Working in the Virus’ Shadow: SARS-CoV-2 4 April, 2020, 1600 Hrs

One can gain a brief view of the specter sweeping our country – indeed the world – by walking the halls of our medical centers. There is concern and fear everywhere.

Firstly, one sees health care workers – nurses, physicians, pharmacists, Respiratory Therapists – always wearing masks, touching nothing without gloves, scanning the horizon as they walk the hospital corridors for threats. One can sense the tension in what is normally a somewhat freewheeling culture.

There’s something more than this, though. More than the masks and the furtive glances.  One can almost see fellow workers in the hospital glancing over their shoulders, trying to catch a glimpse of the disaster that’s coming our way, that threatens all of us and appears to be gaining on us, despite all our efforts.

They know – we all know – that our health system, our country, remains unprepared for this disaster. From the earliest days of the Trump Administration, before this pandemic was even a consideration, our ability to protect our citizens was compromised. Trump and his National Security Advisor, John Bolton, removed the Pandemic Response Group from the NSC; they were simply eliminated. When the first cases of the viral infection were reported from China, the group that would have focused on this was gone. When it was clear there was a problem and our Centers for Disease Control and Prevention jumped into action to develop a test for the virus, they stumbled. Then the stumble was made worse by the Administration’s initial refusal to create a Pandemic Group to handle all of the issues related to the SARS-CoV-2-induced disease. The administration refused to to use the WHO test, developed in Germany, while the CDC trouble-shot the flaws in the one CDC had created. This left us blind; we had no idea how many of our citizens were infected. When Trump finally put together a Pandemic Group, it was (briefly) led by HHS Secretary Azar, then by the science-denying VP Pence, and now by Jared Kushner, a boy-man who has bought his way into each of his “successes”. A more motley and incompetent group of “leaders” could not be imagined.

The CDC has been sidelined form the Pandemic Group. We are fortunate to have Doctors Fauci and Birx who at least appear to have the ability to focus the Pandemic Group on reality, although Doctor Birx’s descent into obsequiousness remains disturbing. Yet even with knowledgeable scientists as members of the Group, even with these scientists counseling Trump to order a nationwide stay at home order, he has refused to do this, stating that he wants the Governors to run this process. Presently, ten Republican Governors have refused to do so.

In addition to the administrative mismanagement, there is the problem with equipment, supplies and personnel. Inadequate supplies of Personal Protective Equipment (PPE), sanitizer, ventilators, hospital and ICU beds, even intravenous saline solutions. It is true that even with the best of administrations, this Pandemic would have been challenging, yet the Trump Administration has not been the best. There is and had been, centrally and most importantly, no coordination of requisitioning and delivery of equipment and supplies. The States, trying to buy equipment, are forced to bid against each other and, shockingly, FEMA. This is an inexcusable breakdown of authority and responsibility. Trump’s Government has behaved as does a criminal organization: rewarding friends and punishing perceived enemies.

How many of us will die or become disabled due to this Pandemic? The numbers depend upon the assumptions made for the calculations. And these assumptions vary because all states have not issued Stay at Home orders. If we don’t prevent, if we don’t mitigate, if we don’t suppress, more of us will be infected and more will die.

What is clear, what is sure, what is true is the following: Through his incompetence and vindictiveness, and by installing incompetents into high positions in our Government, Trump has ensured that somewhere between 200,000 and 2 million Americans will die from SARS-CoV-2. This is, if not technically criminal, at least morally so. Each death is on his hands and on, of course, the hands of those who continue to support this criminal incompetent.

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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