A plea from NYC physicians: Our window of opportunity is closing to avoid Italy’s fate
We are two New York City physicians and public health advocates and are pleading with our municipal, state and federal leaders to take drastic public health measures to save lives. The house is on fire, and this is the alarm bell.
The view from the frontlines is grim. Our health systems locally and nationwide are already dangerously stretched thin in terms of staff, protective equipment, ventilators, intensive care and isolation beds. By even the most generous estimates, given current rates of transmission, we do not see any possible way to continue to operate within the fundamental bottlenecks of ICU and equipment capacity. This system shock alone will lead to unnecessary and preventable deaths unless we act now. But our clinical toolkit for this disease is fundamentally limited even if these needs are met. This is why, to both prevent overburdening our health system and to save the most lives, we must direct attention, political courage and resources to dramatically halting transmission.
Without comprehensive action, we are in imminent danger of replicating Italy’s experience not only in New York but also nationwide. Saving the most lives requires the following urgent action.
Nationwide Shelter in Place
This week seven counties in the San Francisco Bay Area and now the rest of California has moved towards shelter in place policies, which are the strictest forms of mandated social distancing in the country. We feel that these measures should be expanded nationwide for two weeks to bend steep and unrelenting transmission curves.
From a public health and ethical perspective, the rationale is simple. We know the death toll and burden of disease may be drastic in worst case transmission scenarios. Modeling studies and empirical evidence from China and other countries demonstrates that the only hope of limiting peak incidence and overall deaths is through strict limitations of social contact. As unconfronted transmission curves are exponential, evidence from the Institute of Disease Modeling demonstrates that the most aggressive forms of social distancing can reduce deaths more than tenfold and relieve crippling pressure on overstrained health systems.
Once health care systems reach their breaking point, we’ve lost our opportunity. We feel shelter-at-home should be rolled out as a public health measure of collective action and solidarity. It can be done without policing of individuals, and can provide social support to those who need it most. Social support can take the form of temporary shelter to those experiencing homelessness, food and medical needs delivered to those at home and a people centric bailout that helps those forced to miss work meet their financial needs.
Without these supports, and with only calls for voluntary social distancing, we are outsourcing tough decisions to the most vulnerable individuals. With only closures of some sectors in the places hardest hit, the other places with looser restrictions continue to have exponential growth and soon become the next hardest hit.
We regularly have such restrictions and limitations for public health and safety in the case of mandatory evacuation zones during hurricanes and floods. We view this no differently, only the magnitude of lives saved in this setting is far greater.
Mobilize the National Guard and Army Corps of Engineers
The calculus of ventilator and ICU availability suggests that we are very likely to reach capacity in less than two weeks. We have been reading reports of the extraordinary circumstances facing our brave Italian colleagues. We don’t feel that any physician should have to make the decision about whether a patient survives based on the availability of space and machines.
Others have laid out detailed plans to build capacity jointly led by the U.S. Public Health Service and the military, and by opening up VA hospitals. The military, and particularly the Army Corps of Engineers, is adept at building combat support hospitals and field hospitals. We feel this is urgently needed in places like New York and other metropolitan hubs. The recently announced Naval hospitals deployed to New York harbor and the West Coast are one such example. We support these measures to build a parallel system staffed by a secondary workforce to not only unload highly burdened hospitals but also to save as many lives as possible. We believe these services should be deployed where requested by local or state leaders.
We have deployed our military and resources around the world for far less. We can’t think of a more patriotic, America centric policy that requires the support of our military.
This pandemic lays bare a simple truth: We’ve built a world that is greatly focused on the nonessential, but also a world where we lack many truly essential things. These measures will reduce those infected, slow the pace of spread and buy time for our health system to adapt and develop treatments and vaccines..
Now is not a time for partisan politics. We have one chance to come together to save lives. As Dr. Tedros Ghebreyesus, director-general of the World Health Organization, recently said, “the amazing spirit of human solidarity must become even more infectious than the virus itself.”
Dr. Akash Goel is an assistant professor of medicine at Weill Cornell / NewYork Presbyterian Hospital and has been recognized by the UN and awarded a Cannes Lion for his work in human rights advocacy. Dr. Andrew Goldstein is a physician activist and an assistant professor of medicine at New York University.
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