The pandemic’s global toll has risen to hundreds of thousands of infections and thousands of deaths. The U.S. toll at the end of the third week in March, the New York Times reported, exceeded 21,000 infections and nearly 300 deaths, with 1 in 5 Americans also now living under tough restrictions that have shut non-essential businesses, schools, colleges and universities, restaurants, gyms and health clubs, and sports and cultural events.
In the throes of such calamitous circumstances, consider:
A viral comeuppance for partying young
The state of Florida and throngs of beach-going, partying young people on spring break inflamed sentiment around the globe, defying public health recommendations aimed at reducing Covid-19’s harms by halting large gatherings and limiting close human contact. Broadcast news media reports quoted young revelers saying they would not be denied their chance to be part of an annual ritual of fun in the sun, drinking heavily and pursuing heavy hormonal pursuit of recreational partners.
Ron DeSantis, Florida’s GOP governor, fought off critics’ calls for him to impose restrictions that governors in New York, California, and Illinois imposed on their residents to safeguard public health. Mayors in Florida beach cities also declined to act. Federal officials, however, began to push out increasing information showing that, contrary to some misperceptions, Covid-19 takes a toll not only on older patients with underlying health conditions but also more youthful targets, too.
The Centers for Disease Control and Prevention, as the New York Times reported, campaigned to inform the public that almost 40% of virus-related cases serious enough to require hospitalization were occurring among patients ages 20-50. Florida officials relented and shut down spring break, as well as the businesses and entertainments commonly closed across the country. News organizations also began popping out many new articles about Covid-19’s risks for the young, including how gruesome the infection can be, even for a youthful patient.
A fury about senators and ethics of their stock sales
Two U.S. senators created a political firestorm for themselves by sitting in on closed, top-level, classified briefings in late January and February on the exploding coronavirus pandemic, then selling off hundreds of thousands of dollars of their personal stock holdings before the markets plunged.
Richard Burr, the Republican chair of the Senate Intelligence Committee, also provided wealthy donors an exclusive preview of potential harms of the viral outbreak, even while publicly downplaying its risks and praising the nation’s readiness. He has asked Senate ethics officials to review his conduct, which may have involved share sales valued at as much as $1.72 million.
Kelly Loeffler, a new Republican senator from Georgia, also has pushed back at harsh criticism of her selling shares, also valued in the seven-figure range, just after receiving classified briefings on the coronavirus’ negative effects. She is married to the head of the New York Stock Exchange and has insisted that her financial advisor, without consulting her, arranged the controversial share sales. She also had publicly downplayed the virus’ threat. She had not reported stock transactions between her new year appointment to her Senate seat and the late January intelligence briefing, in which she sat next to Burr. Her stock sales, which eventually would include a subsequent investment in a firm that specializes in now important video conferencing technology, launched the day after her first virus briefing.
Other senators also have come under fire for their stock trading, though news reports have made less compelling cases about their dealings, often conducted by advisors running blind trusts. The furor, of course, puts Congress on the griddle yet again for failing to regulate its own ethics and practices, particularly with members holding stocks at all, including of companies whose business about which they may legislate.
Promises, promises — and emergency pleas for stiches in time
Despite President Trump’s relentless broadcast blandishments about how well his administration was getting desperately needed virus tests and medical, personal protective equipment (PPE) in production and out the door to doctors, clinics, labs, and hospitals, state and local politicians and health leaders put out dire calls for urgent help. Hospitals began pleading for those in their communities with sewing skills to please volunteer to stich together face masks. New York Gov. Andrew Cuomo not only made a similar PPE appeal, he heaped praise on a fashion designer who stepped forward to volunteer help. The Journal of the American Medical Association published an editorial, imploring readers to provide innovative ideas to address PPE shortages. Social media began to circulate photos and videos of medical personnel using glue guns, Styrofoam, and plastic to jerry-rig facial safety shields for doctors, nurses, and med techs.
The CDC outraged health workers by telling them they could, in a pinch, don scarves and bandanas on their faces to get minimal infection protection. The president baffled his own officials as well as public health officials with his confused discussions of whether he would invoke his powers under the Defense Production Act to get U.S. firms to step up the acquisition and production of PPE and other vital medical supplies, including ventilators. Chuck Schumer, the Senate Minority leader, reportedly lobbied Trump to stop talking about his powers and to use them immediately. News reports indicate that Trump paused during a phone call with Schumer to yell at aides to do so.
Dr. Anthony Fauci, the infectious disease expert from the National Institutes of Health who is serving on the president’s coronavirus task force, has told reporters that the U.S. has stockpiled 12,700 of the mechanical breathing devices — a number woefully short of anticipated need. As with virus tests — promised in the millions weeks ago — the president has insisted that his officials will secure needed supplies of the ventilators, including potentially by getting auto makers to convert plants they are closing to build the complex medical devices. Patients may be holding their breath over the failed pledge. And, by the way, those much promised Covid-19 tests? Their delivery still lags. Badly.
Breast augmentations and hip replacements still? Yup.
Even as hospitals nationwide found themselves overwhelmed while treating their regular patient loads plus the individuals with Covid-19 infections, other institutions persisted with routines that they found themselves forced to defend.
The independent, nonpartisan Kaiser Health News Service described the incongruency in northern California, for example, reporting: “In the same week that physicians at the University of California-San Francisco medical center were wiping down and reusing protective equipment like masks and gowns to conserve resources amid a surge of Covid-19 patients, 90 miles away teams of doctors at UC Davis Medical Center were fully suited up performing breast augmentations, hip replacements and other elective procedures that likely could have been postponed … in pockets of the country, some hospitals have continued to perform a range of elective procedures, spokespeople confirmed.
In Pennsylvania, the University of Pittsburgh Medical Center is continuing to offer elective procedures on a case-by-case basis. In Indiana and Illinois, Franciscan Health will continue some elective surgeries, depending on the availability of protective equipment and the concentration of Covid-19 cases in the area. And in California, Nebraska, Nevada and Wyoming, Banner Health will continue to offer elective procedures in communities that haven’t yet reported cases of Covid-19.”
As KHN reporter Jenny Gold noted of the nation’s decentralized health system, where decision making may occur hospital by hospital, “The divergent responses underscore not only the disparities in supply stockpiles from hospital to hospital, but also a lack of coordination — even at a regional level — in getting equipment and medical care where it’s needed.”
Patients may suffer due to glaring differences, notably geographic disparities in the close availability of intensive care for those with serious Covid-19 infections, KHN reported in a separate investigative piece. It found that “More than half the counties in America have no intensive care beds, posing a particular danger for more than 7 million people who are age 60 and up ― older patients who face the highest risk of serious illness or death from the rapid spread of Covid-19 … Intensive care units have sophisticated equipment, such as bedside machines to monitor a patient’s heart rate and ventilators to help them breathe. Even in communities with ICU beds, the numbers vary wildly ― with some having just one bed available for thousands of senior residents, according to the analysis based on a review of data hospitals report each year to the federal government.”
KHN further pointed out that the urban-rural gulf in health care may yawn wider — again, to patients’ detriment, with the news service headline summarizing the problem: Coronavirus Threatens The Lives Of Rural Hospitals Already Stretched To Breaking Point.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing complexity, uncertainty, and cost of medical therapies and prescription drugs, too many of which turn out to be dangerous drugs. The coronavirus pandemic is exposing long-existing problems in the U.S. health care system, whether in leadership, facilities and equipment, or capacity and practices. This is sad because for too long the glaring issues have not been addressed, and this crisis may see patients harmed as a result. We need to remember how people and institutions performed at peak demand — or failed to do so — because we may not have time during this crisis to deal with the challenges they created. We must do so, later. We have much work to do with a health system that has its own sicknesses.