The recently fashionable practice of hooting and clapping from the windows of Brooklyn, NY round about sunset ostensibly demonstrates popular appreciation for Healthcare Workers and others actively caring for patients afflicted by Covid-19.
Yet, that appreciation seems to be absent from institutional and major media organizations when the same health professionals try to inform us about serious harm being done as a direct consequence of the “War on Covid-19”.
I wish to make the well known point here that medical practice at the most elite and organized institutional level is vulnerable to errors in clinical management when hasty or misguided judgements are made under pressure during emergency situations. When the demeanor of healthcare organizations radically changes from disciplined to unnerved as has happened in the case of the recent pandemic, then large scale mistakes in both diagnosis and treatment will be made and the consequences unfortunately include excess mortality that is due not only to the emergency itself but due to the overzealous mass reaction.
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A uniquely synchronous and methodically alarmist global public-health warning of the outbreak and spread of SARS-COV-2 was amplified by a sensationalist media and by officials at all levels of government. The response of the general public as well as doctors, hospitals, nursing homes and their administrators was nothing but predictable. In past epidemics, and even during non-epidemic periods, hospitals have experienced actual shortages of personnel and equipment when tightly imposed staff and bed limits confronted seasonal fluctuations in illness. The recent and needlessly prolonged health delivery fiasco is certainly beyond any institutional disaster that I have experienced in my 40 years of medical practice in NYC.
I suggest that part of the evident calamity resembles what happens when someone screams “FIRE!” in a crowded theater. It is indisputable that a deadly stampede of terrified groups of patients resulted in hospitals being overwhelmed. For many years chronic care facilities have been known by ER staff to be apt to send their long-term care patients to local emergency rooms when they would complain of slight symptoms. Under the terror of Covid-19, many such facilities emptied their beds as fast as ambulettes could pick up and transfer their patients to local hospitals for evaluation.
In the ambulatory care realm there has been a dearth of physicians and dentists available to render routine or primary care. Their patients have thus sought care in ERs and urgent care facilities though the latter are curiously underwhelmed since early April when the number of new cases was evidently fewer and patients were self isolating or just avoiding contact with medical providers altogether out of fear of contagion. Civil servants, NYPD, healthcare and transit workers and others were not immune to the fear and were either ordered by superiors or rushed of their own accord to seek diagnostic testing or treatment whether they were symptomatic or not.
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As a result, hospitals were less able to deal effectively with the most seriously afflicted ARDS patients and thus adopted broad uniform policies and procedures that were injudiciously applied. There are many examples of this maladaptive response, with the misapplication of mechanical ventilation being one example that has been highlighted by physicians and nurses working in ICUs in NYC. Other horrifying incidents have been reported to me by nursing home workers who have observed patients literally starved for food and water due to fearful and inadequate staff and neglect of feeding.
The curious institutional response to these dedicated individual professionals who try to shed constructive light on the problems at hand is to silence or remove them. Personal acquaintences and professional colleagues have been threatened with summary termination by NYU Langone Brooklyn Hospital if they discuss shortages of masks, gowns and other equipment with news media.
The tactic of professional censure and intimidation is not new in 2020. In late summer of 2009 Lutheran Medical Center (which was soon to be taken over by NYU Langone) issued an ultimatum to all hospital staff that required Doctors and Nurses to take a new swine flu pandemic H1N1 vaccine before it had completed phase three clinical trials, or be summarily terminated. Many nurses and doctors were opposed to this mandate but rolled up their sleeves for fear of losing their jobs. See this.
The statewide mandate was temporarily restrained by court order and ultimately withdrawn after the UFT nurses union mounted a legal challenge to the NYS Health Department.
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NYU Langone consummated it’s purchase of Lutheran Medical Center in 2015 and shortly thereafter disbanded the community Institutional Review Board, the hospital’s ethics committee and revoked it’s longstanding medical staff bylaws in the course of its’ “partnership” with the 130 year old Brooklyn institution. An NYU Langone Hospital mandatory policy of annual influenza vaccination for all staff was ordered by Dr. Robert Grossman (dean and CEO since 2007) who gave a speech in which he scoffed at the utility or effectiveness of surgical masks worn during Flu season in lieu of healthcare worker vaccination. In an open letter to the CEO I outlined the lack of evidence for any benefit accruing to patients from this new mandate which even exceeded CDC healthcare worker guidelines at the time. The not unexpected response was summary termination of my admitting privileges and EMR access at the hospital where I had served for 35 years as a family doctor. The casualties of that termination were the many patients whose in-hospital care I could no longer supervise, coordinate or even review.
It is becoming clearer that early official models of the lethality of Covid -19 were gross overestimates. The effects of systematized social lockdown and an induced health panic have reverberated through our medical systems and are causing attendant morbidity and mortality that is ongoing. A rational and humane health system should seek to encourage constructive voices from its’ front line workers during an emergency, not smother them.
