I’m an ER Doctor Here’s How the U.S. Needs to Prepare for the Next Pandemic

The clash of public health, politics and human frailty

As with any great horror movie, the coronavirus –or more specifically COVID-19– exhibits all the criteria for an excellent monster. It’s mysterious,strikes without any warning, and kills with indiscriminate devastation.

What makes the coronavirus worthy of any Stephen King novel is its mystery and ability to harm otherwise healthy people.  The other ingenious terror is that we do not know whether we are asymptomatic carriers of the beast. This sad reality allows us to bring the virus into our homes, our businesses and our schools. The monster often appears like a well-known acquaintance — the common cold —— all the signs and symptoms of a mundane virus — cough, sore throat, headache, muscle aches, and then it inexplicably ravages our lungs causing us to gasp eventually smothering us.

As an emergency physician, I not only have a front row seat to this horror show;  I get to be a bit character in the unfolding drama. At first many of us were optimistic that this would not reach our state, our community with the same dire consequences seen in China, Italy and Iran. We thought our American exceptionalism would protect us. The power of the federal government would be harnessed to test, prepare and protect the country from the devastation of this demon virus. This clearly did not happen.

I’ve developed a deep respect for this new adversary — this monster, this unseen foe. 

Last week I intubated my first COVID patient.  Typically, intubating a patient –putting a breathing tube through the vocal cords and into the lungs– is a relatively routine procedure.  I have the good fortune of working with a big team that makes this procedure effortless. However, in the time of COVID, these teams shrink to four people to minimize exposure and risk to others. The seamless communication in a normal intubation disappears as your ability to hear, speak and communicate is greatly diminished with PPE and the roar of a negative pressure room.  This is disorienting and distressing.

It is also deeply disturbing to see an otherwise healthy middle-age man have his ability to breathe so significantly compromised. It is profoundly unnerving.

Despite being in PPE with an N- 95 mask, face shield, gown and gloves, I felt naked.  This is considered a high risk procedure and exposes us to the potential of a large viral load which has been thought to be the cause of numerous healthcare worker deaths.

After the intubation, I wanted to dip myself in a vat of hand sanitizer. I left our resuscitation room and washed my hands, my neck and face with soap and water. I believe I even took hand sanitizer and wiped my neck down with it. I then began to wonder if washing my face was the right thing to do and did I just spread the virus all over my face. Next time I thought, I will wear the PAPR and look more like the astronaut I always wanted to be.

Yep – this monster scares us. 

This demon virus has taken away what we took for granted.  After the intubation of the COVID patient, I felt that my risk of exposing others to this virus was significant. I was afraid I was going to give this to my family, friends, neighbors and strangers at the grocery store.

I have now isolated myself and I am banished to solitary living.  I do not stay with my family. If I see my wife or family it is from a ’safe’ distance with an N-95 mask on. I no longer have lunch with my colleagues or spend time with my friends. All that social interaction and human connection that we all need and took for granted is gone. Love in the time of COVID is a new reality.  

The COVID-19 monster has revealed the weakness of our disaster preparedness and clearly demonstrates how important public health infrastructure is to our safety, security, prosperity and happiness.  By not investing in universal health care, paid sick leave, broadband, caches of PPE and ventilators, and COVID testing, we have inadvertently allowed the virus to spread effortlessly across the country wreaking havoc on our health, economy and future. Let’s not allow politics to get into the way of common sense because hundreds of thousands of Americans may die.

We will survive this pandemic.  However, there will be other pandemics and other threats to our security– climate change, cyberattack, bioterrorism, growing inequality and lack of social cohesion.  Tax cuts and dysfunctional government are not solutions to the real problems that we all face.  

It is time for investment in healthcare, public education, infrastructure, broadband and rational environmental policy.  These are common sense fundamentals that will protect all of us against the next monster. Like all good horror movies, when you think you have vanquished your demon, the monster returns.  Will we be ready?