Early in the pandemic, the slogan was “14 days to flatten the curve” with the objective of preserving the health care system and ensuring that it was not crushed beneath a tsunami of COVID infections. The strategy has largely worked, keeping cases below a level that would have resulted in a catastrophic overloading of the nation’s hospitals.
According to some commentators, relative success in protecting the nation’s health care capacity means we can get back to something like our pre-COVID normal. Most of the data say otherwise. Dr. Anthony Fauci said in early August that we need to be at around 10,000 new infections daily by September or “we’re going to have a really bad situation in the fall”—but now, in mid-October, at around four times that number and racking up over 700 deaths per day. New York state has reached 1,000 infections per day for the first time since June. Boston just announced a pause in its school opening as positive COVID test rates jumped to 4 percent. Smaller states, like North Dakota, are already struggling to find enough ICU beds to care for critically ill patients.
Most of the modeling platforms suggest that within the next few months, we can expect an additional 100,000 COVID fatalities. The highly regarded University of Washington model estimates we will see between 100,000 and 245,000 additional deaths between now and January 1 depending on whether social-distancing policy is maintained or substantially relaxed. We’re still deep in the woods, and the only conceivable way out is widespread deployment of an effective vaccine, which is still months away.
In the meantime, these figures suggest that the “healthcare system”—a depersonalizing phrase that obscures what it means to describe—has its work cut out for it over the next six months. The teams of highly skilled physicians, nurses, and technicians that constitute the “system” are not machines but flesh-and-blood people. They have been conditioned by years of training and practice for workplace resiliency but they still have limits.
Earlier this year, hospitals in urban areas across the United States were close to being overwhelmed. From springtime horror stories in New York to summertime despair in Florida, Texas, and California, what we saw were hospitals so overtaxed that heroic efforts by physicians, nurses, and hospital staff were required to meet patient needs. It is estimated that over 1,000 U.S. healthcare workers have died of COVID, many of them working in primary-care settings where PPE has been in especially scant supply. When we say we have successfully protected the system, what we really mean is that these highly trained professionals and support staff have lost coworkers and colleagues but mostly survived to fight another day.
The figures on infections and deaths among health care workers tell only a small part of the story of how they have been affected by COVID-19’s extreme demands. In hard-hit urban areas, where our largest and most sophisticated hospitals are located, physicians and nurses spent much of the last nine months on what amounts to a war footing. In an interview with WBUR in Boston, Jack Hammond, a retired brigadier general who leads care for veterans with PTSD and head injuries at Massachusetts General Hospital, compared the stress of caring for large numbers of COVID-19 patients with working conditions in military hospitals in Iraq and Afghanistan. The wounds, he says, are not visible but they are real—manifesting in anxiety, depression, sleep problems, and feelings of despair. The most thorough research to date on the health workforce impacts of COVID comes from a recent study of health care providers in Wuhan which found more than 80 percent of medical and nursing staff had accessed counseling or psychotherapy as a result of their experiences during the outbreak. This is the battered healthcare army we may be about to throw into the teeth of the next wave of COVID-19.
The pandemic has thrust irreconcilable priorities on the entire country. Our children and college students need in-person education—but sending them to school is likely to accelerate transmission. Our largely service-based economy is in extremis—but reopening bars, restaurants, and hotels is an invitation to disaster. Our health care workforce has performed miracles on our behalf—but the people that make it up are, in many cases, exhausted.
Lockdowns, masking, and social distancing are expensive and have become tedious but other policy choices—like inadequate testing and virtually nonexistent contact tracing—have left us with few other options to help us bridge to vaccines and therapeutics. If we want to protect our health workforce, and by extension our own health, we will have to flatten the curve. Again.