Unknown Pathogenic Agents: When Common Decency Is Better Than Nothing
The pandemic of COVID-19 is a challenging situation for every member of society; we all have our role to play in mitigating the mortality caused by the infection. Medical professionals are at the heart of our efforts to prevent a large number of our population from being lost to the virus. Simply, the U.S. health care system risks collapse as a result of COVID-19 and the actions of society as a whole are important in preventing an outcome that benefits no one. If collapse occurs, there will be no health care available for anyone, not just COVID-19 related cases.
As individuals who are not actively involved in clinical care, we must play our role to decrease the burden on overworked health care workers. Many ICUs were already operating at maximum capacity before the pandemic hit the U.S. and personal protective equipment (PPE) shortages were already present in many hospitals. Before exponential growth even started, many hospitals were already stretched to their limits, due to poor funding. In addition, health care workers are getting infected, having worse outcomes than patients, and still must work even while they are sick because there is nobody who is able to replace them. The burden on the family of health care workers is great, as they must decontaminate and isolate themselves after every shift. This is even more complicated in double health care worker households, where children may not be able to be cared or even see their parents for weeks on end.
Health care workers are risking their lives, compromising their family, and still dutifully going to work despite the risks and hazards. They don’t have to show up to work and they don’t have to risk their lives for us, but rather it is their desire and their professional responsibility. As a society, we must support them as it is the very least we owe them for their efforts. Your personal liberties are irrelevant when it comes to isolation; breaking isolation frivolously is tantamount to violence against the elderly, immunocompromised, those who had procedures scheduled that must be deferred (such as cancer patients receiving palliative surgery), as well as health care workers.
The best mechanism to help health care workers is to contain the spread of disease as much as possible. To do this, we need proper PPE that does not affect the hospital supply.I do not worry about my personal risk of hospitalization (which is about 2.4% for a 20-44 year old infected with COVID-19; this requires supplemental oxygen) or developing acute respiratory distress syndrome (which is about 0.05-0.11% for a 20-44 year old infected with COVID-19; this requires ICU care), but rather I am deeply scared of my potential to spread the disease as an asymptomatic carrier. To this end, I wear a cloth mask and gloves when I go to shop for groceries. Cloth masks are effective in containing viral particles emitted by the wearer; they are not as efficient or clean as disposable N95 masks, but those should be reserved for health care workers.The protection conferred by cloth masks is modest at best, but layering and ensuring decontamination can improve their efficacy.In addition, they make the wearer more aware of their face, preventing face touching. A pair of cotton gloves reserved for going out to the grocery store can minimize the contamination of surfaces in one’s car or house and the spread of the virus. Also, note that proper PPE removal is a must to avoid contaminating your hands and face. Ensure that no surfaces of the PPE that are exposed to the environment contact your skin or surfaces in your home.
The second best steps one can take are to improve personal hygiene and keep things clean within and around your household. Hand washing is effective, but as the pandemic grows, it will become prudent to take a shower after a grocery trip as well as wash your clothes or contain them in a designated area to prevent contaminating your home. It will become reasonable to wash store bought produce with soap. Shoes should be removed at the entrance and stored in an isolated area to prevent contamination of your living space. Further, storing delivered packages for a duration of time (24-48 hours) prior to opening would be adequate to minimize spread from delivery or warehouse workers (as of 3/24/2020, there has been one confirmed case of COVID-19 occurring in the Katy, TX Amazon warehouse).
Going outside should be rationed for essential activities, as you risk coming in contact with the virus and spreading it. The major mechanism of spreading COVID-19 is likely to be asymptomatic infection, in which those who are infected shed large amounts of virus but do not have obvious, if any, symptoms. To mitigate this risk, we must all act as if we were infected and assume that our actions have the capacity to spread the virus. Every person you come in contact with is connected to many more, and we cannot risk frivolous actions that endanger others.
Lastly, talk about hospitalization and death with your family. A former classmate of mine wrote an excellent article that was featured in the Washington post about this. Determining goals of care and identifying what life support measures should be utilized in your care is important. We need to face the real consideration that we might lose a family member or a loved one during this time. What level of permanent disability are you and your loved ones comfortable living with? What level of specialized intensive care would you want, eg, full code or are you DNR/DNI? Knowing the answers to these questions will enable better clinical decision making and help in processing the consequences of those decisions.
I plea that those who read this article do their best to support our health care workers and the people marginalized by the pandemic. We cannot let our health care system collapse nor can we forget the lessons this pandemic will teach us. The pandemic has unveiled a major problem in medical supply and hospital management: a lack of reserve capacity. It is now obvious that we cannot run our hospitals without surplus materials to accommodate disasters. Medicine needs more funding and should not be run for profit, as this will only lead to compromises in patient care and crisis response, as optimal immediate profit means jettisoning long term investments, such as reserve capacity.
Our lives are connected and our health is dependent on coordinated action as well as empathy for our fellow humans. Inaction and ambivalence will be our undoing, but simply considering the lives of others will make an impact. As Albert Camus has eloquently put it: “… there’s no question of heroism in all this. It’s a matter of common decency. That’s an idea which may make some people smile, but the only means of fighting a plague is common decency.” Only through compassion for our distant neighbor will we make it through this without watching our health care systems collapse. Let us do our best.
About the Author
Brian Iskra is a dual degree M.D./Ph.D. student in the South Texas Medical Scientist Training Program. To read an article about him, click here. The “Beyond The Bench” series features articles written by students and postdoctoral fellows at the Graduate School of Biomedical Sciences at The University of Texas Health Science Center San Antonio.