Can Doctors Survive a Second Wave of Coronavirus?

“Doctors are heroes! Not all heroes wear capes! Heroes work here!” The signs are everywhere. It’s a nice sentiment but our “heroes” are barely surviving. The first wave of COVID19 was devastating for doctors – physically, emotionally, and financially.  

The coronavirus pushed a dysfunctional healthcare system closer to the brink.

  • According to an interactive database tracking healthcare providers in America, 1256 have died.. Doctors, nurses, staff, and home healthcare workers have lost their lives serving patients.
  • In 2019, the financial impact of COVID was widespread as reported by the Medical Group Management Association. The coronavirus caused financial distress for 97% of 724 medical practices. According to JAMA, some communities created GoFundMe pages to keep medical offices open.
  • The combination of an impossible workload and financial uncertainty contributes to burnout. Burnout goes way beyond stress. FYI – heroes are humans, there is only so much they can take for so long. We’ve also seen a rise in suicides among front-line doctors and nurses.
  • John Hopkins data shows that 30 states are over the recommended positivity rate. Those stats are from September 2020. Flu season starts in October and peaks between December and February.

If coronavirus cases continue to rise in conjunction with flu season, how bad will it get?

What We Can Expect

Let’s start with the good news. Based on data from nations where flu season has started, the incidence is lower than normal. That can change, but for right now – the outlook is positive. The decline is attributed to COVID precautions – masks, hand washing, staying home.

It’s unclear whether the same circumstances will play out in America.  In the U.S., the inconsistency of mask use and social distancing may produce a different outcome. There is also some concern that fewer American seniors will venture out for a flu shot. As the most vulnerable to COVID19, venturing out to drugstores may not be worth the risk.

Mental Health disorders

COVID-19 is behind a rise in anxiety and depression. People are dying alone. Families face a new model of managing grief. Parents are struggling to balance jobs, childcare, and homeschooling during quarantine. As winter comes, social isolation will likely rise. This will lead to more loneliness, fear, and depression.

Doctors regularly deal with death, but this is different. Depending on location, the number of COVID deaths is traumatic. Doctors find themselves live streaming messages from families to terminal patients.

The hospitals are struggling with the caseloads. Elective procedures are backlogged. Like everyone else, doctors worry about exposure to the virus.

COVID Confusion

The coronavirus and the flu are both airborne diseases. Their symptoms have some similarities. One concern is flu patients may overwhelm the limited COVID-19 testing system. Its a catch-22. We can’t ignore a possible coronavirus exposure, but it puts more stress on the system.

The flip side is people with COVID may assume they have the flu. That can increase the exposure rate for all the people around them, including doctors, nurses, and home healthcare workers.

Think About This

For doctors to focus on patients is the norm. People expect them to go above and beyond. We take for granted they will work double-shifts. We expect they will volunteer. To continue to work without proper protective gear. To be afraid they are putting their families are at risk.

As of September 28th, the global death toll from coronavirus is 1 million. There are currently 7.1M cases in the U.S., with 205,000 deaths. Doctors, nurses, and hospitals are the touchpoints for every recovery and every death.

Public health experts predict a second surge. Will it push doctors to the breaking point?

Health Infrastructure

We think of American infrastructure as physical structures – roads, dams, electric grids. The public health infrastructure is built on the backs of doctors and nurses. The burden sits on them whether in private practice or a hospital.

The public tends to think of physicians as wealthy people. The truth is it takes about 13 years for a doctor to pay off their student loans. Do they make a good salary? Yes. After 8 years of school and 3 -year residency, they deserve it. Since COVID-19, medical practices have seen a 60% decrease in patients and revenue loss of 55%.

At some point, the system is going to break. We need to take action now before it’s too late.

1. Follow public health guidance

COVID transmission diagram

COVID is an airborne illness. It’s not spread by droplets that fall to the ground. Airborne particles are expelled from the mouth or nose and travel through air.

When people wear masks, they slow the spread. Masks keep airborne droplets from passing between people. We also cannot ignore the asymptomatic aspect of the disease. It can take 14 days for an infected person to show symptoms. During those two weeks, they’re passing the virus to other people. Masks slow or stop that transmission.

This image provided by Science.com shows the release of different size particles. New research from WHO shows that smaller particles can remain suspended in the air for hours. Without a mask, you can breathe in those particles and become infected with the virus.

Masks are your frontline defense. Handwashing and social distancing are the supports. Together, they reduce the risk of transmission and mean less cases.

2. Advocate for PPE distribution

Personal protective equipment is how doctors can safely care for COVID patients. Without it, they risk daily exposure to the virus. They aren’t immune to infection or to passing the virus while asymptotic.

Hospitals are a high-risk environment in the best of times. They aren’t only serving COVID patients. According to the CDC, 145.6 million patients came to emergency rooms alone – and that was in 2016. Anyone who comes into the ER with a broken arm or chest pains or an asthma attack could be carrying the virus. The risk (and resulting anxiety) is intense.

It’s not only hospitals and doctors that need PPE. Prisons, schools, nursing homes, EMTs, and other first responders all need protective gear. As of April 2020, 4,127 first responders have died of COVID-19. It can be hard for people to grasp the big picture impact of this pandemic.

Don’t underestimate how fast the virus can shut down the systems we rely on. Advocate for the proper distribution of PPE.

3. Doctors need to practice self-care

Doctors take care of other people. Now they have a responsibility to take care of themselves. The public health infrastructure relies on them. The more physicians we lose – to COVID, stress-related illness or burnout – the weaker our system gets.

Physical Health

Medical professionals need healthy food, restful sleep, and exercise to function. They tell their patients that all the time. But they struggle to incorporate those disciplines into their routine.

Here are some tips:

  • Uber Eats, Grub Hub, and other services will bring salads the same as they do burgers. Set up an account now.
  • Set alerts and reminders for exercise breaks, lunch, or meditation.
  • If your workspace has a gym, use it. You deserve the time – you will always be “too busy.”
  • Go outside. Take a walk during lunch. Fresh air and sunlight don’t seem like much until you go out and see how much you’ve missed them.
  • Get an app that helps to clear your mind – here’s 10 to pick from.
  • Get your flu shot now.
  • Use your PTO no matter what (stop rescheduling
  • Buy some earplugs, lock the door and take a nap.

The hardest part of being a physician is letting go. There will always be reasons why you can’t take care of yourself. Don’t listen. The world will get by if you take a break.

Emotional Well-Being

This can be a very touchy subject for many physicians. It goes counter to how they are seen in society. There are also issues with shame and doubt. But untreated depression and anxiety isn’t going to go away. It typically gets worse.

Depression has numerous causes, none of which will disappear. Some people are genetically inclined to the illness. In others, the brain doesn’t regulate mood the way it should. The side effects of some medications are depression. Anxiety disorders are can be paralyzing. All of it is treatable. If you’ve gone from having a bad day to thinking you have a bad life, it’s time to get treatment.

There are so many support groups you can’t think you’re alone. Try PeerRxMD. There’s also a confidential hotline specifically for doctors. Call 1 (888) 409-0141 and get back to being yourself. There’s no shame in that.

Financial Well-Being

Financial stress keeps anyone up at night. How long could you survive if your small business lost 55% of its revenue? One advantage of the pandemic is the mainstreaming of telemedicine.

Telemedicine companies are hunting for talent. Medical professionals can work full time or part-time. Doctors can make money doing video consults and remote patient monitoring.

If telemedicine doesn’t interest you, consider picking up a side hustle. Side gigs are becoming the norm due to economic uncertainty. Even in better times, relying on your salary alone can be dangerous.

4. Best practices for facilities

Hospitals have many resources but they are struggling under the coronavirus. The AMA offers several suggestions on best practices for protecting staff and patients. This guide defines the 17 steps for building a resilient organization.

Finding ways to reduce the workload is helpful. The National Student Response Network matches medical students to volunteer needs in the public health community.

Hospitals need to protect PTO, salaries, and benefits for all staff. Insist on providing necessary PPE. The business community is offering resources like childcare for essential workers. It’s easy to set up discounts or free delivery with local restaurants.

The COVID staffing project helps hospital administrators forecast what they need. When hospital staff get the support they need, everything operates efficiently.

5. Involve your patients

Most of them want to help but they don’t always know what you need. Set up a page on your website and use social media to let them know.

For example:

  • Help them to understand the number of calls you receive. Show them how to ranks the urgency of their call – critical, important, informational. Then set expectations for a response time and share the load with colleagues or staff.
  • Encourage them to use your telemedicine services instead of a doctor-on-demand app. It helps the practice stay afloat and keeps money in the community
  • Have a way to accept contributions or donations of services. Create a childcare fund or wellness club. Don’t be afraid to let people know what you need.
  • Communicate on a regular basis. – if you need to, hire a writer to send a newsletter to your email list at least once a week. Thank and recognize people, businesses, and organizations.
  • Create an advocacy council of people who support local medical care.

Healthcare is an essential community service. Your patients know it. Don’t leave them out of the fight.

Second Wave COVID Summary

It’s coming, right on time for flu season. Some people think it’s already here. Either way, we don’t need to get caught by surprise. Let’s assume it’s going to be as bad as the first surge. There is concerning research coming out of Brazil about re-infection.

We need to recognize the impact on rural hospitals and smaller medical practices. Doctor deserts are already way too prevalent in country communities. PPE is not optional – it’s essential.

We all have to step up. Our health care infrastructure must survive.

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