Home Moral guidelines COVID’s assault on the moral fiber of medicine

COVID’s assault on the moral fiber of medicine


The fourth wave of COVID-19 tests the moral fiber of American medicine. The virus has infected more than 42 million Americans and killed more than 675,000 in less than 2 years. Now, the Delta variant again forces us to deal with an onslaught of critically ill patients while delaying routine care and emerging surgeries for others. As intensive care units fill up and dozens of people, mostly unvaccinated people, needlessly die, those of us in health care find themselves facing a deep chasm – a chasm filled with frustration and of exhaustion, where the reserves of empathy quickly dry up.

As COVID-19 tests the medical community in new and unimaginable ways, we can turn to our predecessors for advice. In 1983, a small group of doctors and nurses from San Francisco General Hospital opened ward 5B, the first AIDS service in the United States. Despite an incredibly high death rate, a lack of evidence on disease transmission, and an anemic government response, these volunteers were determined to bring humanity to their increasingly isolated and desperate patients. At the cost of great personal sacrifice, they put aside their fears and an attack of societal judgment, including a hostile narrative that blamed squarely on the “personal choices” of those who contracted HIV.

Room 5B eventually became iconic for how we have provided care to AIDS patients around the world. The experiences of its health workers informed some of the first studies in the mid-1980s on the risks of exposure and transmission of the disease. Soon after, the CDC introduced new guidelines to protect workers from HIV and other blood-borne pathogens. Guidance from the CDC and the Occupational Safety and Health Administration in response to viral outbreaks of illnesses ranging from Ebola to SARS continue to inform how we treat patients and protect ourselves.

Today we are again at war with a hostile virus – this time with COVID-19 causing levels of morbidity and mortality that make the early days of the AIDS epidemic seem tame by comparison. The most brutal reality of all is that we know it didn’t have to be this way. Safe, free and highly effective vaccines are readily available. Healthcare professionals find themselves broken, frightened and furious as the pandemic unnecessarily continues and the number of deaths rises. Some of us even harbor righteous indignation. Many are considering or have left the profession.

These are harbingers of a dark inflection point in American medicine that could have lasting and potentially catastrophic consequences for the most valuable connection we hold: the deep alliance with patients we have sworn to. protect. Passing judgment on the personal decisions of those in our care may seem justified at the time, but the collateral damage to ourselves and to our patients is permanent. There is no medical innovation, no prescription, no surgery that can relieve suffering without the basic trust that exists between patient and healer.

When we hear the story of releasing the unvaccinated, we can take the opportunity to refocus on our core load as healers, one that requires us to listen to patients with empathy and build trust. Persuasion, not coercion, is our best hope for promoting COVID-19 vaccination and defeating our common enemy. Together, we can assume our collective freedom from the suffering this virus has created.

The COVID-19 pandemic will eventually come to an end. All pandemics do. When the fog of battle clears, we will all have to ask ourselves: How will history remember us? As healthcare professionals who did what we were trained to do when the patient in front of us needed us most? As an exhausted, horrified but resolute army fighting a common enemy? Or will our chapter be about the moment in American medicine where we fundamentally reset our moral compass, damaging our most important relationships?

For years, we have been unable to identify the source of HIV infection. Many healthcare professionals feared for their own safety, believing that “lifestyle choices” were the cause of the suffering. Many have even refused to treat AIDS or HIV-positive patients. Of course, we now know that HIV is not as contagious or deadly as COVID-19, and its direct threat to healthcare workers can be largely mitigated by universal precautions.

But the doctors and nurses in room 5B did not know then what we know now. They stepped forward, despite their anguish and fear, and called on their collective humanity to carry them forward. History looked fondly on their sacrifice.

Stephen Parodi, MD, is Executive Vice President of the Permanent Federation and National Infectious Disease Leader for Kaiser Permanente.


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