A Doctor Warns of the ‘Biggest Risk’ We Face Right Now

Can we keep health-care workers healthy enough to provide care?

On Tuesday, I spoke with Daniel Horn, a physician at Massachusetts General Hospital. He is leading a team preparing his institution for an influx of coronavirus patients. In our last interview, on Sunday, Horn was anxious that his broader community hadn’t yet adopted social distancing. That policy is now firmly in place, but a new set of problems is looming.

Franklin Foer: Are you carrying any new worries since we spoke on Sunday?

Daniel Horn: At this point, there is really growing concern about the safety of health-care workers. We are already seeing clusters of health-care workers having to take time off of work while they are tested or awaiting test results.

Foer: Let’s just pause there. When does a health-care worker have to go out of commission?

Horn: Every institution is working through this. I think the simplest way to think about this is, today in the United States, if you are a health-care worker and you develop any upper-respiratory symptoms—cough, sore throat, sniffles—you’re going to be out of work for some period of time. That really puts us at risk of losing large swaths of the health-care workforce before the escalation of cases really comes.

Foer: Is that already happening? Is it happening at MGH?

Horn: I can’t talk about specific numbers, but we’re seeing clear signals that this is happening. And my message to you is that you should not come to the doctor’s office without an appointment, and you should not come to the doctor’s office with any sort of upper-respiratory illness, without notifying your health-care provider that you are coming in. I expect that hospital systems will rapidly build dedicated clinical sites to manage patients with respiratory illnesses, where all workers are appropriately wearing personal protective equipment. At this point, we are starting to see signals that practices are beginning to struggle with managing phone volume. If you’re on hold for too long and then you show up with a respiratory illness, even if you’re feeling well, you are putting the health-care workforce at risk.

Foer: If I’m a health-care worker, and I was exposed, say, two days ago, to a colleague who started to come down with symptoms, would I have to stop working?

Horn: Guidelines will range. But if a worker spends a few minutes within six feet of someone with a confirmed case, they are being furloughed.

Foer: How does a hospital compensate for sick workers or those awaiting tests?

Horn: We are operating as virtually as we possibly can now. We are staffing our clinics currently at 10 to 30 percent, and we are very actively keeping as many of our health-care workers home as possible. I would strongly encourage everyone to send routine inquiries to your health-care workers through patient portals or any other electronic means of communication because so much of our workforce at home is working.

Foer: It’s interesting that even at a hospital you’ve adopted teleworking to protect the workforce.

Horn: We want to do everything we can to protect the workforce right now. That’s the biggest risk. Again, the biggest risk, and I can’t emphasize this enough, is we lose our health-care workforce before the caseload rises dramatically, as we worry that it will.

Foer: How close are we to shortages of crucial supplies?

Horn: Most hospitals are now pulling from the national reserve. And unless we have a pipeline to resupply that reserve, this is a looming disaster.

I would also just say that it would be great to see our collective society, our large corporations, consulting firms, logistics experts like Amazon, be thinking aggressively about how to rapidly either procure or manufacture personal protective equipment for health-care workers. Yes, we moved to social distancing. That is tremendous. The next thing that needs to be solved: We need personal protective equipment for our health-care workers, and then ventilators.

Or, thinking aloud here: Corporations and global communities really ought to stand together to collect all the hoarded personal protective equipment, masks, Purell, surgical masks. In particular, no one in a house needs an N95 mask. They are in short supply. We should find a way to get them back out of houses, and into the hands of health-care workers. I don’t have a plan, and it would need to be a very thoughtful approach. What if a community put all their hoarded supplies on their front porches at the same time, one day during the week? Amazon could set up an operation to gather it. If we designed it right, we could make it safe and get those supplies back into hospitals.

Foer: What is it like to come home at the end of a day in the hospital after staring catastrophe in the face?

Horn: It’s hard. It’s hard. I think that the risks around provider burnout, with all the stress and profound fatigue, are going to grow. Health-care workers are essentially in wartime mode, where they’re having to navigate unprecedented rapidity of change. Health-care changes really slowly, and right now we’re changing really, really quickly. We are trying to do two years’ worth of work in two weeks. Prime example being I am involved in a large team trying to get 2,000 physicians and nurse practitioners tele-health capacity, to do video consultations with patients. We’re going to try to get that done in the next two to three weeks.

And so people are being asked to step up. Old job descriptions may no longer apply and people are asked to do whatever their skills allow them to do, whatever their credentials allow them to do. I think that for me personally, I have had to quickly try to find some moments in the day to pause and breathe, meditate. And I think everyone’s going to have to ask themselves: What is it that they need day to day? I need breakfast with my kids.

One thing I would say is just, the spouses and partners of health-care workers are particularly lonely right now. They often have no other support. And so if you have those people in your life, it would be good to give them some love.