We now see reports of how the US is short of either masks, gowns, doctors, hospital beds, ventilators, community health workers, tests, treatments, or some combination thereof, to manage the new COVID pandemic and the annual influenza season. We see Congress hustling to adopt a funding package to catch up with the gaps.
I just saw, as an attending physician on a busy urban internal medicine hospital service, how that shortage potentially endangered mine and my colleagues lives, as well as that of my patients. At first we were told to reuse our masks--there might be or would soon be a shortage. Then we were told NOT UNDER ANY CIRCUMSTANCE to reuse them--we could infect patients by room-to-room transmission. Then we ran short of masks and.....well you can guess what we were told.
All this got me to thinking about a project I was involved in nearly 15 years ago. I was part of a national task force asked to develop a national public health and primary care response plan to respond to a theoretical (then presumed influenza) pandemic in the US. We did, over a year-long series of scholarly and cordial meetings and document exchanges. All the primary care disciplines lent representatives to the committee, organized by the Agency for Healthcare Research and Quality (then AHCPR).
As far as I can tell, our report, which would have required a significant cost outlay for workers and equipment which would sit idle until the pandemic arrived, was not adopted, and no funds were approved to beef up the already anemic public health infrastructure at that time, just post 911. Even 911 was not enough to boost a response that, I suspect, national leaders saw as wasteful.
Wasteful... hmm. That means pockets would be emptier, balance sheets more toward the red, taxes higher, and stockholders' value down. We needed to operate more like a business, cut waste, and increase efficiency.
But wait, that's managerialism right? Increase shareholder value at all costs, even, in this case, human lives. We've got a business--I mean public health infrastructure to run here. No time for more idle firemen.
I wonder if anybody in power around 15 years ago remembers sitting on our plan, and regrets not adopting it? This year, almost 60,000 have died from influenza, and we are waiting to see the death toll from COVID. How much money is a life worth?
Wally R. Smith, MD
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