Into the COVID fray again, or for the first time

https://mailchi.mp/45f15de483b9/the-weekly-gist-october-9-2020?e=d1e747d2d8

Addressing Workforce Needs for COVID-19 | University at Albany

While it sometimes seems like the coronavirus has been with us forever, it’s worth remembering that there are still parts of the country that are only now experiencing their first big spike in cases—that’s the nature of a “patchwork” pandemic working its way across a vast country.

One of our health system members in the Midwest, with whom we recently spent time, is in just this situation: they’re seeing their highest inpatient COVID census to date, just this month. As they shared with us, there are advantages and drawbacks to being a “late follower” on the epidemic curve. The good news is that they’re ready.

Back in March, like most systems, they stood up an “incident command center”, and began preparing for a wave of COVID patients, designating a floor of the hospital as a “hot zone”, creating negative pressure rooms, cross-training staff, developing treatment protocols, stockpiling protective equipment, and securing a pipeline of critical therapeutics and testing supplies. There was a moderate but manageable number of cases across the late spring and summer, but never to an extent that stressed the system.
 
Eventually, recognizing that they couldn’t ask their doctors, nurses, and administrators to stay on high alert indefinitely, they “stood down” to a more normal operational tempo, only to watch with dismay as the surrounding community seemingly forgot about the virus, and lessened precautions (masking, distancing, and so forth), wanting life to return to “normal”. And now, the post-Labor Day, post-return-to-school spike has arrived.

The challenge now is getting everyone, inside and outside the system, to stop talking about COVID in the past tense, as though they’ve already “gotten through it.” The preparations they’ve made are paying off now. Hospital operations continue to run smoothly even with a high COVID census, but the workforce is exhausted, and citizens aren’t stepping outside to bang gratefully on pots every night anymore.

Asking the team to return to war footing is no easy task, given the fatigue of the past seven months. A question looms: what is the trigger to restart “incident command”? As cases begin to increase again in some of the original COVID hot spots—New York, New England, the Pacific Northwest—healthcare leaders there will need to learn from the experiences of their colleagues in the newly-hit Midwest, about how to take an already virus-weary clinical workforce back onto the battlefield.

Melinda Gates: US coronavirus response ‘lacking leadership at the federal level’

https://finance.yahoo.com/news/us-coronavirus-response-lacks-leadership-at-the-federal-level-melinda-gates-151610533.html

Melinda Gates: US coronavirus response “lacks leadership at the ...

Philanthropist Melinda Gates on Thursday sharply criticized the U.S. response to the coronavirus outbreak, telling Yahoo Finance that the country is “lacking leadership at the federal level” and as a result has endured unnecessary deaths and economic pain.

“It’s highly distressing and disappointing,” says Gates, co-chair of the Bill and Melinda Gates Foundation, which she said has donated $300 million to organizations involved in the coronavirus response.

“To have 50 state-grown solutions is inefficient, it makes no sense, and it’s costing people their lives,” she adds.

President Donald Trump said on Tuesday “there’ll be more death” as states lift stay-at-home measures but has urged a path toward reopening the economy in order to blunt job loss and other damaging effects caused by the mandates.

The Trump administration has drawn criticism for what some consider a failure to adequately address the coronavirus outbreak in its early stages. Trump has repeatedly said “nobody” could have foreseen the pandemic though he reportedly received dire warnings as early as February.

“The lack of action is really causing harm and hurt unnecessarily in this country,” Gates says. “I’m incredibly disappointed to see that.”

The White House recently declined to take up guidelines written by the Centers for Disease Control and Prevention for how schools, restaurants, and other institutions can safely reopen, the Associated Press reported on Thursday.

The Trump administration did release a set of conditions for coronavirus containment that it recommends states meet before they reopen, including a 14-day downward trajectory in new cases or positive test rates. However, many states that remain short of that benchmark have started to reopen or will do it soon, among them Kentucky, Ohio, and Utah, the AP reported on Thursday.

On Friday, the monthly jobs report showed the U.S. economy cut 20.5 million payrolls in April, and the unemployment rate jumped to 14.7%.

The severity of economic pain is a direct result of inaction from the federal government, Gates said.

“It is impacting families now, because if we had a good testing and tracing system like Germany has, we would have started to reopen slowly more places in the economy, people wouldn’t be struggling so much to put a meal on their table,” says Gates, who released a book last year entitled “The Moment of Lift: How Empowering Women Changes the World.”

‘Difficult tension’ faced by parents at home

She said the U.S. must bolster its benefits for paid sick, medical, and family leave in order to mitigate some of the economic pain and reopen the economy, since some workers will return to their jobs while others will need to remain home to care for sick family members or children educated remotely.

Speaking with Yahoo Finance, she called on Congress to improve the paid sick and family leave expansion passed in March, which excluded many companies from the benefits requirements.

“Congress made a first step that is in one of the stimulus packages, they really did put in sick days and paid leave,” she says. “The problem is, it doesn’t go far enough.”

Moreover, she advocated for a nationwide paid medical and family leave plan — a proposal backed in part by both parties, though they differ sharply on the details.

The Republican-controlled Senate and Democrat-controlled House remain divided over an additional stimulus measure, while President Donald Trump has sought likely-polarizing tax cuts to be included in the bill, the New York Times reported on Wednesday.

Nevertheless, Gates said she is optimistic that Congress will enact paid medical and family leave.

“Congress is hearing about this difficult tension moms and dads — but particularly moms — are facing at home,” she says.

 

 

 

Truth dies in silence. Sadly, so do people.

Truth dies in silence. Sadly, so do people.

UNESCO launches “Truth Never Dies” campaign to tackle crimes ...

I have been writing columns for physicians for twenty years.  And year after year, I have had physicians say this: “I’m glad you said what you did. If I said it, I’d be fired.” There are variations on the theme, but they’re much the same.  Twenty years, and far more than 20 years, during which the alleged health care leaders in America have been routinely muzzled because they aren’t supposed to speak the truth.  Open discussions shut down because they might embarrass someone or upset an administrator. Because it might, heaven forbid, shine a light on a genuine problem.

Some years ago, as the mental health crisis was gathering steam across the emergency departments of the land, I was contacted by a news show in France.  The producers wanted to come to South Carolina and follow me on some shifts in my ED. They wanted to see how mental health was working out here. “We have socialized care, but mental health is also a huge problem in our country,” the producer said.

I dutifully, and appropriately, went to administration. “No, we can’t do that,” I was informed. I was given this explanation when everyone knew the mental health system was at the breaking point: “What if they uncover a problem?” Here was a chance for publicity, for potential grant money or to demonstrate that a political solution was in order.  How dare we let in fresh air? How dare we suggest that things were not perfect?

The same thing is happening in the midst of the pandemic.  Physicians, nurses, and other assorted health care professionals are being threatened for wearing masks.  Administrators say, “They make the patients nervous.” Also likely, administrators have realized they don’t have adequate equipment.  Facilities and systems with enormous budgets caught unprepared in a pandemic.

I see the stories of these professionals as I follow online forums.  Physicians, nurses, and others, threatened with firing because they dared to speak out on the issue of PPE (personal protective equipment).

Like police officers without ballistic vests, these physicians don’t want to go into the rooms of COVID-19 patients without the masks and respirators, gloves, gowns, and face shields that will keep them safe. The equipment that will allow them to return home to their loved ones and prevent them from infecting their families.  This isn’t a good look.  A hospital that refuses to acknowledge the concerns and safety of its professionals is a hospital that ultimately doesn’t deserve them.

The same veil of silence pervades dialogue on the treatment of coronavirus.  When I follow discussions, I see a lot of shaming. “There just isn’t enough evidence to try hydroxychloroquine, Zithromax, convalescent plasma, an untried vaccine, HIV drugs, etc.” Those who suggest we might try are considered reckless or ignorant.  As the battle rages and lives are lost, innovation and risk are viewed with disdain.  And our medical establishment is locked into the paradigm of double-blinded, placebo-controlled studies involving tens of thousands of people and lasting years. Here’s a view of the same from the U.K. Unfortunately, to suggest that we may need to react faster is only met with ridicule, and often tied to political views instead of expediency. Worse,  it ignores the deep, fundamental need to offer hope, any hope, to hundreds of millions of professionals and citizens who are living in fear.

There is a tragic irony here; a painful coincidence.  Physicians silenced. Let’s see.  Where did we see that sort of thing resulting in a worldwide pandemic?  Does China come to mind? The Chinese Communist Party threatened (and who knows what else) physicians who dared to speak out about coronavirus, even when they knew its danger.  Even when they knew how easily and widely it spread.

They continued to soft-peddle numbers about total cases and case fatality.  The party continued to allow travel to and from China long after the problem was known. They even suggested that Italians have a “hug a Chinese person” campaign to combat alleged racism; a charge delightfully accepted and repeated by gullible Western journalists in pursuit of a narrative.

Truth dies in silence.  Sadly, so do people.  And certainly when we tell dedicated health care professionals to keep their mouths shut when they have identified problems, offered solutions and simply asked for help.  Whether it’s a private business, a totalitarian government, or anything in between, we should insist that the truth be spoken; freely and without fear of punishment.

Because, for the foreseeable future, lives will depend on it.