After five surges, and with vaccines and treatments widely available, it’s human nature to want to believe the job is done. In reality, our health-care system is in no better shape today than it was two years ago — and, in fact, it might be in worse condition.
Last week I received an email from my state’s Department of Health telling me that because Congress had not re-funded the White House’s requested covid response measures, there was no longer any coverage for testing, vaccines or treatment for uninsured Americans. That means 28 million Americans will have to pay for these resources on their own. Which means, of course, they’re more likely to end up sick and needing emergency care.
Have Americans really forgotten the early days of the pandemic, when we rallied to “flatten the curve” to preserve health care for the sick? What happened to that spirit? We need to renew our commitment to shore up our health infrastructure and invest in health-care workers, now.
The U.S. health-care system had plenty of problems before the pandemic, from overcrowding in emergency departments to insufficient mental health services. But never, in my 20 years of practice, have I seen the kind of dysfunction — day in and day out — currently afflicting providers and patients.
Recent surveys indicate that somewhere between 30 percent and 66 percent of nurses are considering leaving their profession because of pandemic-related stress. As many as 18 percent of health-care workers have already left the industry during the pandemic. In my own specialty, the proportion of emergency physicians reporting burnout has increased from 43 percent to 60 percent during the pandemic. Health-care workers also report increasing rates of depression and post-traumatic stress disorder. Workplace violence against health-care workers is rising. Instead of being hailed as “heroes,” we find ourselves questioned, underappreciated, abused and struggling to provide basic standards of care.
It’s important to state what should be obvious but bears repeating: This state of affairs is not the result of covid precautions. Rather, it is a result of the pandemic itself — the every-100-days surge in hospitalizations; the staff sicknesses and departures; the societal trauma. Staff are leaving health care not because of vaccine mandates but because they simply can’t take it anymore. Should more surges happen, the departures and dysfunction will only worsen.
The preventive measures that we in health care and the government put in place to reduce infections (lockdowns, briefly, when there was no other option; and then masks, ventilation, testing, vaccines, treatment) allowed a modicum of functioning during the worst months. But now, governmental resources are being removed. We will not have adequate supplies of treatments or vaccines, nor any surge capacity, if and when the next variant hits.
As cliche as it might be, health care starts with the people. To keep the staff who can take care of the people, we need a functioning system. Our health-care infrastructure should be a concern of national security. We need supply chains that work; staffing that is adequate not just during times of calm but also during moments of crisis; data systems that allow us to identify the surges before they overwhelm us; and a public health environment that not just preserves beds for emergencies but also allows us to prevent and treat disease and injury before they become a disaster.
We cannot count on troops or retired workers to fill the gaps. Nor can we continue to wait for another pandemic surge to solve well-known underlying structural constraints. We know how to do this; we have a playbook from other public health problems, from reducing car crash injuries to treating HIV/AIDS. Ignorance is not an excuse.
The health-care and public health system is just as vulnerable to covid as it has ever been. That’s a problem not just for covid patients but for anyone who walks through our doors. Yet, it appears, the country has moved on.
We must not forget the lessons from the early days of the pandemic. Change is possible. Let’s invest in health care and public health, now.