Maybe This Is Our Burden Too

By Marybeth Lambe MD FAAFP

It's not like we medical providers haven't been overwhelmed already. Engulfed, shipwrecked, pretty much underwater. But still... Who else is there at the end? I keep coming back to a duty I think we also have; whether I've done my part on this one. I thought about it again last week as I sat, the only person available to witness another health provider’s death, as he died, alone, on a ventilator at age 41. I don't like doctors as an abstract concept. never mind that I am one. We aren't the best listeners, many of us give substandard care especially to women, minorities, even to those with disabilities or simply a weight we find fault with. if you disagree then maybe you are part of that problem. I volunteer in ER's & sure, right now, aren't we the heroes but then anyone is a hero who takes one step forward. In truth, we feel helpless, scared, and we aren't doing this thing I think we should be. Meanwhile, people keep dying of this damn virus. Sure, health care workers too. And who would have guessed we would be wading into the whole thing wondering where the next mask, the next protective piece of equipment was coming from? But that’s part of my point. We have always been strangely apolitical. And WHY is that? How is it we couldn’t get even a DPA going from the federal government at a time we were critically short of ventilators and PPE? Why were we unable to light the sky for a federal reaction? What good were we in that?

The Defense Production Act, dates from the Korean War era. It's a law enabling our federal government to command private industries to ramp up and provide items needed in national use. Peter Gaynor, Federal Emergency Management Agency Administrator admitted that President Trump never did use the DPA to produce anything. I still try to imagine if every citizen could have had an N95 mask & been taught to use it. And we had sent out instruction from among our 40 million unemployed. We never even tried. Health care providers could not get enough masks, there are still shortages. The excuse? Well, only 13% of the public could understand the YouTube instructions on how to fit an N95 mask. Turns out about that many providers also understood that video but we had other help in learning. Why didn’t we scream about this? Why didn’t we demand DPA for first us & then our brethren, the people we are sworn to defend-our patients, our communities, the citizens around us? 

Well, because we never got enough. That’s true. We just kept working away. Where did our protective outrage go? 

Why did we let the lies build? I am not trying to disrespect my colleagues who vote republican, who voted for Trump. I am sure you know why you do. 

When our own leader refused nationwide lockdown, causing a delay that has already tripled our death toll did we scream enough? When governors were taunted as wimps until they caved, reopened, and caused devastating scenes we now witness--were we loud enough? We worked while our leader mocked masks. We worked & died as confusion grew over mask-wearing while the leader showed more interest in his ability to memorize “Person, man, woman, camera, TV” than in the human carnage wrapping itself around our collective hearts. 

Had the president realized mask-wearing would have saved trillions of the GDP, would we now be offering, as human sacrifice those who would caretake children in school? Are we complicit? It's too dangerous to have Republican convention but sure, open the schools to fix the economy? The economy ruined by an endless surging first wave can be repaired if public schools will serve as daycare so parents can get back out & work.

Our leader's own son will not be going back to school himself. And no worries for that private school—not only richly endowed St. Andrew's Episcopal School in Potomac, Maryland, it also received PPP funds it will get to keep, open or not.

Do we speak out about real science? We are providers. Do we agree we care? Do we agree that facts matters?

While children UNDER age 10 years may well shed virus less—at least in countries where the virus has been wrestled to a standstill, children OVER age 10 transmit at a rate equal to adults. Adolescents get on the bus, sit with teachers, go home to parents, grandparents, aunts, and uncles and spread COVID. 

Are schools to run by 9-year old’s or what is to become of the adults in those institutions known as public schools? Do you think, for one minute that Mr. Trump has an abiding interest in children? Have you witnessed Betsy DeVos’s interviews? Any of them? Perhaps the one in which she suggested firearms may be needed by those in Wyoming schools because she believed Grizzly bears might be quite a risk in those schools? Seriously. How I wish I was not.  

18% of American teachers are age 55 years and older. In California, that number rises to 24% of teachers being over age 55. [Florida does not release statistics] Almost 12% are 50-54 years of age. Only 15% are under 30 years of age. 

The average age of a principal is 50 years of age. 

The median age of school bus drivers is 52.3 years of age. Male bus drivers tend to be older with an average age of 54.4 years. 

7% of seniors live in a home with elementary age children More than half of seniors live in one of 11 states. Please note how many of these states are hot spots: Florida, California, Georgia, New Jersey, Texas, Pennsylvania, Illinois, Ohio, North Carolina, New York, and Michigan

COVID deaths are occurring in younger age groups. In California, for example, reviewing COVID deaths, 25% of COVID-19 deaths as of July 10 were in those between 25 and 64 years old.

A recent mutation in COVID has made it more transmissible. 

The value of schools opening lies in the vital need children have for education, social exposure and that some children otherwise suffer neglect, abuse, & hunger. Mr. Trump’s reason for wanting school opening is that he wants schools to serve as daycare so parents may return more fully to work. The economy, he hopes, might then improve.

Both Mr. Trump and Betsy DeVos refer to a non-peer-reviewed, non published piece of research from Germany that has even those researchers concerned. “We are not trying to argue that children do not spread the virus at all, and you are absolutely right that in high-infection communities, children will get infected and will transmit to close contacts.” Betsy DeVos had blithely claimed children could be COVID “stoppers” Want to sign your own child up for the cause? 

And many studies do support the fact that children age 10-19 DO spread COVID easily: A South Korean study by Park YJ, Choe YJ, Park O, Park SY, Kim YM, Kim J, et al. Contact tracing during coronavirus disease outbreak, South Korea, 2020. Emerg Infect Dis. 2020 Oct This study showed clear evidence 

Mask wearing in schools would be vital. Our acceptance of masks have seemed rather dismal. Kids CAN be accountable and will do well with masks when it’s an accepted norm. I was surprised too, having assumed children would pull on them so often it wouldn’t be helpful. And would small children need them if young kids had only limited contagiousness? Here’s what I learned. In China, South Korea, Japan, and Vietnam—where masks are already widely accepted and worn by many during flu season—schools require them for almost all students and their teachers. They take them off only for meals. This is true in many other countries but the evidence it matters occurred in Israel when a heat wave caused a pause in mask use in young school children. Guess what happened? Gymnasium Rehavia, a school in Jerusalem that—2 weeks earlier had relented on mask use in the young kids due to terrible heat—had a very large outbreak exactly 2 weeks after this event. So much for the idea that young kids are safe from the virus…

In Israel some schools had to close as the virus spread- By mid-June, 503 students and 167 staff were infected, at least 355 schools closed temporarily. Other schools managed to stay open. And remember schools had only opened AFTER the country had stopped all transmission. 

The administration has pointed to school opening success in other nations as evidence that our country should go ahead and open too. Mr. Trump repeatedly avoids noting these other countries only opened after they had controlled their first wave. USA has now 4,000,000 cases. We average 1,100 deaths every day. Our ICU’s are overrun. We are shuttling critically ill patients hundreds of miles, wherever we can find a bed for them. We have been on a terrifying upward trajectory of our first wave unlike almost any other country save Brazil and India.

I agree school opening decisions are tremendously complex. I beg you to value another duty we have. One to children, to teachers, to school assistants, to principals, to bus drivers, to daycare providers—to know honestly that they matter. To become more vocal about science, about truth--even while you can barely hold your head up anymore. To hold this decision away from those who have other motives beyond love, science, and hard thought. 

Keep them safe in that arduous moment of consideration. I do not believe Mr. Trump values them. Besty DeVos puts no price on such children and on those who would shepherd them. These children and those who would guide them are treasures and only those who understand this may enter the debate and the decision. We cannot allow such valuable lives as this to be used as a gamble, as a way to recoup when masks were mocked, when an early lockdown was laughed at, when "liberate' states were tweeted when COVID was called a hoax by our own president. Yes, it is too much to ask us. And no, it is not even half enough of what we should be doing. We should have been louder long before this. Thanks.