woman with iv in her hand in hospital. Labor and delivery preparation. Intravenious therapy infusion. shallow depth of field. selective focus

Protecting Patients and Staff in Labor and Delivery During the COVID-19 Pandemic

As a labor and delivery nurse, I see patients at their most vulnerable and am there for them during an incredibly intimate time. After thirteen years, I am still awed and amazed at each birth I am lucky enough to be present for.

But in March of 2020, everything I knew as a nurse changed when COVID-19 reached my small community hospital.

Our struggles were two-fold — making our patients feel safe and making our staff feel safe.

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DUQUE DE CAXIAS,(BRAZIL),MAY,20,2020: doctors take care of patients with covid-19.

The Future of Medicine Post-COVID: Not a Healthy Outlook for Women

By Laura Dean, Valerie Dobiesz, and Peter Chai

During the COVID-19 pandemic, women health care providers have not only put their health at risk, but also suffered disproportionate professional consequences.

Women comprise 70% of the global and 76% of the US health care workforce, and data from the U.S. Centers for Disease Control (CDC) suggest that nearly three-quarters of the COVID-19 cases among health care workers are women. Additionally, pregnant health care workers suffer greater morbidity and mortality from COVID-19, face uncertain risk from medications and vaccines due to exclusion from clinical trials, and experience significant psychological and medical risk managing pregnancy amidst an uncertain pandemic. Returning to work in an era where limited and ill-fitting personal protective equipment (PPE) is available and risk of infection is uncertain is especially challenging to new and lactating mothers seeking to advance their careers in academic medicine.

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NEW YORK, NEW YORK - JUNE 06, 2020: A health care professional kneels in protest in New York City as part of the movement, 'White Coats for Black Lives,' during the COVID-19 pandemic.

Scope Creep: Serving Many Roles, Health Care Providers Need a Supporting Cast

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?

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New York City, New York / USA - May 2 2020: New York City healthcare workers during coronavirus outbreak in America.

Pandemic Threatens Future of Emergency Medical Services

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.

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Healthcare workers carrying signs protest for improved Covid-19 testing and workplace safety policies outside of UCLA Medical Center in Los Angeles,Dec. 9, 2020.

Beyond 20/20: The Post-COVID Future of Health Care

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.

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Emergency department entrance.

Pandemic Lays Bare Shortcomings of Health Care Institutions

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.

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NEW YORK, NEW YORK - APRIL 05: Emergency medical technician wearing protective gown and facial mask amid the coronavirus pandemic on April 5, 2020 in New York City.

Don’t Call Me a Hero: How to Meaningfully Support Health Care Workers

By Molly Levene

“Heroes Work Here.”

Sometimes those three short words make me angry; other times they make me cry.

I was one among thousands of EMTs and paramedics who were deployed to New York through FEMA last year. Having studied public health in school and worked in EMS for over a year, I thought I had seen the extent to which we fail patients; I believed myself disillusioned enough to be prepared for any injustice or chaos I might encounter.

But last April, I quickly learned I was wrong. And when you feel complicit in such deep structural dysfunction, it is incredibly difficult to feel heroic.

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LOMBARDIA, ITALY - FEBRUARY 26, 2020: Empty hospital field tent for the first AID, a mobile medical unit of red cross for patient with Corona Virus. Camp room for people infected with an epidemic.

The Fourth Wave of COVID-19: The Effects of Trauma on Health Care Workers

This post is the introduction to our newest digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce. All contributions to the symposium will be available here.

By Stephen Wood

On this day one year ago, World Health Organization Director-General Tedros Adhanom declared COVID-19 a pandemic, sounding the alarm about the international threat posed by the virus.

Today, one year later, I fear the end is not in sight. In fact, I believe that we are on the precipice of a fourth wave.

The fourth wave will strike the people on the frontlines of this pandemic — health care workers. It will be the effects of the trauma that health care workers entrenched in this pandemic have faced. And it is likely to have significant and lasting effects on our health care system.

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Empty hospital bed.

New Data Reignites Concerns over COVID-19 and Nursing Homes in New York State

By James W. Lytle 

Concerns over New York State’s response to the COVID-19 pandemic, particularly with respect to its treatment of nursing homes, have recently re-emerged in light of a new report and court ruling related to the matter.

Almost from the outset of the pandemic, the State faced scrutiny as to whether it was accurately reporting deaths of nursing home patients.

After nursing homes complained in April about the lack of PPE and other resources to combat the pandemic, Governor Andrew Cuomo responded that it was not the state’s responsibility, and asked the Department of Health and the Attorney General to launch investigations into nursing homes’ response to the pandemic.

Nine months later, in late January 2021, the report by New York State Attorney General Letitia James of the nursing home investigation was released.

Among the report’s headlines, the Attorney General’s preliminary analysis found that the Department of Health had undercounted deaths of nursing home residents due to COVID-19 by about 50%, largely because of the failure of the State to count the deaths of those residents who were transferred to hospitals immediately prior to their deaths. No other state excluded patients who had been transferred before death to hospitals from their nursing home fatality reports.

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Senior citizen woman in wheelchair in a nursing home.

COVID-19 and Nursing Homes: The New York State Experience

By James W. Lytle 

While New York State has generally earned high marks for its response to the COVID-19 pandemic, nagging questions continue over whether more might have been done to protect patients in nursing homes and other congregate settings — and whether some of the state’s policies even may have made matters worse.

Lessons from the New York State experience may prove helpful to those regions that have displaced New York as the epicenter of the American pandemic, and may help ensure that adequate steps are taken to protect the most frail and vulnerable among us from any resurgence of COVID-19 or from some future disease.

Although New York was among the hardest hit states, with the highest number of deaths thus far (over 32,000, more than twice as many as California), the aggressive steps taken by Governor Andrew Cuomo and his administration have been widely credited with reducing the spread of the disease in the State.

But a key, sustained criticism of the Governor’s handling of the pandemic focuses on the state’s nursing homes.

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