As a psychiatrist, my role in COVID-19 has included that of a therapist for my colleagues. I helped start Physician Support Line, a peer-to-peer hotline for physicians staffed by more than 500 volunteer psychiatrists. Through the hotline and social media, physicians are revealing their emotional fatigue. One doctor shared her sense of powerlessness when she couldn’t provide comfort but instead had to watch her young patient with COVID-19 die alone from behind a glass window. Another shared his sorrow after his 72-year-old patient died by suicide. She was socially isolated and didn’t want to be a burden on anyone if she contracted COVID-19. An internist felt deep distress and alarm that her hospital was quickly running out of ventilators and had 12 codes in 24 hours.
Through a brief survey I
conducted across the U.S., 269 physicians reported moderate to severe symptoms
of anxiety (53%), depression (43%), and insomnia (16%). About 46% wanted to see
or would consider seeing a mental health clinician for severe anxiety (30%),
not feeling like themselves (27%), or being unhappy (21%). These are all similar statistics to
the front line health care workers in Wuhan.
While President Trump mulls whether to reopen the country again in May, and as Fox & Friends host Brian Kilmeade suggests that “only” 60,000 people will die from the coronavirus, there are some warning signs that the White House COVID-19 Task Force’s prediction of 100,000-240,000 deaths may be way too low.
That isn’t surprising, considering that Administration
officials said this projection depended on us doing everything right. Of
course, it appears that large sections of the country have done many things
wrong—whether it’s Florida Governor Ron DeSantis’ reluctance to close houses of
worship or the refusal of several state governors to issue stay at home orders.
That doesn’t include Trump’s own refusal to admit the seriousness of the
COVID-19 outbreak until mid-March and the continuing failure of the federal
government to ensure an adequate supply of test kits, PPE and ventilators.
So here’s what all of this may be leading up to: a minimum
of 600,000 COVID-related deaths in the U.S. over the next two years.
COVID-19 testing in grocery store parking lots. Clinicians crossing state lines to practice in hard-hit hospitals miles away from their health system. ICU doctors made to shore up shortages of ventilators by adapting medical equipment from its intended purpose. Are these just medical malpractice suits waiting to happen?
Margaret Nekic, CEO of Inspirien, a hospital-and-physician-owned medical malpractice and worker’s comp insurance company, reveals what’s happening behind-the-scenes as professional liability carriers hurry to adapt to the changing circumstances of a healthcare system thrown into crisis-mode.
While new legislation is emerging to somewhat safeguard healthcare workers from bearing the risk of some of the pandemic’s unprecedented circumstances, what happens when the immediate surge has passed? Will costs for medmal insurance go up? And, what happens from a worker’s comp standpoint if a healthcare worker becomes infected with COVID-19?
As healthcare delivery in hospitals continues to change — and, at the same time, more and more care extends outside the traditional doctor’s office by way of an uptick in use of digital health and telehealth options among non-COVID patients — it seems the pandemic might ultimately also accelerate changes in the way healthcare organizations think about risk management and their insurance coverage for it.
Our strategy with nursing homes in the midst
of the current pandemic is bad. Nursing
homes and other long term care facilities house some of our sickest patients in
and it is apparent we have no cogent strategy to protect them.
I attempted to reassure an anxious nursing home resident a few weeks ago. I told him that it appeared for now that the community level transmission in Philadelphia was low, and that I was optimistic we could keep residents safe with simple maneuvers like better hand hygiene, restricting visitors, as well as stricter policies with regards to keeping caregivers with symptoms home. I was worried too, but optimistic.
I figured the larger medical community would be on the same page if someone did get COVID. It made sense to me to be aggressive about testing staff and residents and quickly getting COVID-positive patients out of the nursing home. So when I heard of the first patient that was positive in the nursing home, my heart sank, but it fell even further when I found out the COVID-positive patient was sent back from the hospital because they weren’t “sick enough” to be admitted.
Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC), opened up a new front in the Coronavirus War by saying we don’t just need to treat the acute disease, we need to treat the underlying conditions that make people more susceptible to serious disease progression. He focused on heart disease, and managing mitigating risk factors such as CVD, diabetes, hypertension and smoking in order to increase people’s odds for recovery. The initial focus has been pneumonia and acute respiratory distress syndrome (ARDS), with risk factors including asthma, chronic obstructive pulmonary disease, and emphysema.
Dr. Frieden calls for better
management of people’s underlying health problems to help mitigate the impact
of COVID-19. I would take this one step further and say we need to go beyond
managing chronic diseases, and find and treat the pathogens that underlie and
fuel their pathologies. Why?
In 2001, my work as an Army
Reserve medical officer took me to Bolivia to treat 10,000 Andes Indians with
parasite medications. Not only did this resolve their parasite problems, but
many reported it helped them overcome a range of additional chronic health
problems. When I returned to St. Louis, I began to dig deeper with my chronic
disease and “mystery disease” patients and treat some of them for parasite
problems, and saw many improve. I expanded this “search and destroy” mission
with my patients to fungal and dental infections, as I learned many such
infections – often overlooked in medicine today – are overlapping, synergistic,
and can present as chronic illness.
A Conversation with Dr. Richard Isaacs, CEO of The Permanente Medical Group and the Mid Atlantic Permanente Medical Group
By AJAY KOHLI, MD
Organizations aren’t built in crises. Their mettle, their history and their leadership define how organizations adapt and succeed, particularly in difficult times. Of the three, the most important quality is leadership. In this regard, Kaiser Permanente is leading the way in healthcare delivery.
had the opportunity to speak with Dr. Richard Isaacs, CEO of The Permanente Medical Group and The MidAtlantic Permanente
Medical Group, to discuss the strategic vision and granular details of
Kaiser Permanente’s response to the global pandemic of COVID-19.
Kaiser Permanente has a strong foundation in the history of delivering care to the vulnerable. Founded in 1945 by a surgeon, Dr. Sidney Garfield, and an industrialist, Henry J. Kaiser, the organization grew from a single hospital in Oakland, California into one of the largest physician-led organizations in the world. Currently, it boasts more than 22,000 physicians responsible for the care of more than 12.5 million lives.
Many question how large healthcare organizations, like Kaiser Permanente, can adapt to a rapidly evolving problem, like the global pandemic of COVID-19, especially when cities and even countries are struggling under the burden.
Crises — like our
current COVID-19 pandemic — force people to come up with new solutions.
They slash red tape, they improvise, they innovate, they collaborate, they cut
corners. Some of these will prove inspired, others will only be temporary,
and a few will turn out to be misguided. We may not know which is which
except in hindsight.
Governors like Andrew Cuomo of New York have discovered the price for inefficiency and conflicts of interest in the face of the COVID-19 epidemic. As he said last week, “No one hospital has the resources to handle this. There has to be a totally different operating paradigm where all those different hospitals operate as one system.”
Our system is marked by extreme variability: a nation of health care haves and have-nots. Yet even when we Americans acknowledge the absurdity of our convoluted system of third-party payers and the pretzel positions our politicians weave in and out of as they try to justify it, reform it, then un-reform it, many still find solace in telling themselves, “Well, we still have the best health care in the world.”
crisis in a matter of weeks has revealed the limitations of a conflicted
network built on short-term profiteering and entrepreneurial adventurism. Here
are a few early learnings:
COVID is here. A little strand of RNA that
used to live in bats has a new host. And
that strand is clearly not the flu. New
York is overrun, with more than half of the nation’s new cases per day, and
refrigerated 18-wheelers parked outside hospitals serve as makeshift
morgues. Detroit, New Orleans, Miami,
and Philadelphia await an inevitable surge of their own with bated breath. America’s health care workers are scrambling
to hold the line against a deluge of sick patients arriving hourly at a rate
that’s hard to fathom.
I pause here to attest to the heroic response
of the medical community and the countless more working to support them. At the
time of this writing, despite 368,000 confirmed cases in the United States,
11,000 deaths have been reported. A
horrid number, but still a far cry from Italy with 130,000 cases, and 16,523
deaths, and Spain with 14,000 deaths amidst 140,000 cases. Italy and Spain may be a few weeks ahead of
the United States, but at the moment, Italy and Spain have case fatality rates
(12.5%, 10%) that are multiples of the United States (2.5%). If this rate does
stand, it will be a testament to the tenacity of medical workers toiling under
With the scale of the tragedy now obvious, the
take from some very smart people is that the people who should have been paying
attention were asleep at the wheel. The
easy target is the bombastic New York real estate developer and current
President of the United States who repeatedly assured raucous campaign crowds
and the nation that the virus was under control before it wasn’t.
The charge is made that the President ignored
warnings and painted a rosy picture of an unfolding crisis in a short-sighted
attempt to preserve the economy and a beloved stock market. He may be guilty of the latter charge, but
the real question relates to ignored warnings.
Where were the warnings? Who was sounding the alarm that was ultimately
To be honest, the United States blew it on the mask front. From a public health, caregiver and patient safety, as well as community transmission standpoint, we are at least 3 months late to game. Anytime a brand new virus that humanity does not have any immunity to makes an appearance, is highly contagious, starts rapidly infecting people as well as the doctors and nurses caring for them, hospitalizing, and killing them in concerning numbers across the globe, we should enable every proactive safety measure at our disposal.
The first confirmed case of COVID-19 in the US was on January 20, 2020. The general public and the millions of people who are considered at high-risk for complications from COVID-19 were advised that wearing masks in public was unnecessary. Many individuals were shamed and called out for wearing masks in public, being directly blamed for personal protective equipment (PPE) shortages on the front-lines. Meanwhile, hundreds of millions of masks and PPE are exported out of the country by brokers daily. People out in public have been mocked for a spectrum of reasons, being criticized as to why masks were being worn, used to run errands, and for removing them incorrectly. On April 4, 2020, the Centers for Disease Control (CDC) recommended that the general public wear cloth face masks in public where social distancing may be difficult, such as at the grocery store or pharmacy, especially in areas where cases of the infection are high for active transmission.
There has been extensive media coverage of PPE shortages at
hospitals on the front-lines of this pandemic. Protecting our doctors, nurses,
and all caregivers and first-responders is of utmost priority as we work to
fight against COVID-19. As a patient advocate, patient, and carepartner to 2
disabled adults, with multiple family members in the high-risk population, was
the call-to-action for the public to wear masks delayed so as to not risk
further depleting PPE needed for those directly caring for patients sick with