Medical personnel transport the first patient affected by COVID-19 to an ICU tent ( Emanuele Cremaschi/Stringer/Getty Images)

In a defunded health system, doctors and nurses suffer near-impossible conditions

“Who knows how many of us have been exposed?” one nurse said



Seth Holmes - Liza Buchbinder
March 29, 2020 6:50PM (UTC)

"This virus is deadly, but they're throwing us into the fire and saying, 'oh well.'"

The doctor who said this continues to show up daily, caring for patients in need. Her health — and that of millions of other doctors, nurses, their families and the patients they care for — is put at risk when our leaders de-fund the health system that protects us all. She and other front line health workers, covering extra shifts and working overtime in this historic pandemic, tap into reserves of strength and resilience in hopes that the long overdue staff, equipment, space and systems arrive before the cases of COVID-19 surge out of control.

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One Seattle area critical care physician, working in the intensive care unit (ICU) told us this past week, "I'm trying not to get too freaked out, but it's hard." Another called us from a large, urban hospital on the West Coast said, "It's very scary and I've panicked many times. But what can you do?"

Another nurse from a rural hospital told us: "I'm going in to work in the hospital tonight. There's a patient positive for COVID-19 in the ICU. Dreading to go in, but obviously wouldn't call out of my shifts."

These are the distressed voices of our friends and colleagues — frontline health workers entering hospitals every day, working overtime, covering extra shifts in this historic pandemic. Our friends, colleagues and co-workers have asked not to be named for fear of losing their jobs in this uncertain time.

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We are acutely aware of how contagious and deadly the virus is — especially for elderly and chronically ill people. Yet, we and our patients are put at unnecessary risk due to shortages of basic protective health equipment and testing kits. These shortages were avoidable and they never should have happened. The Trump administration's active de-funding of our health system is leading to additional exposures, infections and deaths.

We have trained over many years to calmly soldier on in the face of the turmoil, suffering and pain that plays out every day in health care. But the avoidable shortages of basic equipment in this pandemic add layers of uncertainty and strain that are pushing providers and our health system toward the breaking point.

Another colleague and single mother of two young girls shared this week, "All these other moms are sharing color coded schedules to keep kids busy and I'm thinking I just don't want to end up in the ICU as a COVID statistic."  A nurse working in a large, private hospital in a major U.S. city explained, "Our hospital alone has had close to 300 cases. The latest person to test  positive has been in the hospital for over 90 days. Who knows how many of us have  been exposed?"

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Yet, what causes fear most for front line physicians and nurses is not the COVID-19 virus itself nor even the Severe Acute Respiratory Syndrome it can cause, but rather the lack of protective equipment and testing kits. The lack of protective equipment — including N95 masks — and the lack of test kits to diagnose and treat patients make it nearly impossible for us to care effectively for patients. Without this basic protection, dozens of clinicians in the U.S. have already contracted COVID-19. Others are on mandatory home quarantine, unable to work as they wait to know their own fates.  Some are currently intubated on ventilators in ICUs as patients themselves. Many continue to work in the midst of fear and uncertainty. And many more are on mandatory standby for COVID deployment – what could become effectively a medical draft.

Echoing statements from other friends and colleagues across the country explained, a nurse in New York City shared, "I don't think hospital staff should be destined to contract COVID just because there's a lack of Personal Protective Equipment. I did not sign up to die because of a lack of PPE!"

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A physician in an outpatient clinic in the Midwest explained, "Clinic gets hairier every week. Still can't believe we can't do testing." Another physician in a hospital in the South stated, "This is not that hard – get us what we need so we can work. We will work, just with the right equipment. How is this even a roadblock in a country like the US?"

Due to avoidable shortages, many hospitals now require doctors and nurses to re-use masks day after day, sometimes for more than 30 days – prompting the Twitter hashtag #GiveMePPE. The lack of equipment also leads to policies prohibiting clinicians from using protective masks even when concerned for our own safety, unless caring directly for a patient designated a "Person Under Investigation." Due to lack of simple synthetic nasal swabs, we are prohibited from ordering tests for many patients in whom we suspect COVID-19— even if the patients have a fever or cough and predisposing condition. These policies are not due to rational, evidence-based medicine. Rather, they stem from a lack of "staff, stuff, space and systems".

In the words of one of our physician co-workers this week, "Unless hospitals want to burn through their doctors and nurses with us all in quarantine, they better let us protect ourselves." A medical school classmate of ours now working in a level one trauma center added: "I'm not going into another room with a patient being ruled out for COVID-19 without an N95 mask. Period. They can fire me and the rest of the doctors and nurses who feel similarly."

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The lack of basic equipment is not due to the pandemic itself. Rather, the effects of the virus are intensified by the active de-funding of our health system by the Trump administration.

Since his inauguration, Trump has left almost half our scientific leadership positions unfilled. In 2018, the CDC was forced to close or downsize its efforts to fight global epidemic outbreaks in 39 of 40 countries, including China. That same year, the Trump administration dismantled the National Security Council's global health security unit and recalled $252 million of emergency funds for rapid response to outbreaks. In 2019, the Trump administration closed the US Agency for International Development's program working with researchers across the world to respond to viruses. And Trump's 2021 budget released last month includes $3 billion in further cuts to core federal agencies including global health response programs. As Robert Reich, former Secretary of Labor, pointed out, in many senses we do not have a public health system. Instead, we work in a for-profit healthcare system that is disjointed and ill-prepared for this and future crises.

We are not sure how long this can continue – especially as more health professionals are quarantined or become sick themselves. Instead, we must stand with frontline health workers and their patients, demanding health and social systems that serve all people, fully funded and supported with staff, stuff, space and systems.

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The cuts to the health system are adding fuel to a fire that is now burning out of control. As a society, we must begin to see health and social systems, as well as the frontline doctors and nurses working within them, as more important than the banks and corporations we rush to bail out. In this moment, our lives are in their hands.


Seth Holmes

Seth Holmes is Associate Professor and Chair of Society and Environment and Medical Anthropology at UC Berkeley and UC San Francisco and author of the book, "Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States."

MORE FROM Seth Holmes

Liza Buchbinder

Liza Buchbinder is a physician and anthropologist in the Center for Social Medicine and Humanities at the UCLA whose work focuses on human trafficking and health.

MORE FROM Liza Buchbinder


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Commentary Coronavirus Covid-19 Doctors Health Professionals Medical Industry Nurses

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