Something has got to be done...
about our current medical disaster and the ones to come
I used to hear that a lot in the early years of my career. ‘Doc, something has GOT to be done!’ Back then I was in a busy, semi-rural community hospital emergency department. Folks would show up at 3 am with problems that had plagued and vexed them for months to years. Occasionally decades. ‘Doctor Leap, the thing is, it all began back in ‘Nam.’ It might have been a headache that had been worked up by every imaginable expert. It might have been a rash, or often as not, back pain. Sometimes it was shortness of breath. At any rate, they were fed up and ready for a solution.
Occasionally, they were right. That chest pain was coming from heart disease. Or that headache was from an aneurysm or tumor. That’s the tough thing; sorting out what’s an emergency and what’s an annoyance. It takes quite a few years of medical practice to know how to sift through that sort of thing with compassion and a hint of suspicion. (Since no small number of those complaints were capped off with, ‘if I could just get some Dilaudid or Percocet, you see, since my pain specialist is in Thailand this week…’)
What was often the case was that the thing for which ‘something had to be done’ was a thing which could have been prevented. The heart disease might not have developed without smoking and obesity. The toothache could have been prevented with flossing and brushing; and the occasional visit to the dentist. The list goes on.
It doesn’t make those things less real to patients. Any physician who dismisses the pain of toothache has lived a sweet, sheltered life. Toothaches hurt…a lot. I’ve had a few and I’d rank them up there near kidney stones in misery. Still, there would have been less suffering with more preparation and forethought. That’s the human condition though, right? We don’t think ahead about things. Whether it’s our relationships or our bad habits, we tend to live right now. This is especially true in the modern West where we have the luxury of putting things off until they become a crisis, and then demanding to know why the crisis can’t be fixed right now.
Fast forward to ‘the Vid,’ aka ‘the Rona.’ My place of employ, Tiny Memorial Hospital, is overrun. I worked during the storm as I mentioned on my VERY FIRST EVER post on Substack.
I love working during weather. (I know, it’s kind of weird but it’s how I am). We had insufficient beds, no ICU and no other hospital which would accept our patients in transfer. To add salt to the wound, gasoline to the fire, insult to injury, we couldn’t have transferred anyone because EMS was not able to go out in the ice and snow and take long transports. Obviously, helicopters don’t do well in such weather either.
The painfully simple explanation for all of this is a gross over-simplification. ‘Well, if people would just get vaccinated then none of this would be an issue. The pandemic of the un-vaccinated is causing all of the misery.’
While I’m absolutely pro-vaccination, the issue is far more complicated. Just as my chronic abdominal pain patient says ‘something has got to be done about my ten years of pain,’ our country is crying out ‘the problem will be totally solved with vaccination so let’s fix it all now.’
I’ve written about this before. The column linked below is from 2018.
During the 2017-18 flu season, ICU beds were at capacity and emergency departments were overwhelmed. Flu vaccines were available but participation was about 37% in adults, per the CDC data I found.
When it passed, we kind of forgot about it. There were about 710,000 flu related hospitalizations and 52,000 flu related deaths. Sure, those numbers don’t come close to the devastation of COVID. But we’ve had bad years like that before. And once it passed, it was back to business as usual.
I used to say to colleagues that we were ever on the razor’s edge of disaster in American hospitals. I was right.
What could we have done? Well, more research on how to rapidly develop vaccines would have been useful. We need to be able to do this really quickly. The COVID vaccine was an incredible scientific achievement. Institutions should be in place that constantly have the machinery and staff to start the process at any given time. This should be one of the absolute top priorities of the CDC, every single day.
We could also have built more hospital beds and ICU’s. We function on the deluded idea that our preparation for disaster tracks nicely with profit margins for hospital systems. That is, it doesn’t make sense to spend money on beds we won’t occupy, since after all, what could happen? We know now what could happen. And we just blame COVID. And (yawn) the un-vaccinated.
Staffing would have been helpful. Rather than bare-bones staffing, exhausting nurses and expecting miracles, we could have over-staffed. Ditto for physicians who have also been worn down by the pandemic.
Instead of having barely enough ambulances and paramedics, we could have purchased more trucks, trained and prepared more medics. Maybe CEOs could have gotten by with million dollar salaries instead of multi-million. Just a thought. Crazy I know.
How about this? What if we had thought ‘someday we might have a huge pandemic, or meteor strike, earthquake or even war?' Maybe we should make our own protective gear and pharmaceuticals in the US?’ It would certainly create jobs and absolutely improve our strategic stability. It would have made COVID more manageable, for sure.
Instead, we let the tooth rot. We ignored the chest pain. We didn’t go to the doctor, or stop smoking, or prepare for what was absolutely going to happen eventually.
Even as our hospitals are struggling, even as my colleagues around the country make call after call after call to try and get care for the sick and dying, the truth is that we got off easy this time. Imagine if this disease had carried a 5% or 25% or 50% case fatality rate? Imagine if we had a massive solar flare or intentional EMP during the worst of this so that our electronics simply stopped working? What if this had been accompanied by an actual ‘shooting war?’ I’m surprised it didn’t happen. The US has ideological enemies. And there’s no better time to attack an enemy when said enemy is dealing with a pandemic. It’s a sobering thought.
Indeed, something has got to be done. But what mustn’t do is simply hope for this to pass, rest on our laurels and have parades in our ‘Front-line Hero’ t-shirts. I suspect we’re nearing the end of the worst, between vaccinations, therapeutics and the great biological gift of omicron variant. While I’m only a lowly clinician, I believe that immunity to COVID will continue to improve. I’m already seeing it in those who are vaccinated and have already had one run of the Vid. They now have head-colds and flu-like symptoms. The numbers of those I’m seeing who are critically ill is much lower.
There’s an old maxim in military circles that we perpetually fight the last war. Something has got to be done so that before we know it, we aren’t fighting the last pandemic.
And while vaccinations are great, there’s a whole lot more to be done.
We can only hope that history teaches us more than just that we don’t learn from history. The best lesson we had, imho, is that climate change is real, always was and always will. I like to think of it as the earth’s immune system and, …. And that elitists (political, academic, scientific, idle billionaires) with a god complex hobby playing with viruses and new/complex technology is by far a much more existential threat to humanity. Especially when you rely on an authoritarian government with documented disregard for human life to be ethical and non political Apparently we don’t learn from history very well. Don’t get me started on Marxism.