COVID-19 and The Future of Health Care in The United States
By Dr. Anuj R. Shah, Founder, Apex Heart and Vascular
ICUs face challenges in the COVID-19 pandemic. Here are 8 solutions for the future | Opinion
We knew this tsunami was coming our way. We kept looking at it and we could have done more to protect citizens of metropolitan New York. Can you imagine knowing you are going to war and not preparing? Or saying the war was fake news? This is what we were told by the media and politicians for weeks leading up to the start of this pandemic.
As an interventional cardiologist and vascular specialist working in New York and New Jersey ICUs during the pandemic, here are some of the top challenges I have encountered and some hopeful recommendations for the future to ensure we are never in this position again.
1. There was a disconnect between PPE supply and PPE demand. As surgeons, we are not trained in supply chain management. We are trained in cutting, fixing and healing. Supply chain-management is not what we signed up for. It should not be upon individual health care workers to buy medical supplies. Our time is better spent in the ER than it is on eBay trying to buy medical equipment. America does not have a reserve of PPE gear and our frontline healthcare workers are underprepared for this pandemic.
2. Health care workers need armor. If New York City and New Jersey are battlefields, then we must rely on our government to give us the armor we need to win this war. When I see health care workers dying from this fight against coronavirus, it is gut-wrenching. Some of them just didn’t get the protection they needed. Why should any of us be forced to touch a patient without protective gear? If we are potentially infected, it means we could be infecting patients.
3. Protect medical trainees. A central venous catheter — commonly called a central line — is essential for every intensive care unit patient. If a patient is coding, they require a central line. There are stories of hospitals all over the United States asking inexperienced hospital residents to insert central lines. These residents are in training. An attending physician is supposed to supervise residents, but the pandemic’s realities have apparently required residents to handle these procedures. I want to ensure that it never happens again and that we propose solutions to protect medical trainees from being put in this position.
4. Be consistent in public-facing communications. The Centers for Disease Control and Prevention changed their stance on N95 masks several times throughout the pandemic, causing chaos and confusion. That did not exactly instill trust. Would you want to intubate a patient in a pandemic wearing a scarf or a bandana?
5. Don’t make doctors choose between our jobs and our oath to practice medicine. While we took an oath in medicine, we are not trained for war. We took an oath to take care of patients, with the understanding that our government would take an oath to protect its workers. Please keep your promise to us.
6. Lead by example. There is no country that has a better defense than the U.S. Before the pandemic, I had the same level of confidence in our health care system. I am proud of the city and the health care we have in this country, and yet we have nothing to demonstrate that we are truly the world champion. This should be a country protecting our weakest and protecting our frontline workers and yet we are not.
7. Offer mental health resources for frontline healthcare workers post pandemic.This pandemic is leading to incredible levels of anxiety and stress for health care workers. Our family members are also stressed and anxious because we — and them by extension — are being exposed. Nobody wants to run away from their responsibility and health care workers want to go the extra mile, but we also don’t want to be responsible for potentially giving a deadly virus to the people we love.
8. Never put doctors in the position again where they have to make triage decisions because of a medication shortage. At the start of the pandemic, ICUs all over the country ran out of vital medications like Propofol and Precedex, which help keep intubated patients sedated. These shortages prompted colleagues to make tremendously difficult triage decisions. Luckily, these shortages abated. However, I want to make sure this never happens again.
Thank you to all of the nurses, therapists, transporters, technicians and trainees who have been on the front lines of this pandemic. This includes med-surg nurses, overnight ICU nurses, respiratory therapists, patient care technicians, ultrasound technicians, transporterss, security personnel and staff who have been catapulted into this war against COVID-19. All of you are the true heroes on the front line. It is critical that you receive the recognition you deserve as the ones on the frontline fighting this war. Thank you from the bottom of my heart. I appreciate you. And every cardiologist appreciates you.
Dr. Anuj Shah, MD is an interventional cardiologist and vascular specialist. He is a founder of Apex Heart and Vascular in New Jersey.