Mar 24, 2020
Last week, Dr. Amy Hale's schedule treating patients in the Columbus, Indiana Regional Health system included two shifts in special clinics set up to examine and treat persons with upper respiratory problems that could indicate infection with the COVID-19 virus. On Friday, she had a break from clinical duties. So she got on the phone.
Hale called every federal and state official she could think of. She even called the White House, where she told an operator that she was a physician calling from Vice President Pence's hometown and would like to speak to him. When the operator quickly transferred her call, Hale's hopes rose for a moment. She ended up in someone's voicemail, but with every call she made her message clear.
"Every single person in the healthcare system is at risk, including our environmental services colleagues and the workers at the front desk," she said.
Hale is an active member of First Presbyterian Church in Columbus, Indiana, especially with the church's social justice committee. Before returning to her hometown of Columbus after medical school, she served two years in Swaziland as a United States Peace Corps volunteer. Leaving U.S. healthcare workers out on the front lines of a pandemic without protection is a human rights issue, she told lawmakers.
"We have to do a better job of equipping all of us with protective equipment, and we have to do it urgently," she said.
Hale was referring to the masks, gowns, gloves, respirators, and eye protection that are the recommended personal protective equipment (PPE) for healthcare workers who are in contact with patients who may be infected with a dangerous virus. She had the necessary protective equipment when she saw patients last week, but the supply was limited. In hard-hit locations like New York City and Washington state, the stock is dwindling. The Centers for Disease Control has suggested that healthcare providers may need to resort to covering their faces with bandanas and scarves.
At this writing, President Trump appears to be resisting calls to use his federal powers to order private industry to increase production of necessary supplies, although the U.S. has done exactly that many times in wartime and during other crises. "The federal government's not supposed to be out there buying vast amounts of items and then shipping," Trump said last Thursday. "You know, we're not a shipping clerk." In the meantime, dozens of U.S. healthcare providers have fallen ill with the virus, suggesting a risk of following the Italy's tragic pattern of over 2,000 providers stricken.
Hale's usual clinical assignment is seeing patients at the VIMCare Clinic located in the Columbus Regional Hospital, which cares for patients who are uninsured or have Medicaid coverage. The acronym is a tribute to the clinic's origins as Volunteers in Medicine, founded by members of the same First Presbyterian social justice committee Hale belongs to now. Members of the church still volunteer in an affiliated food bank and shelter.
"The example of living their faith that my healthcare predecessors and my grandparents showed me is definitely what led me to this role," Hale says. "As people of faith, we are called to love and care for one another. We have a responsibility to be catalysts for healthcare reform in this country."
Yet, as others have pointed out, our disjointed approach to healthcare in the U.S. contributed to the slow start in responding to the COVID-19 outbreak, especially the absence of tests to confirm infections. Hale says there is only one confirmed case in her county, but there are likely many more who are infected but have never been tested. "Tests would have been nice to have weeks ago," she says. And there is widespread concern that the 40 million uninsured or underinsured Americans will be wary of coming in for treatment -one Boston-area uninsured COVID-19 patient has already received a $34,927.43 bill.
Hale applauds her area's health system for mounting an aggressive response with the resources on hand, including quickly setting up a phone triage process, diverting all patients with upper respiratory problems to distinct clinics, and searching far and wide for the precious protective supplies. "If we are learning anything from our brothers and sisters overseas who have been dealing with this virus for months, it is that we can't wait until the care crisis is all around us," she says. "We need to be prepared before it happens."
And Hale credits healthcare colleagues for convincing her that the looming crisis was in fact quite serious. "I admit to not being too worried about the possible outbreak at first, but the more I learned the more I realized this is not an overreaction," she says, citing, in particular, an account from a U.S. physician who treated patients during the worst of the outbreak in China. "Panic is not the right response, but caution and concern definitely are."
Hale's concern extends to the impact on her family by her personal exposure to those who may be infected. "I want to be able to help my patients but also be safe while I am doing so," she says. Hale is the mother of two daughters age 4 and 7, and she worries about putting them and her husband at risk or leaving them to respond if she falls ill herself. "You would be hard-pressed to find a healthcare worker who does not have some fear right now."
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