Fiber medicine

COVID’s Assault on Medicine’s Moral Fiber

The fourth wave of COVID-19 is testing the moral fiber of American medicine. The virus has infected more than 42 million Americans and caused more than 675,000 deaths in less than 2 years. Now the Delta variant again forces us to deal with an onslaught of critically ill patients while delaying routine care and emerging surgeries for others. As intensive care units fill up and dozens of people, mostly unvaccinated people, die unnecessarily, those of us working in healthcare find ourselves facing a deep chasm – filled with frustration and burnout, where reserves of empathy quickly dry up.

As COVID-19 tests the medical community in new and unimaginable ways, we can look to our predecessors for guidance. In 1983, a small group of doctors and nurses at San Francisco General Hospital opened Ward 5B, the first dedicated AIDS ward in the United States. Despite an incredibly high death rate, lack of evidence on disease transmission and an anemic government response, these volunteers were determined to bring humanity to their increasingly isolated and desperate patients. At great personal sacrifice, they cast aside their fears and the onslaught of societal judgment, including a hostile narrative that squarely blamed the “personal choices” of those who had contracted HIV.

Ward 5B eventually became emblematic of how we have provided care for AIDS patients around the world. The experiences of its healthcare workers informed some of the earliest studies in the mid-1980s of the risks of exposure and disease transmission. Soon after, the CDC introduced new guidelines to protect workers from HIV and other bloodborne pathogens. Guidance from the CDC and the Occupational Safety and Health Administration in response to viral outbreaks of illnesses ranging from Ebola to SARS continues to inform how we treat patients and protect ourselves.

Today we are again at war with a hostile virus – this time with COVID-19 causing levels of morbidity and mortality that make the early days of the AIDS epidemic seem tame in comparison. The starkest reality of all is that we know it didn’t have to be. Safe, free and highly effective vaccines are readily available. Healthcare professionals find themselves broken, scared and furious as the pandemic unnecessarily continues and the death toll rises. Some of us even harbor righteous indignation. Many are considering or left the profession.

These are harbingers of a dark inflection point in American medicine that could have lasting and potentially catastrophic consequences for the most precious bond we have: the deep alliance with patients we have sworn to protect. Judging the personal decisions of the people we care for may seem justified in the moment, but the collateral damage to ourselves and our patients is permanent. There is no medical innovation, no prescription, no surgery that can relieve suffering without the basic trust that exists between patient and healer.

When we hear the story of the release of the unvaccinated, we can seize the opportunity to refocus on our primary charge as healers, a charge that requires us to listen to patients with empathy and build trust. Persuasion, not coercion, is our best hope for promoting COVID-19 vaccination and defeating our common enemy. Together, we can own our collective freedom from the suffering this virus has created.

The COVID-19 pandemic will eventually end. All pandemics do. When the fog of battle clears, we must all ask ourselves: how will history remember us? As healthcare professionals who did what we were trained to do when the patient before us needed us most? Like an exhausted, horrified but resolute army fighting a common enemy? Or will our chapter focus on the moment in American medicine when we fundamentally reset our moral compass, damaging our most important relationships?

For years we have been unable to identify the source of HIV infection. Many medical professionals feared for their own safety, believing that “lifestyle choices” were the cause of the suffering. A lot, even refused to deal Patients with AIDS or HIV positive. Of course, we now know that HIV is not as contagious or deadly as COVID-19, and its direct threat to healthcare workers can be largely mitigated by universal precautions.

But the doctors and nurses in Ward 5B didn’t know then what we know now. They stepped forward, despite their angst and fear, and called upon their collective humanity to carry them forward. History has looked fondly at their sacrifice.

Stephen Parodi, MD, is Executive Vice President of the Permanent Federation and National Head of Infectious Diseases for Kaiser Permanente.