As emergency rules put social distancing measures in place in communities across the United States, doctors Aaron Kofman, M.D., and Alfonso Hernandez-Romieu, M.D., infectious disease fellows in the Department of Medicine at Emory University in Atlanta, wrote in Stat that these policies aren’t making their way into the healthcare system, where many of its staff, like the patients they are caring for, are at risk because of age or underlying conditions. Since there isn’t clear messaging, policies have differed from hospital to hospital, without continuity or consistency. Some institutions have taken “half-measures,” such as not placing its employees who are immunocompromised or pregnant on COVID-19 wards. Even precautions like this aren’t widespread, and at most institutions, at-risk healthcare workers are continuing to report on the frontlines.
While younger or middle-aged people are by no means escaping the virus unscathed, people who are older or immunocompromised are at increased risk of dying. For those working directly with COVID-19 infected patients, it can be a death sentence. The truth is medical workers are already vulnerable. Exhausted, overworked, stressed, and without adequate personal protective equipment (PPE), healthcare workers on the front lines have become disproportionately impacted by COVID-19. In some ways, this seems obvious. After all, they’re dealing with infected patients day in and day out, and the virus isn’t just in front of them but in their environment. Hospitals have become a source of infection, resulting in medical staff in Italy to implore their peers to explore telehealth, mobile care, and house visits. In other ways, it doesn’t initially make sense. Why would a healthy, young medical worker without underlying issues be more at risk than a similarly positioned person who is exposed to it in the general population? It’s because healthcare workers are exposed to more of the virus’ particles. In Spain, nearly 14% of confirmed cases are medical workers. Combine that with advancing age or underlying conditions, and it’s a frightening reality for many medical workers.
In the article, Dr. Kofman and Dr. Hernandez-Romieu call on healthcare systems to reorganize, shifting at-risk healthcare providers—people over the age of 60 and those with underlying conditions—away from direct care. These at-risk workers will continue to be vital during the pandemic, fighting the virus telephonically or virtually while younger healthcare staff “with more robust immune systems” transition to “clinical work in hospitals.” Veteran staff can still provide guidance to those workers on the frontlines through virtual rounds, looking at electronic medical records, and training colleagues on life-saving procedures like intubation.
Healthcare workers who are quarantined are already contributing similarly, virtually screening and evaluating patients who are symptomatic for COVID-19. Some institutions, like University Medical Center New Orleans, have also moved to video-equipped isolation rooms where doctors evaluate symptomatic patients from a distance, minimizing the number of staff in direct contact with patients with the virus.
Dr. Kofman and Dr. Hernandez-Romieu write that, as young physicians, they are willing to absorb the risk of putting themselves, instead of those who are vulnerable, on the front lines:
“…we understand that our risk is much lower than our mentors, teachers, and older or vulnerable colleagues. We are willing to absorb their risk. We could not forgive ourselves if we do not act now and down the road stand mute at the burials of physicians, nurses, physician assistants, and countless others who have turned us into the providers we are today.”
Of course, the PPE shortage remains an equally pressing matter that must go hand-in-hand with the reorganization Dr. Kofman and Dr. Hernandez-Romieu suggest, which is similarly putting all healthcare workers at risk of large particle exposure to COVID-19.