“Plagues are infrequent but constant, and they do not alter the conditions of mankind (everybody dies) but rather concentrate our misfortunes into moments where everyone thinks for a change that mortality is afoot.” – Albert Camus In Camus’ construct, there was no mass media or the internet, yet the fear of imminent death spread like wildfire in a parched California landscape. Nothing is as contagious as that type of fear, as stampedes illustrate. The COVID-induced fear of an individual’s imminent death from exposure is similar, and now fanned by the unprecedented gale force winds of media attention despite evidence that half of those infected by this virus are completely asymptomatic and the vast majority are suffering moderate symptoms not requiring medical care. Also, it is estimated that more than 99 percent of those infected will survive (especially if you include the non-tested asymptomatics). An infected individual’s actuarial risk of a COVID death is on the same order as dying from an accident. Constructive fear does have a role in focusing people’s attention on critical response to societal directives. Yet the constant body count, the horror in China, Italy, and NYC have entranced collective human consciousness and perhaps hijacked our social and economic endeavors. I do not ignore the strict need for personal hygiene, self-isolation when sick, and situational short term social distancing. Nor the tens of millions who will be infected, and the huge impact of serious illness, the totality of tens to perhaps a hundred thousand lives lost in the U.S., and the derivative suffering. It is staggering. I have also been reflecting (in my forced periods of inactivity) on some tangential observations. We are not now hearing much about the percentage of GDP devoted to health care, or the rapacious insurance and drug companies, wasteful hospitals, and rich doctors. We are forced to take time out from debating national health care plans. As Mike Tyson said, “Everyone has a plan until they get punched in the mouth.” One other thing made acutely conscious in this onslaught is the importance of doctors, nurses, other clinicians and first responders in particular (not to slight all the other “essential” workers needed to maintain basic social functions in this and non-medical urgencies). The critical importance of acute care specialists and hospitals, in an era where policy has been driving care into outpatient venues has been dramatically demonstrated. What has also been shown is the need for some degree of redundancy in our hospitals and workforce without it being deemed “waste.” The acceleration of telehealth by this crisis opens up a new day for primary health care access, but perhaps a recalibration for the role of primary care physicians as compared to physician extenders armed with evidence-based triage tools. This is not the Spanish flu of 1917/18, when we barely had medical schools, and health technology was inchoate. We have a superb workforce of dedicated professionals and excellent technology, now being challenged severely but at the same time highlighted and responding like never before, much more so than the novel flu winter pandemic of 2017-18, which infected an estimated 50 million Americans, killing 80,000. Our policy leaders and health care administrators are reminded that specialist expertise on the front lines is not just a commodity, but a critical asset, and an indispensable “means of production” in the health care industry – particularly when a crisis hits. That expertise needs reinforcement in an age when most doctors would not recommend the profession to their children, physician, and nurse “burnout” and moral hazards are being debated. Greater and more prominent place at the administrative leadership table for clinical leaders should be a goal, not just at times of crisis. Perhaps that will help forestall some future ones. It’s tempting to consciously or unconsciously exploit a crisis (as in “never let a good one go to waste”), whether it be the media looking for clicks and eyeballs, politicians scoring points, legislators adding pork to relief bills, experts seeking the limelight, business people protecting assets, or even writers like myself wanting an audience. What may really be needed at some point is a sober re-evaluation of the appropriate role for all of us in constructively weaving the collective socioeconomic fabric to its optimal use — knowing that mortality is afoot not just today, but at all times. Michael Brant-Zawadzki is a senior physician executive, and endowed chair, Pickup Family Neurosciences Institute, Hoag Hospital, Newport Beach, CA. The author’s opinions are his own and do not reflect those of his employer. Source
