By Marian Grant
Those living with serious illness — a life-threatening or life-limiting illness, such as metastatic cancer, dementia, or heart failure — are at higher risk for complications from COVID-19.
Their increased vulnerability has posed additional challenges for the health workers who care for them.
By Christian Rose
During the COVID-19 pandemic, physicians and nurses have found themselves on the frontlines of more than just medical care, advocating for their patients, their families, and themselves. Facing overwhelm and burnout at a scale hitherto unimagined, they continue to fulfill their ethical obligations to their communities and their patients. If they don’t, who will?
By Samyukta Mullangi, Johnetta Blakeley, and Stephen Schleicher
The COVID-19 pandemic has brought many challenges to oncology care; an area of medicine that typically involves frequent, in-person patient visits to complete a course of treatment.
In many ways, COVID-19 has served as a stress test for the specialty, and has catalyzed adaptive changes that we hope will make the oncology care, and the health care system in general, more resilient going forward.
By Elizabeth Clayborne
I was a little less than six months pregnant when the COVID-19 pandemic hit in 2020. As an Emergency Physician, I am well aware of additional risks that my job often exposes me to on a daily basis. We frequently face physical and emotional strife from unstable psychiatric patients, critically ill nursing home residents, sexual assault victims, and newly diagnosed cancer patients.
People who work in an emergency department tend to understand what comes with the territory: a lot of hard work, unexpected outcomes, and daily traverses of the human experience, from the best emotions you can imagine, to lowest depths of human despair. This is what accompanies caring for every ailment for people from all walks of life. I actually love this part about my job! I never know what I’m going to see when I walk through the doors.
That said, being a frontline physician during COVID-19 has provided me with a profoundly different lens on the pressures surrounding health care workers. And experiencing this while pregnant was pretty terrifying.
By Benjamin Podsiadlo
The COVID-19 pandemic has posed persistent, wide-ranging existential threats to effective 911 emergency response.
The EMS (Emergency Medical Services) system, which sits at the intersection of emergency medicine and public safety, is the out-of-hospital component of the acute care health care system. The EMS mission is targeted at identifying, responding, assessing, treating, and entering suddenly ill and injured patients in the community into the health care system.
The EMS system’s viability is entirely dependent upon the capacity of its workforce of EMTs, paramedics, and 911 EMS telecommunicators to respond 24/7/365.
The devastating impacts of the COVID-19 pandemic on EMS include: severe damage to workforce sustainability; grossly insufficient logistical resourcing; and further erosion of cohesive system identity.
By Cynthia Orofo
There are two experiences I will never forget as a nurse: the first time I had to withdraw care from a patient and the first day working on a COVID ICU.
Both were unforgiving reminders that the ICU is a demanding place of work that will stress you in every way. But the latter experience was unique for a few particular reasons. Before the end of that first shift, I had overheard several staff members on the floor speak about their fears, thoughts of the unknown, and their version of the “new normal.” As I realized that life would almost certainly not be the same, I developed my own vision of the “new normal” of health care.
By Lauren Oshry
In 1982, when AIDS was first described, I was a first-year medical student in New York City, the epicenter of the epidemic in the U.S. To the usual fears of a medical student — fears of failing to understand, to learn, to perform — was the added fear of contracting a debilitating and universally fatal infection, for which there was no treatment. But our work felt urgent and valued, and the camaraderie among medical students and our mentors is now what I remember most.
Nearly forty years later, my experience as an attending oncologist during COVID-19 has been different. Yes, I am older and less naïve, but also this pandemic has been managed in fundamentally different ways. Aside from the obvious federal mismanagement, my own institution has deeply disappointed me. The institutional shortcomings we had long tolerated and adapted to were laid bare by the COVID-19 pandemic, and massively failed our patients and morally devastated those of us on the frontlines.
As a provider in a large safety net hospital, I care for a predominantly minority population in the lowest economic bracket. These would be the individuals disproportionately affected by COVID-19, with highest rates of infection and worse outcomes. My patients have the additional burden of cancer.
By Lindsay F. Wiley
For centuries, public health advocates have understood that our health is shaped by the conditions in which we live and work — conditions public health researchers now refer to as the social determinants of health. Law itself is a social determinant of health. Structural racism and other forms of socioeconomic subordination, which are embedded in our laws and public and private policies, are social determinants of health.
Unfortunately, these statements are not uncontroversial. Commentators have debated whether structural racism and other forms of subordination are social determinants of health, and whether dismantling these forms of subordination is within the legitimate scope of public health law and policy. Critiques run along at least three main lines—semantic, civil libertarian, and progressive.
By Sravya Chary
Many racial minorities and low-income individuals rely on 340B hospitals and associated child sites for access to discounted drugs and charity care.
In 1992, Congress enacted the 340B program as an avenue of access to prescription medication for “the nation’s most vulnerable patient populations.” Hospital savings incurred from purchasing 340B drugs at a steep discount are invested in charity care programs to enhance patient services and access to care.
The 340B program is an essential component of the COVID-19 response. Increased flexibility for 340B covered entities is necessary to address disparities faced by marginalized communities.
By Beatrice Brown
Human subjects research has long been plagued by racial inequality. While flagrant abuses have been curtailed, disparities have, unfortunately, persisted.
One area ripe for scrutiny is clinical trial enrollment. A 2018 study by William Feldman, Spencer Hey, and Aaron Kesselheim in Health Affairs documents racial disparities in trials that are exempt from typical requirements for informed consent from study participants.