is not prepared for disasters. (Even though as of 2019 the U.S. was ranked first by Global Health Security Index.) There’s Trump ignoring—or rather refusing to act—on the basis of the warnings by his own administration. “The Growing Chaos Inside New York’s Hospitals,” by Lizzie Widdicombe, paints the picture that the U.S. health care system is woefully unprepared in terms of dealing with an onslaught of sick patients and of medical personnel not knowing anything about this virus. “It’s challenging,” one doctor said. “Nobody has any experience with this at all, because there’s been nothing like this since 1918. We can all read the Wikipedia page on the Spanish flu, but that doesn’t show what it was like or describe the experience of people who had actual responsibility.” “The vibe at work is this feeling of impending doom.” One person sums up, “Since the first week of March, when the virus arrived in the city, there had been “confusion and chaos” around safety protocols.

Hospital Bed Shortages: There aren’t enough beds to deal with the surge of patients; New York now has 53,000 beds, and Cuomo says it needs 140,000—nearly triple the current number. (“I would call Governor Cuomo probably the single most important person in terms of the drive to close down hospital beds in this state over the last 20 years,” a nurse told Democracy Now! “In New York state, we’ve gone from 73,000 beds to 53,000 beds from the year 2000 to the present time.” These were part of “Medicaid Redesign” and other “reforms.” People have talked about “just in time” production of medical supplies and cutting the number of beds when empty beds are unprofitable.)

Equipment Shortages: Cuomo said: “FEMA says ‘we’re sending 400 ventilators.’ Really? What am I going to do with 400 ventilators when I need 30,000? You pick the 26,000 who are going to die because you only sent 400 ventilators.” Several days ago Mayor Bill de Blasio warned that New York City was just 10 days away from massive shortages of critical supplies.

Trump’s promises are so far empty—health workers haven’t seen any surge in equipment and the 500 million masks the federal government ordered this week, for example, may not be delivered for 18 months... Democracy Now! reports, “Michigan Governor Gretchen Whitmer said Monday a recent shipping of personal protective equipment, or PPE, from the national stockpile was barely enough to cover one shift at a hospital.”

Lisa Baum of NYSNA—New York State Nurses Association—told WNYC’s Brian Lehrer there’s a lot of double-talk from the Federal government on shipments of equipment—have they been shipped or not? Have they been shipped but not distributed? Nurses and medical personnel aren’t seeing any of it—a large amount of smoke and bullshit to make it seem like the Trump/Pence regime is taking bold action. Pence claims construction masks are perfectly acceptable to protect health care workers, but the nurses haven’t seen any delivered.

As of Thursday afternoon, hundreds of thousands of health care workers had signed an online petition demanding the government do more to ensure an adequate supply of masks and other protective equipment. New York State Nurses Association (@nysna) is tweeting #GetMePPE and the Nurses Association has a petition with demands here. The group has a more extensive bulletin on what’s needed.

Meanwhile, on Thursday, Trump told Fox News, “I don’t believe you need 40,000 or 30,000 ventilators. You know, you go into major hospitals, sometimes they’ll have two ventilators. And now, all of a sudden, they’re saying, ‘Can we order 30,000 ventilators?’”

Life-threatening shortages of personal protective equipment (PPE): Health care workers are suffering from a dire lack of PPE—masks, especially N95 masks (“the only proven prevention in terms of masks for health care workers”), face shields, gowns, potentially even gloves (the factory in Malaysia that makes them is cutting back production (“Key medical glove factories cut staff 50% during outbreak,” PBS, March 24). These are all criminally simple, cheap items to make!!

Health care workers are being forced to dangerously reuse protective equipment rather than throw it away, potentially spreading the disease; others are trying to improvise protective equipment. Meanwhile the regime is gutting well established medical standards for worker and patient safety and health by weakening regulations protecting health care workers, lying about the delivery of supplies, and refusing to force the capitalists to mass produce what’s needed.

A few of many, many examples, from Politico and other publications:

Guidance from the Centers for Disease Control and Prevention released Monday that bluntly acknowledged the [equipment] shortages ... health care workers tell POLITICO they consider [the guidance] dangerous, includes reusing respirator masks between different patient visits, using masks that have passed their expiration date, and even constructing “homemade” masks out of a bandanna or scarf. (Some are told to use N95 masks for a week when they’re supposed to replace after every high-risk patient.)

With medical workers already getting sick and dying from the disease in Washington state and other coronavirus hot spots, health care workers tell POLITICO they’re terrified for themselves and their patients.

“It’s the scariest thing about going to work every day,” said Sean Petty, a pediatric ER nurse and member of the New York State Nurses Association. Petty told POLITICO that his public sector hospital in the Bronx implemented what he described as “extreme rationing” of masks this week. (Politico, March 19; “Medical staff describe shortages and rationing of masks as White House assures they’re available ‘now’”)

Health workers are foraging for equipment, and people are forced to turn to unproven, unsafe attempts at makeshift cleaning of respirators. There are stories of people making “masks” of coffee filters and vacuum cleaner bags or attempting to “sterilize” them by freezing, all non-scientific means. “Hospital Workers in Washington state Produce DIY Masks as Medical Supplies Dwindle,” was one headline on Democracy Now! In wealthy Marin County [California], they don’t have enough gear, so one school district scoured its science classes for goggles and donated them to a nearby and newer Kaiser medical center—that day they were texted the goggles were in use. One doctor in another area reported getting goggles, face masks, and shields at Home Depot. Others are buying supplies on the black market. There are shortages of gowns, doctors re-using masks, keeping them in paper bags.

Health care workers report they often can’t even get tested themselves unless they are very ill, and/or are being told to work as long as they’re asymptomatic. Lisa Baum, occupational health and safety representative for the New York State Nurses Association, said on Monday’s Brian Lehrer Show that previously health care workers exposed to COVID-19 who didn’t have full PPE had to quarantine 14 days, but the Centers for Disease Control (CDC) “turned on a dime” and now if medical workers don’t have symptoms they can continue working—putting them back in the hospital to infect co-workers and patients.

• There’s potential for health workers to turn into disease vectors—both by being gone from work if ill, or those at work spreading the disease.
• There aren’t enough healthcare workers (they’re trying to bring people out of retirement, graduate medical students earlier to join the battle, and other measures)
• Cleaning staff as well as home health workers who care for some of the most at risk and elderly people are also at grave risk ABC reports in Pennsylvania.

Endangering health workers is unnecessary! Atul Gawande has done a New Yorker piece on how health workers can be protected, as aggressive measures are taken to halt the spread of the virus, drawing from very specific lessons he sees from Hong Kong, Singapore, and South Korea. (Interview with him on PBS, March 23). On Democracy Now! nurse Sean Petty cites the example of China: “They imported 42,000 healthcare workers to help with the crisis, they outfitted them with N95 masks and full protective equipment, personal protective equipment... And they achieved an unbelievable zero out of 42,000 infection-noninfection rate.” So this CAN be done, even before a vaccine is created, etc.

As the disease surges these problems are going to become far more acute and self-reinforcing. There’s a terrible dialectic between the situation of healthcare workers and the vast shortages of things like test kits, ventilators, even collection swabs, viral transport vessels, because the lack of kits means health workers can’t get tested and quarantined—and now the CDC is changing the criteria for sending them home—and the lack of enough ventilators means more people will be sicker and die, putting health workers at risk and forcing them to attempt other, less safe, measures.

Warning signs from Europe: The New York Times, “Virus Knocks Thousands of Health Workers Out of Action in Europe”:

The thinning ranks of doctors and nurses, particularly in Spain, are hampering the ability to fight the epidemic, straining hospitals and raising fears that health workers are spreading the coronavirus.... Out of Spain’s 40,000 confirmed coronavirus cases, 5,400—nearly 14 percent—are medical professionals, the health ministry said on Tuesday. No other country has reported health care staff accounting for a double-digit percentage of total infections.... But the problem is widespread throughout Europe. In Italy, France, and Spain, more than 30 health care professionals have died of the coronavirus, and thousands of others have had to self-isolate.... As doctors, nurses and other practitioners fall sick, the burdens increase on health care systems already groaning under the strain of an expanding epidemic. And infected workers and their hospitals are increasingly being recognized as vectors for the spread of the virus.... Spain also did not shore up its stock of medical equipment early on. Doctors and nurses have had to work with a dangerous shortage of masks, gloves and other essential gear that has proved disastrous for them.

Meanwhile Trump has ignored and continues to ignore these and other danger signals while he cheerfully—even buoyantly—talks of what a great job he and his regime are doing as infections soar to #1 in the world and people die in emergency rooms.

The Atlantic, in “What Happens If Health-Care Workers Stop Showing Up?,” warns that unless the country does dramatically more to provide health workers with the equipment they need to do their job safely, many may fear to come to work.

 

Other Sources:

“What doctors are seeing in emergency departments across the country,” PBS, March 23

“Hope Is Not a Strategy”: Emergency Doctor Asks, Where Are COVID-19 Tests? Where Is Protective Gear?” Democracy Now!, March 23, 2020

Nurse in Seattle: “Seattle Nurses Scrounge For Masks To Stay Safe On Pandemic’s Front Lines” (Kaiser Health News, March 23, 2020)

New York Post article by a nurse in Manhattan: “NYC nurse reveals what it’s like on front lines of coronavirus fight” (March 23, 2020)

Article on nurses, doctors in Baton Rouge area: “Louisiana doctors, nurses grow desperate for protective gear, fear they’re infecting patients” (Advocate, March 19, 2020)

This article is not about coronavirus per se, but does indicate some of what health professionals face in particularly backward areas: “A Call to Arms: Under Attack, Pro-Vaccine Doctors Fight Back” (New York Times, March 10, 2020)

The situation facing many rural hospitals: “Rural Texas hospitals should be staffing up to face coronavirus. Many can’t afford to.” (Texas Tribune, March 24, 2020)

Brief stories from several nurses: “10+ Nurses Share Their Experiences/Stories About Coronavirus (COVID-19)” (Thought Catalog, March 24, 2020)

Nurse in Los Angeles denied testing by her own hospital after she was exposed: “An ER nurse told us she was exposed to the coronavirus and has symptoms but still can't get tested, and it highlights both America's crippling inequality and its broken healthcare system” (Business Insider, March 20, 2020)

With shortage of protective gear, nurses at Elmhurst Hospital wear trash bags for protection. (Photo: NYPost video screengrab)

At Elmhurst Hospital in Queens, New York, medical personnel examine and treat patients in make-shift tents because of the surge of people ill with COVID-19. Photo: AP

From The RNL Show — Revolution, Nothing Less!
An interview by host Andy Zee with Dr. Phil Rice about the COVID-19 Pandemic

People wait in line to get into Elmhurst Hospital in Queens, New York, last week. The people who run this system knew in advance that something like the coronavirus pandemic could happen anytime. But they did nothing, because of the nature of their system. Photo: AP

Communique #4 from the Revcoms