2020, Guest Post, healthcare — April 5, 2020 at 8:48 am

I’m an ER doc. Here’s how Trump’s catastrophic failures endanger health workers and patients.


Today’s post was written by Dr. Rob Davidson, executive director of the Committee to Protect Medicare. Dr. Davidson got national attention recently when he confronted Vice President Mike Pence over the Trump administration’s attacks on healthcare, particularly Medicaid:

Dr. Davidson’s experience as an emergency room doctor gives him a unique perspective on the danger the Trump administration’s failed response to the coronavirus pandemic represents to the citizens of America.

As an emergency physician working in rural Michigan, I see dozens of patients every overnight shift. Every day, more of them show up with symptoms consistent with COVID-19, the pandemic that has turned our lives upside down. I test the ones with the most distressing symptoms. First responders and pregnant women get tested. But I can’t test everyone because though mass testing is the best way to trace and contain this novel coronavirus, the United States doesn’t have enough tests for everyone, not by a long shot. So, patients with relatively mild symptoms, we send home, ask them to self-quarantine and hope we don’t see them anytime soon, laboring to breathe and in respiratory distress.

The chain of incompetence, misinformation and mismanagement that is needlessly putting countless Americans at risk of COVID-19 links directly to President Trump. No matter how many times he tries to avoid responsibility, President Trump is culpable for the failure to contain an outbreak that in just a few weeks has sickened more than 164,000 Americans and killed 3,700 people.

Trump failed to prepare the United States even as he was given repeated warnings from January 2017 through early 2020 about a coming pandemic that would devastate lives and wreck the global economy. The Trump Administration refused to deploy mass testing for COVID-19, a critical step in better understanding the spread of the virus. Eight weeks after the first patient tested positive, the United States could test only 55,000 people. In comparison, South Korea tested 287,000 people in the same time frame. Where South Korea bent the curve, America has the hockey stick graph.

Trump’s failures directly affect frontline staff, from doctors and nurses to lab techs and the custodians who clean patient rooms. We desperately need N95 masks and other protective equipment, which are the only things that stand between health workers and a virus that’s 10 times more lethal than the flu. Yet a new report shows that Trump cut the budget for the national stockpile of respirator masks and other protective supplies by 75 percent, and he ignored recommendations to build that stockpile in late 2019.

Because Trump didn’t act with the urgency the moment required, my colleagues at our hospital and I must now carefully store our masks in a bag at the end of our shift and reuse them for as long as possible, even though health experts warn against reusing N95 masks because pathogens trapped in the filter over time could potentially infect the user.

If I or a member of my emergency team gets sick, we can’t be where we’re needed most: in our hospital treating patients. Failing to protect health workers during a pandemic also fails the patients who turn to us for help and treatment.

In addition to fewer health workers to care for more very sick patients, hospitals don’t have enough ventilators.

Ventilators help people with failing lungs breathe. These complex machines push oxygenated air into the lungs at positive pressure. It then displaces fluid from the pulmonary alveoli, which enables the exchange of oxygen and carbon dioxide to and from the bloodstream. The ventilators require staff trained to operate pressure and volume settings, and squeeze the ventilator bags for days. For patients whose lungs don’t work, the absence of a ventilator — and staff to operate them — means the heart stops beating and circulation ceases. The patient typically dies within minutes.

By some estimates, the nation needs 1 million ventilators for this pandemic. The nationwide supply is about 160,000, 200,000 tops. Had Trump acted sooner to mobilize U.S. manufacturers through the Defense Production Act instead of dragging his feet, hospitals would have received those much-needed ventilators in April, before the expected peak of COVID-19 in hard-hit states like New York, Michigan and Louisiana. Instead, even under rosy scenarios, those ventilators might not arrive until June, too late for countless Americans who could die of respiratory failure.

In the leadership vacuum that has left us scrambling for ventilators, hospitals and staff are exploring what else we can use besides actual ventilators. Some are considering using one ventilator for two patients. Some have thought of using anesthesia machines as ventilators. Theories have even been raised that CPAPs — typically used to treat apnea — are possible alternatives in the most desperate situations. (They’re not.) A pandemic is not the time to jerry-rig breathing machines.

The shortages in ventilators and N95 masks are intertwined. Both speak to the enormous risks patients and health workers now face. As more serious COVID-19 cases present at our hospitals, health workers will find themselves rushing as a team to care for one patient after another. That team might consist of a physician as a team leader, another physician to help intubate the patient, a respiratory therapist to manage the patient’s airways, a nurse to provide medications, and one or two health workers to assist with compression. Six people, all likely with used N95 masks, repeatedly entering an environment that increases their risk of infection.

Without enough ventilators and critical supplies, doctors will soon have to tell patients they lack the equipment they need to save that patient’s life. In my 20-plus career as an emergency physician, I’ve only had to do that once, in Haiti, right after the 2010 earthquake that killed 250,000 people and injured 300,000 more. Haiti is the poorest country in the Western Hemisphere. The United States is not Haiti — not until that heart wrenching moment when doctors will have to look patients in the eye and tell them we can’t save them because we don’t have the equipment.

I have no doubt that my brothers and sisters in medicine and healthcare will rise to the occasion. Many of us are putting themselves in harm’s way time and time again. We’re doing our job. We just wish President Trump did his.

Dr. Rob Davidson and the CTP are spearheading a sign-on letter that demands three specific strategies from the Trump Administration. CTP members include hundreds of doctors in more than 40 states. Find CTP on Facebook. Dr. Davidson is on Twitter @DrRobDavidson.

[CC Trump image by Gage Skidmore | Wikimedia Commons]