This essay was shared with me by its author with a request for it to be published anonymously. I have no professional affiliation with this individual. It has not been edited.

Across the country, physicians and healthcare workers are being dubbed “heroes” and thrust into the limelight in unprecedented ways while simultaneously being stabbed in the back at every turn.

Our government, through its inadequate preparation for this crisis, has failed us. This is true at the federal, state, and local levels. Despite seeing the need to organize a national response, and the many opportunities to do so post-911, we cannot manage to supply basic PPE to healthcare workers who will assuredly be exposed to COVID-19. Our president, concerned primarily with restarting the economy, has limited regard for American lives, and no interest in listening to the scientists and public health officials who have dedicated their careers trying to understand the best way to save people during pandemics.  Our executive branch, full of nepotism and cronyism, refuses to release stockpiled ventilators and PPE to states who desperately need it. Our Republican-led Senate is too cowardly to stand up to the President. In Missouri, our governor said that staying at home was a personal choice and a personal responsibility and delayed issuing an executive order for over a week while healthcare workers begged for it. In other states, governors are rushing to open their beaches and cities while thumbing their nose at the concept of physical distancing and the scientists promoting it.

Why have we not yet developed a test and deployed mass testing like other industrialized nations? Why do we insist on developing our own test? As a result, months into this crisis, we have yet to deploy mass testing, and we genuinely have no idea how many people are asymptomatic carriers, how many people have recovered, or what the case fatality rate is.  How can we make any epidemiological predictions if we do not have this information? That is right—we cannot. How is it that other industrialized nations are outfitting their front-line care givers in PAPRs and Tyvek suits, while I am getting a used N95 mask and throw away gown? Why does our president continue to insist on the use of medications for which there is no evidence of either safety or efficacy? This has resulted in very real consequences of people who actually need these medications not having access to them due to shortages, but this doesn’t seem to slow down our medically illiterate president from saying whatever he believes. 

I work in a health system that was similarly inadequately prepared to deal with this crisis and failed to take the necessary steps to prepare. Early in the crisis, when stories were coming out of hot spots like New York and Seattle that healthcare workers were running out of PPE, we continued with “business as usual” and treated everything like it was disposable. Now, we are given one mask that is UV sterilized for five total uses prior to disposal. Compared to other hospitals, we are incredibly lucky. However, it did not take a tremendous amount of foresight to see this as inevitable.

Never ones to miss a chance to take advantage of people, alternative medical practitioners are using this crisis to peddle their dangerous pseudoscience that spinal manipulation, essential oils, and herbs can magically protect you from getting sick. At the same time, nurse practitioners and physician assistants are using this crisis to promote their own agenda to gain full practice authority (rather than practice under the supervision of a physician) in multiple states. While this could be an essay unto itself, having someone with as little as 500 clinical hours of training (the minimum for some NP schools), compared to 20,000 hours for a physician, is laughable at best and dangerous at worst. While there is a great need for more health care workers in hotspots, nurses and nurse practitioners are being offered $10k+/week for their services. On the other hand, physicians are being asked to volunteer or potentially be drafted to go to these same places.

Due to social distancing (good job, keep up the good work), people are not getting as sick or injured, and they are staying away from the ER. As a result, ER visits across the country are at 25-33% of the usual volume, but I worry that people are not seeking care even when they need it. However, it is truly a slap in the face every time a person chooses to violate social distancing. You may be young and healthy and low risk for having complications from COVID-19. You may be unafraid of death. But your actions do not just affect you. If you contract coronavirus, you will certainly spread it. Who might you harm? An immunocompromised child? A grandparent? A health care worker who is disproportionately affected by this crisis?

Throughout my medical career, I have taken care of patients whose disease could possibly harm me—HIV, Hepatitis B and C, TB, meningitis, just to name a few. I have gone on medical missions to resource poor parts of the world. In all these instances, I had the PPE I needed to protect me, which is appropriate. Afterall, the Hippocratic Oath says, “primum, non nocere,” that is, “first, do no harm,” which includes not doing harm to myself or my family. It says nothing that would require me to take care of you without proper protection. Nothing that requires me to take care of you if your reckless behavior causes you to contract this disease. Perhaps before you join the picket lines, you can sign a waiver stating that you refuse care in the event you contract COVID-19 due to your own irresponsibility.

So here we are, cases appear to be peaking nationwide, and for the most part, the health care system has not been overwhelmed. But instead of listening to public health experts or taking a lesson from the influenza pandemic of 1918, there is a sudden rush to want to “normalize” and open up our country.  Despite the fact that there is inadequate testing, no way to do contact tracing, and a continued inadequate supply of PPE, there is an apparent rush to have a second peak that is worse than the first.  Have we learned nothing in the past month? Do we really want to repeat it?

So, thank you for calling me a hero. But hold the applause, I could use a hand pulling this knife out of my back.

Et tu, America?

Image by Luis Quiles