What is currently unfolding in the U.S. is what happens when you develop a healthcare system predicated around extracting profit from sick bodies, writes Mike Pappas.
Coronavirus has officially hit the United States. Throughout the country, there have been anywhere between 1,600 and 3,600 confirmed cases and 41 deaths. This number is likely a gross underestimate of the actual number of cases, as the U.S. has only tested a small proportion of the population. Meanwhile, top health officials in Ohio estimate 100,000 people could have potentially already been infected with the virus. Researchers at Johns Hopkins estimate there could be between 50,000 and half a million cases in the U.S. at this time, and that number only looks like it will grow. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and top member of President Donald Trump’s coronavirus task force, recently stated it’s possible millions could die in the United States. I hope that we do not see things get worse in the U.S., but based on what I personally have seen and what my colleagues report, I cannot help but believe things will get worse than they are now.
Take it from a U.S. physician working on the ground in communities hit by COVID-19: the U.S. is woefully unprepared for this pandemic. During a recent press conference, after being pressed about the limited availability of coronavirus test kits, Dr. Fauci said, “The system does not — is not really geared to what we need right now, what you are asking for. That is a failure.” The U.S. has only been able to test five individuals per million, while South Korea has tested more than 3,500 per million people. This is largely due to the fact that the U.S. declined to use WHO tests used around the rest of the world.
Testing is not the only place where the U.S. is lacking. It has been reported in multiple outlets that there are critical shortages in personal protective equipment (PPE) for health providers, ventilators, and ICU beds. These shortages are especially concerning, as they risk overwhelming critical care sectors of the healthcare system. Nurses, physicians, and other healthcare workers on the front lines are speaking out about what they need to provide adequate care, but the system is unable to respond. It appears these cries are falling on deaf ears. The U.S. healthcare system has always been horrid, but this pandemic is serving as a magnifying glass to expose its multiple failures.
Corona Overwhelming Other Countries
While COVID-19 has hit over 140 countries, we can see the extent to which it can overwhelm a healthcare system by looking at a country like Italy. The Italian healthcare system, which ranks second in quality in the entire world, has been completely overburdened by the virus. It was recently reported that the virus claimed 368 new deaths on Sunday, which was the largest 24 hour increase in the country to date. The country has over 21,000 cases as of today, and physicians on the ground are reporting there are simply too many patients for each of them to receive adequate care. Recently, the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) even published guidelines likening decisions physicians may face to “wartime triage” deciding who lives and who dies. Physicians in Italy are reporting that up to 80 percent of hospital beds in some provinces are occupied by coronavirus patients, and intensive care units are completely overloaded and short of supplies.
The strain the coronavirus causes on health systems also leads to increased deaths from other illnesses not related to coronavirus. There are stories around the world of patients with various illnesses such as cancer that are turned away from care. Other acute and chronic illnesses do not take a break during viral pandemics such as this. In other parts of the world such as China, the strain is not just leading to deaths of patients, but also medical workers dying from a combination of infection and fatigue.
There is potential for this same tragic dynamic to play out in the U.S., but in an even worse fashion given our disjointed profit-centered model of care. As discussed in a recent analysis published on Statnews.com, the U.S. has about 2.8 hospital beds per 1,000 people — with a population of around 330 million, 1 million total hospital beds. While the number of patients needing hospitalization vary in reports depending on the country, anywhere from 50 percent (Italy) to 15 percent (China) of patients required hospitalization. Based on the rates of spread in the U.S., even if 10 percent of patients required hospitalization, hospital beds would be filled by May. This is not to mention the drastic drain on supplies that such a rate of infection would put on the U.S. healthcare system.
Healthcare Workers Already Noticing Shortages
The Trump administration’s Department of Health and Human Services has been extremely behind on ensuring healthcare workers have the necessary supplies to treat the large number of patients who will be coming to hospitals in the near future. For example, they only recently issued a request for contracts for 500 million face masks to help protect workers against the virus when seeing patients. The proposals for these contracts are not due back until March 18. Requests for information around available medical gowns, masks, respirators, etc. from the Domestic Strategic National Stockpile’s Office of Resource Management are not even due back until March 24. These clearly serve as delays in a time of crisis, when delays and shortages mean increased viral transmission, increased spread of illness, and increased death.
Short supplies of protective masks are hitting hospitals around the country. Staff must often obtain management approval before using N95 masks used to protect against airborne pathogens. In one New York hospital, management advised staff to “reuse” N95 masks with a distributed document saying “N95 masks will be reused by staff until they are soiled, moist, or compromised,” and to obtain a new mask an associate must “request a mask from their supervisor.” Policies such as this one pose great risk of infection for healthcare workers, who would then potentially spread the infection to patients. It doesn’t stop at the special N95 masks, nurses in Chicago are now even reporting they are even running out of regular surgical masks, which is unconscionable in a healthcare setting. I’m part of a discussion group of health care workers; a nurse in New York City recently contacted us, saying, “Ok, so now we get two masks each and that’s it!!! WHAT THE FUCK IS GOING ON????” That is a great question.
take over private industries that are putting profits over patient lives. In the U.S., we are seeing “requests” and “contracts” for money to be funneled into inefficient for-profit companies that cannot and will not respond fast enough, while the government leaders and media pundits continue to tout the brilliance of “public-private partnerships.”
Confusion from Management
Even the type of mask to be used for COVID-19 patients has been up for debate. Hospital administrations direct staff to use regular surgical masks, eyeshields, and PPE for suspected or confirmed COVID-19 cases because according to CDC guidelines, N95 masks should only be worn for “aerosol generating procedures.” This concerns many healthcare workers because at least one study in conjunction with the National Institutes of Health (NIH), but yet to be peer reviewed, suggests that the coronavirus can survive in the air, which would necessitate N95 masks. Healthcare workers speculate the laxity in recommendations results from hospital administrations attempting to save the already short supply of N95 masks.
These issues, along with poor lines of communication resulting from the highly bureaucratized and corporatized U.S. healthcare system, have led to confusion, delays in care, and even some healthcare workers being exposed. As one worker recently shared with me:
“I’m an RN in a MICU in New York. We currently have 3 positives on unit. There has been a lot of fear regarding lack of equipment and PPE [protective personal equipment]. Throughout our facility we have found no plans in place for this. The union has been working on demands. One of the things that has been most difficult is the discussion… is it droplet or airborne. Our institution has gone back and forth, provided misinformation about masks and appropriate PPE. Over the last week we have been told re-use masks. Last night they said the rooms no longer need airborne precaution and only droplet/contact precautions needed. Now, at 11am they have placed the rooms back on airborne.
We are worried they have exposed a lot of us. They aren’t testing a handful of people who might be positive.
Masks (droplet/surgical vs. airborne/respirator) are not the only problem. ICU beds around the country are quickly filling. New York Governor Andrew Cuomo recently stated that 80 percent of ICU beds in the state are occupied. While hospitals rightfully attempt to make more space on units, administrations have been reported converting units to handle ICU level patients without first ensuring nurses are comfortable or trained to handle the care involved with such patients. As reported, nurses throughout the country are already chronically understaffed due to capitalists continually trying to cut staff as much as possible to lower costs and increase profits.
Hospital administrations have repeatedly ignored nurses’ calls for safe staffing ratios, which, if instituted, would have made handling a pandemic more tolerable. Now, around the country they are scrambling, putting out calls for retired nurses to return to work to help fill staffing gaps. Capitalists’ consistent push for profits is now coming home to roost, manifesting as staff shortages during this crisis.
All Staff at Risk
And it’s not only nurses being harmed under these poor working conditions. Resident physicians, supervising/attending physicians, medical assistants, technicians, and other front line healthcare staff are also at risk. Patient care associates — these are often the individuals who take vital signs and perform other crucial services — in hospitals in New York City have noted the absence of training in protecting against the virus. One recently stated, “We haven’t gotten any training. The N95 respirators are on lockdown. They can only be used for ‘more serious cases.’”
Resident physicians, who often work 80+ hours per week in the hospitals, are at particular risk. While many residency training programs across the country are now appropriately pulling residents off of “nonessential rotations,” so they can be prepared to respond to the crisis, many working on the front lines are put at risk. As per a resident who recently contacted me:
“We have a patient that is being admitted for pneumonia but her story sounds really good for COVID-19. I called the infection control line and they were like “This line is only for attendings only. Call your attending if you want to challenge it.” They’re not doing shit to protect us if I can’t say “I think a patient should be reconsidered for a COVID rule out” and have them seriously discuss it as one.”
Decisions such as these put staff on the front lines at risk of contracting and subsequently spreading COVID-19 to other patients and staff.
Capitalism’s Rot in Healthcare System
What is currently unfolding in the U.S. is what happens when you develop a healthcare system predicated around extracting profit from sick bodies — one that continually attempts to drive down costs whenever possible. A system that only reacts to disease instead of preventing disease. Dr. Fauci stated that our “system is not built for this,” but healthcare workers dedicated to treating patients have been condemning this system for years. Our healthcare system has always been a complete disaster, but a pandemic like this just magnifies that fact. We not only need a new healthcare system, but a new economic system that values life over profit. Capitalism will never give us what we need. Hopefully, this wake-up call does not cost too many innocent lives.
Mike Pappas is an activist and medical doctor working in New York City.
This article is from Left Voice.
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I think that one important question is has the total number of deaths increased in Europe above the daily average?(the number of people who die in each country on any given day.) Italy has a death rate of about 2,000 people per day. This has not increased since the covid-19 virus infection in Italy , nor in Europe. See A Swiss doctor on covid-19, Swedish Propaganda Research, swsprs.org/a-swiss-doctor-on-covid-19/.
The US has always been good at extracting profit out of anything. A very materialistic society that places money higher than god.
Healthcare shouldn’t be considered a product to be bought and sold. When it is, it’s nothing but slavery.
When insurance is sold as “healthcare”, it’s nothing more than another item in a stock portfolio.
Medical students should not be charged for their education, hospitals should be nationalized and doctors should have scheduled prices for their services.
Thanks for this.
See “As We Continue to Drift Into a Totalitarian Medical System: A View of a Country Boy” (see: journals.sagepub.com/doi/full/10.1177/1457496918757579).
In a sane functioning democracy, the POTUS candidate offering a real healthcare solution would be the one winning the primaries…
Somewhere I saw some statistics as to the ratio of how much time a Dr. now spends on paperwork/computer compared to patients. It’s excessive, inefficient, and counterproductive. All about liabilities. Not the Doctors’ fault. In the last 20 years, I have observed medical in general in the US morph from scary to insane.
What a circus. Now the ‘spring breakers’ are being chastised for partying. That clip of a whole line of very young chubby ladies dancing on the beach in bikinis. Chubby? When did that happen? For the 50% obesity rate, I have three guesses: GMO, high fructose, tweaked fats, or all of the above.
Also, If a mask leaks around the outside at all it provides merely a false sense of security. Rather, the moisture is a breeding ground.
We will get through this. One would hope we can use our history (now) as a measure of our wisdom.
“U.S. healthcare system” is a complete misnomer, and all the alleged healthcare companies with their overpaid CEOs are the opposite of benefactors of the society.
Mar 19, 2020 Corona crazy, strengthen your immune system by Dr. John Bergman
With between 90 to 99 percent of people who get this Corona virus recover , this virus panic will pass, the loss of freedoms will continue, strengthen you immune system.
Dr. John Bergman see: youtu.be/nlFjAq9zT7I
“stengthen your immune system”
Yes , by buying Bergman’s self-branded , overpriced supplements :
Just another Alex Jones-type Covid-grifter.
To blame capitalism is a total cop out. The problem is not capitalism but the greed of our politicians that look the other way because of some self serving influence (Republican or Democrat). The health of our public is an issue for government over site and input and they should be more involved in guidelines rather than running the system and injecting government bureaucracy and inefficiency. There will always be a need for rewards for efficiency and excellence and people are motivated by rewards. To eliminate rewards (monetary or emotional) will only result in corruption by a different group of stakeholders.
It is not a cop out. Capitalism cares not at all about the public good, and the inequality has increased hugely in recent decades in the USA and in other “free world” nations. Public health, schools, universities, housing, water, electricity, transport all help those who are not the richest few, but the present system helps only the rich.
Peak health consulting, most anywhere on the present planet, must mostly be paid for outside monopoly- mandated practices, mandated by politicians who take money from moneyed interests. Possibly Japan and Sweden have better systems for ordinary people, as their community-health statistics are good, along with those of Finland, where so many do sauna (temescal in Mexico, sweat lodge in some other parts of the Americas). Whether, after a long simmer, the U.S. can have more of a health system than the present illness-promotion system in a big question. It is ok to bash me for not being in a panic, but I am in multiple risk groups so many people say they want to protect.
Here is a very important perspective everyone should read:
See also: timesofisrael.com/israeli-virologist-urges-world-leaders-to-calm-public-slams-unnecessary-panic/ where the author published earlier.
Thank you Dr Pappas for this enlightening but profoundly depressing (though fully recognized) overview of the state of the so-called “health care” system in this country. Profit above all.
My experience – via my late husband’s death and its cause – with the corporate US medical industry (what else is it?) only increased my contempt for it and for many of its practitioners (my apologies Dr Pappas, but that is the case), particularly after I had done a year’s worth of medical research (using the NIH website for research papers as well as other respected medical journal websites, e.g. OUP) into the whys and whats that led to his death from a STEMI – his left anterior descending artery, 75% stenosed, had a 99% blockage. (The effects of his MI worsened by an EMT who *pulled off* the heavy duty nylon, very close fitting, next to his skin, T shirt rather than CUT it off – as had been done for all the rest of his running clothes.)
He had three coronary artery disease, but NO peripheral artery disease at all. His PCP went by outward appearances: lean, muscular (we ran 6 days a week and had done for well over 30 years; we ate healthily; he had stopped smoking some thirty years earlier; he lifted weights 3 times a week). He had Type 1 – but was a late onset (aged 45) and it developed abroad, so, according to the medical records and unbeknownst to us, his PCP and the clinic’s NPs presumed him Type 2 (despite his informing them otherwise on becoming their patient). For a Type 2 he was superbly healthy *appearing* – and *that* was a mind blockage for the medicos, apparently. And apparently for US doctors, no peripheral artery disease means no coronary artery disease. (B*******.)
And then it appears that doctors of all stripes (PCPs, specialists) do not pay ANY attention at all to the long-lasting, atherosclerotic effects of Immune Response Processes. Every single infection, allergic reaction, operation, cancer, hypoglycemic episode (and my husband had an ever-increasing number of these, as is “normal” in an aging diabetic), aging, psychological stress – all, all cause the Immune Response Process to act – and while it works to help our bodies it also produces the chemicals, proteins what have yous that lay down the layers of atherosclerotic plaques. It’s all there, in the medical research, which it seems no practicing doctor bothers to read.
Matters were little better in hospital; and the bills – cannot believe where they came up with such fantastical sums. Take a number and multiply it to the power of ten? Not that Medicare paid out those sums, but even the effrontery…
So I am NOT at all surprised, but am disgusted, with what the medical state of affairs surrounding this pandemic reveals about a system based on $$$$$$$$ and nothing else.
Public Goods = infrastructure, health, education, culture, museums, libraries etc., specific industries, transport, mail, energy, defence, coastal defences and so forth. These formed part of an economy of both developed and developing countries. Non for profit organizations.
Private Goods = Shops, supermarkets, and the whole range of consumer goods and services produced by an economy. For profit organizations.
Unfortunately the powers that be thought that everything should be for profit. Generally speaking this involved privatisation, deregulation and liberalisation. Well like its it didn’t work, just like the Soviet command economy didn’t work.
Little wonder the virus is causing such havoc. But it could only do this given the structure of late capitalism and its ossified institutions.
” the Soviet command economy”
Many are/were immersed in the attempt/achievement conflation which tends to become more pronounced when outcomes and expectations differ.
GOSPLAN was a very good example of this with much wider application including but not limited to “The United States of America”.
Increasing numbers of the inhabitants of “The Soviet Union” were informed by the maxim “They pretend to pay us and we pretend to work.”
This caused many problems, especially but not exclusively for GOSPLAN, whose subsequent practice was informed by ” We pretend that the plan is being fulfilled so they pay us.”
However even politicos with blat and special facilities were not completely oblivious, so they attempted to implement practices of productivity improvement known as perestroika.
However the inhabitants of “The Soviet Union” continued to be informed by the maxim “They pretend to pay us and we pretend to work.” and so the politicos thought this could be rectified by practices of open-ness known as glasnost.
However the inhabitants of “The Soviet Union”‘s experience of glasnost improved their understanding of the maxim “They pretend to pay us in this way and that whilst paying themselves in this way and that, so we have more reasons to pretend to work” illustrating that the utilities of commands have decreasing half-lives and increasing consequences.
The 1980’s in wonderland were amusing and educational.
Good points. I would just like to add that the TYPES of “consumer goods” need to be honestly and rationally evaluated. Until we begin to seriously question notions of “conspicuous consumption” and move away from practices like “engineered obsolescence” I’m afraid we will still be unable to avoid mass extinction.
Exactly! Just do a comparative US vs Canada– we have a public health infrastructure. I am in the medical field and the support is here. I was on a hospital board during SARS and even though there were some problems with protocol , we learned and applied them during H1N1 in 2009 and now.
Please realize there are viruses around us every day. It is your immune system, your underlying health that determines your susceptibility to them. Strengthen your immune system. Take responsibility for your health condition dont depend on govts or pharma.
I totally agree with the post by Torontonian below .Straightening or maintaining a good immune system goes a long way in preventing diseases such as those created by virus . And yes a public health system like we have in Canada is essential .
I have been waiting for something like this to come along and kill off the maximum number of people due to economic stupidity as well asunlimited greed!!!!!!!!!!!!!!!!!!!!
Proof that laziness can be a good thing – you sound like you’d be a serial killer otherwise.
While I share your underlying wish for people to “Wake the eff up!” I cannot condone the killing of a “maximum number of people” in order to achieve it. Would this include innocent children, invalids, and doctors and nurses on the frontlines?
Also, while greed is one component of our current socio-economic malaise, I would include hubris, encouraged laziness, too much information (Huxley), too little information (Orwell), the disparagement of critical thinking, creativity, imagination and compassion, an emphasis on competition over cooperation, and a willingness to ignore or rewrite History’s valuable lessons, among others…
Rather than misanthropically dismissing our fellow humans as “greedy”, let’s pause a moment to consider that maybe, just maybe, this way of thinking is a clever, devious, way of keeping the masses down, reduced to scrambling for the crumbs leftover from the oligarchic table.
We need everyone on board! Time to think holistically.
Unfortunately, it won’t get rid of the those who created this CLuster#uck. That may require a more direct approach which could be a response of the Survivors of this Catastrophe.