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Category: Health Care Workers

  • The Hypocritical Oath

    Residency training often claims to focus on training effective physicians. In reality, it’s an intricately designed conditioning process to train physicians to be tools for profit maximization. In order to be truly “effective” physicians, residents, in solidarity with other healthcare workers, must organize to challenge the systems that lead to suffering and illness both in health care and around the globe.

    Image of person in a white medical coat holding a stethoscope in their left hand and crossing their arms.

    The end of medical school is a moment that, for many medical school graduates, is several years — sometimes several generations — in the making. After four grueling years the graduate is ready to officially get that “MD” behind their name. But what else has the four years of medical school done for the soon-to-be physician? As previously discussed, medical school is not an apolitical environment in which “medical knowledge” is simply passed on to each student. Mechanisms are put in place to condition students to be less likely to question systems of power. Overall, the medical school structure serves as an indoctrination system. By the time they graduate, medical students are forced to take on massive amounts of student loans — the average medical school graduate has around $250,000 in student loan debt — which serves as a form of economic control and coercion. By conditioning thought and using economic coercion, the medical education system helps make the physician more likely to participate in and help maintain a capitalist healthcare system whose focus is extracting monetary value from people’s bodies damaged by capitalism and colonialism.

    This indoctrination starts even before medical school as the educational system filters for a medical school candidate from a particular class and racial background. Folks from working-class backgrounds are systematically excluded from medical school education — from premedical courses designed to “weed out” students, few opportunities for mentorship, and unsupportive career counselors to hard-to-meet shadowing or extracurricular requirements to the highly prohibitive costs of standardized testing, applications, and interviews. To be clear, these dynamics are nothing new. In his book Rockefeller Medicine Men: Medicine and Capitalism in America, E. Richard Brown cites concerns raised by education leaders as far back as 1908, when the Association of American Medical Colleges (AAMC) was criticized for changing attendance requirements for medical school. As Brown states, the proposed requirement for a college education before attending medical school would “exclude poorer classes from their [medical school] ranks.”

    This trend continues today. According to an analysis from the AAMC, the median family income of matriculating medical students has only increased over the years, and it will likely further systemically skew upward in the coming years. These filtering mechanisms also serve to limit the political perspectives of incoming medical students, making it even easier to structure the collective thought of students once they are in medical school.

    After all this, what comes next for the new doctor? Medical residency. Medical residency lasts anywhere from three to seven years depending on the medical specialty. It is considered the place where physicians learn to “practice” the “art of medicine.” But what actually happens in residency? Residents work long hours for large corporations while being told that their work conditions are beneficial to their “learning.” In reality, though, residents work as cheap labor for the medical industrial complex. During residency, trainees learn to respect the corporate hierarchy, keep their heads down, be subservient to authority, and, most importantly for the capitalist medical system, how to more efficiently funnel patients through medical factories for profit.

    A Brief History of Modern Medical Education

    To discuss medical residency, we must understand how residency serves as a training program to produce physicians who function within and perpetuate the capitalist medical system. The field of medicine supporting the foundational structures of capitalism in a settler-colonial society is nothing new. For example, as E. Richard Brown cites, in Walter Fisher’s study of medicine’s role in the antebellum South, Fisher concluded that enslaved people were given medical care mainly because of “the tremendous economic investment they represented to slave owners.” Additionally, medicine was weaponized to justify the racial hierarchy that serves capitalism. As medicine became more modernized and education more formalized, it was important to ensure physicians were trained to practice medicine in a particular way. A document crucial in setting this path for modern American medical education was the Flexner Report.

    As educators of the Health Justice Commons (HJC) discuss, the Flexner Report, a landmark document written by Abraham Flexner and commissioned by the Carnegie Foundation, helped set the standards for modern medical education. The report was critical in helping shift modern American medical education to a strictly biomedical focus. As the HJC discusses, the report alienated traditional healers, criminalized alternative forms of care, and deemed women and people of color unfit to participate in medical education. In Rockefeller Medicine Men, Brown cites Flexner’s views that the practice of Black doctors be “limited to his own race.” Flexner perpetuated racist views about disease transmission by advocating for “improved training for Black physicians” largely because whites lived near Black people. These prejudices translated to medical school reforms and closures. Post-report, Black medical schools were disproportionately affected by closure, with 71 percent of Black medical schools closing compared to 55 percent of white institutions. Of the seven Black medical schools in existence at the time, only Meharry and Howard survived.

    The report also helped solidify a medical education system that systematically excludes applicants of working-class backgrounds, arguably institutionalizing the elitism of the medical education system. Flexner believed the previous requirement of just four years of high school before medical school attracted “a mass of unprepared youth drawn out of industrial occupations into the study of medicine.” As Brown notes, “Neither the ‘crude boy’ nor ‘the jaded clerk’ were suitable material for a career in medicine.” Flexner’s prescription was to require college before medical school. Brown emphasizes that this occurred at a time when “only 15 percent of the high school age population was enrolled in high school and only 5 percent of the college age population was enrolled in a college or university.”

    In the early 20th century large monopoly families were constantly exploring how to increase their wealth and power by controlling societal institutions. The Rockefellers, for example — a family headed by J.D. Rockefeller, an American capitalist and oil baron who profited off the Holocaust — founded the Rockefeller Institute for Medical Research in 1901 to privately fund medical research. Families such as the Morgans (of JP Morgan) were also active in the research-focused Carnegie Foundation, which they used to exert greater control over legislative and governmental bodies.

    The Rockefeller Foundation was headed by Dr. Simon Flexner and notably did not support research investigating the connection between social factors, health, and disease. The ruling elites had no interest in changing society for the general health and well-being of the populace as an end in itself. Instead, research was explored in order to make the public healthy enough to labor, to be further exploited by capitalists. These ruling-class families also hoped to integrate these changes in medical education with contemporary reforms in education more generally to further expand their influence.

    In 1907, in the context of these larger reforms, the head of the newly reformatted American Medical Association (AMA), surgeon and professor at Rush Medical College, Arthur Dean Bevan, invited the head of the Carnegie Foundation for the Advancement of Teaching, Henry Pritchett, to discuss the possibility of a Carnegie-sponsored study on medical education. Eventually Simon Flexner’s brother, Abraham Flexner, was appointed director of this study, even though he had no experience in medicine. And thus, Abraham Flexner’s “Flexner Report” was born.

    While there can be arguments made around potential benefits of “standardizing” quality in medical education, as HJC notes, medical education’s shift to pure biomedicine has created captive markets of communities seen as disease vectors to be controlled through “healthcare.” In doing so, these reforms helped create vertical, high-profit industries in which patients become dependent consumers. The focus on biomedicine also served the financial interest of the medical industrial complex by not treating the root causes of illness, for self-preservation of the medical industrial complex itself. Additionally, it absolves the other interconnected industrial complexes (military, pharmaceutical, fossil fuel, manufacturing, farming) and allows their catastrophic effects on the well-being of the environment and communities to continue. As Brown notes, “The Flexner report united the interests of the elite practitioners, scientific medical faculty, and the wealthy capitalist class.”

    Medical Residency as a Tool for Indoctrination and Labor Extraction

    In their book Social Medicine and the Coming Transformation, physicians and activists Howard Waitzkin, Alina Pérez, and Matthew Anderson discuss how the training and education of healthcare workers can serve the interests of the capitalist system. They cite the work of Vincent Navarro, Spanish physician, sociologist, and political scientist who maintained there is a minimum level of health for the working class if it is to work. As a result an alliance must arise between the capitalist class and medical profession, as healthcare workers are needed to perpetuate the belief that the main causes of ill health are personal and biogenetic rather than social and commonly caused by the very occupations in which people work. Changes made to medical education as a result of the Flexner report, which continue to this day, helped to bolster this alliance. It is the job of healthcare workers who want to destabilize these oppressive systems to grapple with and struggle against this system of education. Today an elaborate array of conditioning mechanisms and structures are now in place to uphold these dynamics. Let’s discuss how some of these mechanisms function.

    Throughout medical school and residency training, students and trainees are subject to a series of licensing and board certification examinations. Studies have demonstrated that there is little to no correlation between United States Medical Licensing Exam (USMLE) scores and clinical performance in residency. Instead of ensuring the production of competent, compassionate physicians prepared to address the structural factors that cause illness and suffering, these examinations function to promote conformity and the status quo. Studying for these examinations can be all consuming, thereby diverting time from questioning and challenging harmful systems to test preparation.

    Additionally, these tests ensure a constant source of revenue for test preparation companies, testing companies, and organizations, such as the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), the licensing and testing bodies, respectively. In fiscal year 2019, the NBME reported a revenue of $180 million, with $177 million operating costs and a profit of $3 million. The FSMB reported a profit of $4.7 million in 2019, and in 2020, their CEO was compensated $726,518. This tax data, available on ProPublica’s Nonprofit Explorer, is an example of how nonprofit organizations function like corporations within the nonprofit industrial complex. Test preparation for USMLE licensing exams and specialty boards is also  highly profitable, forming part of the billion-dollar test prep industry. Preparation courses and practice-question banks all come at a cost, which can be prohibitive to first-generation or low-income students and trainees, which serves to further exclude people of color and working-class people from becoming physicians. In summary, standardized testing with an emphasis on physician competence disguises the real goal of producing physicians for the extraction of profit from bodies damaged by capitalism and is also profitable in and of itself.

    Medical residency is also profitable to hospital systems. Let’s look at the data on Medicare Graduate Medical Education (GME) payments, which has been compiled here. Payments consist of direct and indirect costs of resident education, that is, the salary and benefits of residents and their attending preceptors and program operating costs, respectively. The Per Resident Amount (PRA) paid for each resident significantly exceeds the resident salary. For example, in 2018, Howard University Hospital was paid a PRA of $169,206 for primary care specialties, while the salary for a first-year resident was $50,628.36. The 2017 paper “Eliminating Residents Increases the Cost of Care” calculated the cost of replacing residents. Residents are paid less and work more than their replacements (they are not to work more than 80 hours weekly averaged across four weeks, as established by the Accreditation Council for Graduate Medical Education or ACGME, a body further discussed below). By the author’s calculations, the cost of replacing 1.0 Full Time Equivalent (FTE) internal medicine resident with 1.8 FTE Nurse Practitioner would be $168,104. The cost of replacing 1.0 FTE anesthesiology resident with 1.5 FTE Certified Registered Nurse Anesthetist would be $218,111. They conclude that “GME programs are a positive factor in hospital finances and should not be considered a financial risk.” Though hospital leadership pretends they are doing a service by “training the next generation of doctors,” the financial incentive is clear. Hospital CEOs do not care about training competent physicians; they care about improving their bottom line with cheap, overworked resident physicians.

    In addition to being inherently profitable, medical residency serves as an indoctrination process for the production of physicians who will be complicit with the medical industrial complex. The Accreditation Council for Graduate Medical Education (ACGME) is the accrediting body for residency and fellowship programs, whose stated purpose is “improving the patient care delivered by resident and fellow physicians today, and in their future independent practice.” How does the ACGME determine when a resident physician has become “competent”? For one, through dictating the number of patients that should be seen during residency, with an emphasis on clinical efficiency during a 15–20 minute “patient encounter.” This number is 1,650 for family medicine residents, with the implication being that volume equals learning.

    Does it? Do residents learn to be compassionate listeners? Do they understand their patient’s illness experience and the oppressive systems that cause suffering? Do they have time to fight these systems outside the hospital or examination room? Do they have time to adequately precept and learn from their attending physicians? Do they have the option to slow down to learn if they need more time or support without fear of being placed on academic observation or probation?

    No, they learn to see human beings as a “single problem for today’s visit,” interrupt them midsentence, and further traumatize, police, and perpetuate harms of medical racism and the like. This practice is particularly damaging and exploitative given that residency programs commonly provide medical care in oppressed communities. Education about the systems that produce illness would cause the resident to conclude that the healthcare system, which commodifies illness and maximizes financial extraction from bodies damaged by capitalism and colonialism, must be dismantled entirely. Additionally, the ACGME says they value resident “well-being” and “patient safety,” which is why the 80-hour workweek was standardized. Eighty hours a week, however, is the equivalent of two full-time jobs, which leads to exhausted residents attempting to care for patients and increased risk of medical errors. Yet this comical “work limit” is maintained to give the perception of caring about well-being (of both resident and patient) while solidifying the place of the resident as a cog in the wheel of the medical industrial complex.

    Residency programs themselves take a crucial role in conditioning physicians. One way programs do this is by co-opting “woke” terminology in discussing the training of physicians without implementing policies that would change the actions of physicians practicing. For example, take implicit bias training, lauded in “social justice”–oriented residencies around the country. A study published in the Journal of Personality and Social Psychology in 2019 titled “A Meta-analysis of Procedures to Change Implicit Measures” brought together 492 studies on procedures used to change the implicit biases that influence behavior. The study “found little evidence that changes in implicit measures translated into changes in explicit measures and behavior.” Yet despite data showing these trainings are ineffective, they continue because they allow residency programs to appear as if they are teaching physicians to address systemic problems.

    This sets up a dynamic, which MD/PhD student Ariel Hart references in their piece on Medium titled “what i know to be true:” where “Talking about implicit bias, structural competency, health inequities and even anti-racism can take up a lot of time and energy and most of the times is a checkbox, to make people feel good about doing next to nothing to actually uproot structural violence in our society.” Programs use these checkboxes to pretend they are “doing the work,” but as Hart explains “we will not ‘implicit bias,’ ‘structural competence’ or ‘health inequity’ training ourselves out of this. We need to explicitly name and target colonialism, capitalism, racism, sexism, and other oppressions.”

    In residency programs around the country there also is a focus on “wellness” to address higher rates of “depressive disorders, depressed mood, burnout, and suicidal ideation” among medical residents when compared to their nonmedical peers. Studies demonstrate that “male doctors have suicide rates as much as 40 percent higher than the general population, and female doctors up to 130 percent higher.” While the causes of depression and suicide are multifactorial, the continual alienation of physicians inside the medical industrial complex and its factory-like commodification of patients takes its toll on physician well-being.

    Yet combating this exploitative system is rarely discussed as a solution to resident issues. Instead, individual solutions are proposed, such as “finding better balance” or “improved time management” or “meditation.” Ultimately, residency programs emphasize individual solutions because combating the factory processes of medicine would threaten their existence, and this process of individualizing systemic issues then extends to a physician’s practice after residency. Residency programs deflect responsibility for exhausting 80-hour resident workweeks, citing the ACGME, when programs could institute hour limit restrictions unilaterally, yet fail to do so. Programs rarely feel threatened to make tangible changes as time in residency is limited (typically three to five years); by the time residents start to organize, they will already be graduating. Therefore, less effort is put into changing exploitative dynamics. Residency programs help create and maintain exploitative conditions for residents.

    Prospects for a New Approach

    There is a commonly held assumption that it is possible to practice technically “good care” in the current medical setting despite its goal of maximizing profit at the expense of all else, with medical training systematically designed to depoliticize healthcare workers and uphold the current medical structure. It needs to be explicitly stated — it is not possible. The current medical system does not allow for adequate patient care and the medical education system conditions healthcare workers to either mentally suppress that known reality or perform mental gymnastics to convince themselves that they are providing “good care.” The first step in addressing this system is understanding that adequate healthcare under capitalism is not possible. A medical education that trains physicians to recognize, address, and destabilize destructive systems will be attainable only when healthcare workers, both in training and independent practice, politicize themselves to the degree they recognize the need to build new systems of medical education and healthcare.

    Current residents must mobilize to help create these new systems. One way residents can begin doing this is to participate in the Committee of Interns and Residents (CIR), a union. If the residency does not have a union, the residents should fight to win one. But in the process of fighting for a union or fighting with a union, residents cannot settle there. Once politicized, residents must demand militant, fighting unions that do not campaign for capitalist politicians and do not sign comfortable contracts for the boss that include “no-strike” clauses. Residents must demand that “their union,” CIR, stop trying to play nice with exploitative hospital systems, “asking” for moderately better working conditions, or “seats at” a table of executives who care about profit maximization above all else. Unions should not be fighting for seats at the table of the medical industrial complex — they should be fighting to cut the legs off the table and destroy it all together. Healthcare workers can collectively run these institutions themselves and do not need bosses who only make their jobs more difficult and obstruct patient care. As we have highlighted, residents keep hospital systems running, and they and their union must use all the tools possible, including work stoppages and strikes, to fight employers that ultimately do not care about workplace conditions or patient health. Healthcare workers must resist and reject the boss’s myth that organizing for better working conditions will harm patients.

    While residents fight for combative unions, there is a danger that the focus can become solely on obtaining a union, which misdirects energy from building militant organization between workers in a workplace. Residents can become siloed and lose the view of the exploitation of workers occurring all around them. This must be avoided. At the Institute for Family Health (IFH) in New York City, for example, residents worked to organize across staff lines, combining the struggles among residents, attending physicians, nurses, medical assistants, and all other staff, focusing on the exploitation all workers experienced because of the boss. This fight was ultimately betrayed by workers pursuing their own self-interest instead of maintaining a collective struggle — this serves as another example of the result of the lack of political education among healthcare workers — but fights like these can serve as schools of war for workers organizing together. Another example of the power of resident organizing is advocating for protest as didactics, as done by residents at the Swedish Cherry Hill Family Medicine Residency in Seattle, which now gives didactic credit for participation in political actions within the community.

    In this process, it is important to recognize and accept the interconnectedness of all systems of oppression that harm the working class, and ultimately harm all life systems on this earth. Medical students, residents, and physicians who truly care about health — whether that means the health of the patient, the health of the community, or the health of humans and living beings on the earth more generally — must participate in political organizing outside the hospital to challenge the medical industrial complex, capitalism, colonialism, and U.S. imperialism. You cannot #decolonize medicine at historically racist institutions on stolen land, and the changes needed will not come from within those institutions.

    Workers both within and outside medicine must participate in political organizations focused on not just challenging the medical industrial complex but the capitalist system as a whole. Ultimately, the fight against the system of medical education comes as part of a fight against the medical industrial complex, which cannot be adequately waged unless it also fights other systems of oppression.

    The post The Hypocritical Oath first appeared on Dissident Voice.

    This post was originally published on Dissident Voice.

  • Hospital Workers Report Rising Violence Throughout Pandemic

    Medical worker wearing overshoes in locker room, low section

    The San Leandro Hospital emergency department, where nurse Mawata Kamara works, went into lockdown recently when a visitor, agitated about being barred from seeing a patient due to COVID-19 restrictions, threatened to bring a gun to the California facility.

    It wasn’t the first time the department faced a gun threat during the pandemic. Earlier in the year, a psychiatric patient well known at the department became increasingly violent, spewing racial slurs, spitting toward staffers and lobbing punches before eventually threatening to shoot Kamara in the face.

    “Violence has always been a problem,” Kamara said. “This pandemic really just added a magnifying glass.”

    In the earliest days of the pandemic, nightly celebrations lauded the bravery of front-line health care workers. Eighteen months later, those same workers say they are experiencing an alarming rise in violence in their workplaces.

    A nurse testified before a Georgia Senate study committee in September that she was attacked by a patient so severely last spring she landed in the ER of her own hospital.

    At Research Medical Center in Kansas City, Missouri, security was called to the COVID unit, said nurse Jenn Caldwell, when a visitor aggressively yelled at the nursing staff about the condition of his wife, who was a patient.

    In Missouri, a tripling of physical assaults against nurses prompted Cox Medical Center Branson to issue panic buttons that can be worn on employees’ identification badges.

    Hospital executives were already attuned to workplace violence before the pandemic struck. But stresses from COVID have exacerbated the problem, they say, prompting increased security, de-escalation training and pleas for civility. And while many hospitals work to address the issue on their own, nurses and other workers are pushing federal legislation to create enforceable standards nationwide.

    Paul Sarnese, an executive at Virtua Health in New Jersey and president of the International Association for Healthcare Security and Safety, said many studies show health care workers are much more likely to be victims of aggravated assault than workers in any other industry.

    Federal data shows health care workers faced 73% of all nonfatal injuries from workplace violence in the U.S. in 2018. It’s too early to have comprehensive stats from the pandemic.

    Even so, Michelle Wallace, chief nursing officer at Grady Health System in Georgia, said the violence is likely even higher because many victims of patient assaults don’t report them.

    “We say, ‘This is part of our job,’” said Wallace, who advocates for more reporting.

    Caldwell said she had been a nurse for less than three months the first time she was assaulted at work — a patient spit at her. In the four years since, she estimated, she hasn’t gone more than three months without being verbally or physically assaulted.

    “I wouldn’t say that it’s expected, but it is accepted,” Caldwell said. “We have a lot of people with mental health issues that come through our doors.”

    Jackie Gatz, vice president of safety and preparedness for the Missouri Hospital Association, said a lack of behavioral health resources can spur violence as patients seek treatment for mental health issues and substance use disorders in ERs. Life can also spill inside to the hospital, with violent episodes that began outside continuing inside or the presence of law enforcement officers escalating tensions.

    A February 2021 report from National Nurses United — a union in which both Kamara and Caldwell are representatives — offers another possible factor: staffing levels that don’t allow workers sufficient time to recognize and de-escalate possibly volatile situations.

    COVID unit nurses also have shouldered extra responsibilities during the pandemic. Duties such as feeding patients, drawing blood and cleaning rooms would typically be conducted by other hospital staffers, but nurses have pitched in on those jobs to minimize the number of workers visiting the negative-pressure rooms where COVID patients are treated. While the workload has increased, the number of patients each nurse oversees is unchanged, leaving little time to hear the concerns of visitors scared for the well-being of their loved ones — like the man who aggressively yelled at the nurses in Caldwell’s unit.

    In September, 31% of hospital nurses surveyed by that union said they had faced workplace violence, up from 22% in March.

    Dr. Bryce Gartland, hospital group president of Atlanta-based Emory Healthcare, said violence has escalated as the pandemic has worn on, particularly during the latest wave of infections, hospitalization and deaths.

    “Front-line health care workers and first responders have been on the battlefield for 18 months,” Garland said. “They’re exhausted.”

    Like the increase in violence on airplanes, at sports arenas and school board meetings, the rising tensions inside hospitals could be a reflection of the mounting tensions outside them.

    William Mahoney, president of Cox Medical Center Branson, said national political anger is acted out locally, especially when staffers ask people who come into the hospital to put on a mask.

    Caldwell, the nurse in Kansas City, said the physical nature of COVID infections can contribute to an increase in violence. Patients in the COVID unit often have dangerously low oxygen levels.

    “People have different political views — they’re either CNN or Fox News — and they start yelling at you, screaming at you,” Mahoney said.

    “When that happens, they become confused and also extremely combative,” Caldwell said.

    Sarnese said the pandemic has given hospitals an opportunity to revisit their safety protocols. Limiting entry points to enable COVID screening, for example, allows hospitals to funnel visitors past security cameras.

    Research Medical Center recently hired additional security officers and provided de-escalation training to supplement its video surveillance, spokesperson Christine Hamele said.

    In Branson, Mahoney’s hospital has bolstered its security staff, mounted cameras around the facility, brought in dogs (“people don’t really want to swing at you when there’s a German shepherd sitting there”) and conducted de-escalation training — in addition to the panic buttons.

    Some of those efforts pre-date the pandemic but the COVID crisis has added urgency in an industry already struggling to recruit employees and maintain adequate staffing levels. “The No. 1 question we started getting asked is, ‘Are you going to keep me safe?’” Mahoney said.

    While several states, including California, have rules to address violence in hospitals, National Nurses United is calling for the U.S. Senate to pass the Workplace Violence Prevention for Health Care and Social Service Workers Act that would require hospitals to adopt plans to prevent violence.

    “With any standard, at the end of the day you need that to be enforced,” said the union’s industrial hygienist, Rocelyn de Leon-Minch.

    Nurses in states with laws on the books still face violence, but they have an enforceable standard they can point to when asking for that violence to be addressed. De Leon-Minch said the federal bill, which passed the House in April, aims to extend that protection to health care workers nationwide.

    Destiny, the nurse who testified in Georgia using only her first name, is pressing charges against the patient who attacked her. The state Senate committee is now eyeing legislation for next year.

    Kamara said the recent violence helped lead her hospital to provide de-escalation training, although she was dissatisfied with it. San Leandro Hospital spokesperson Victoria Balladares said the hospital had not experienced an increase in workplace violence during the pandemic.

    For health care workers such as Kamara, all this antagonism toward them is a far cry from the early days of the pandemic when hospital workers were widely hailed as heroes.

    “I don’t want to be a hero,” Kamara said. “I want to be a mom and a nurse. I want to be considered a person who chose a career that they love, and they deserve to go to work and do it in peace. And not feel like they’re going to get harmed.”

    This post was originally published on Latest – Truthout.

  • We’re All in This Together!

    In 2020, health care workers could do no harm.

    We praised their vast medical skills and knowledge. We banged our pots and pans for them and hung signs to profess our eternal gratitude. Well… maybe not exactly eternal. In 2021, you see, we’re dismissing their medical knowledge and our pots and pans have been replaced with pitchforks and torches.

    The message to our “health care heroes” is simple: get the jab or else. Never mind that you are literally health care workers, we get to decide what medicines should be injected into you. And if you don’t like it, you’ll be fired — and you’ll deserve it. And once you’ve been fired for exerting your medical knowledge and protecting your bodily sovereignty, you may even be denied unemployment insurance. Good luck being homeless, you ignorant Trump lovers!

    Never mind that just last year we genuflected in awe before your medical expertise. Today, we’ll publicly condemn you as unworthy of your scrubs. For example, here are just two excerpts from countless “letters to the editor” all across the Land of the Free™:

    “These workers are dishonoring their profession by neglecting patient safety and showing their ignorance of basic scientific facts. I have confidence that this group of people will not get their shots after the vaccines win full approval from federal regulators and will join other anti-vaxxers in spreading dangerous COVID variants.”

    “If you don’t believe in medical science and the safety practices of the profession, then a career in medicine is not for you.”

    Now, I have proven over and over that “basic scientific facts” and “medical science” are both tenuous concepts when viewed through the lens of current corporate propaganda. I won’t rehash that now but you can click here and here for two recent articles of mine. What also should be alarming is how easily programmable we’ve become.

    The powers-that-be required us to support the “health care heroes” narrative in 2020. So we did with obedience and gusto. The narrative in 2021 is all about the jab. And boy, have we delivered! Most Americans not only lined up for a shot without knowing what was being done to them. They also became unpaid cheerleaders, pubic relations workers, and enforcers for Big Pharma and government mandates.  After all, we’re all in this together… right?

    Reminder: This is what happens in a culture addicted to propaganda and fake news…

    The post We’re All in This Together! first appeared on Dissident Voice.

    This post was originally published on Dissident Voice.

  • Many Elder Care Workers Still Refuse to Get COVID-19 Vaccine

    Elder care worker assisting an elderly person using a walking aid

    They are two sisters in two states. Both are dedicated health care professionals who watched in horror as COVID-19 swept through the nation’s nursing homes, killing a staggering number of residents and staff alike.

    One sister is now vaccinated. The other is not.

    “Dude. Get vaccinated!” Heidi Lucas texted her sister Ashley in May from her home in Jefferson City, Missouri.

    “Nope lol,” Ashley Lucas texted back from Orbisonia, Pennsylvania.

    “Don’t you work with old people?”

    “Yeah”

    “What if you killed one of them? Get vaccinated,” Heidi wrote.

    Neither sister is budging as the Delta variant brings a new spike in coronavirus numbers across the nation.

    Their divide mirrors America’s larger one, where the vaccine to combat COVID-19 is eagerly embraced by some, yet eyed with suspicion and rejected by others.

    It is the refusal group, including a significant percentage who work in the nation’s nursing homes, that has confounded and alarmed health care officials who are at a loss as to how to sway them.

    Nursing homes faced a shocking mortality rate during the pandemic. In the U.S., COVID-19 killed more than 133,000 residents and nearly 2,000 staff members between May 31, 2020 and this July 4, according to Centers for Medicare & Medicaid Services reports. The true toll is thought to be even higher as data gathering lagged in the early months of the crisis, health experts say.

    Working in a nursing home became one of the “most dangerous jobs” in America in 2020, according to an analysis of work-related deaths by Scientific American.

    Yet seven months after the first vaccines became available to medical professionals, only 59% of staff at the nation’s nursing homes and other long-term care facilities are fully or partially vaccinated — with eight states reporting an average rate of less than half, according to CMS data updated last week.

    Twenty-three individual facilities had vaccination rates of under 1%, the data showed.

    Staff vaccinations have lagged even as the overall rate for residents climbed to 83%, according to the CMS data.

    The strong vaccination percentage among nursing home residents is credited, in part, to an early campaign to bring the vaccine directly to facilities. That suggests availability is not necessarily the issue behind staff going without.

    So, what is?

    The question defies easy answers. Vaccine refusal is regional and often aligns not only with individuals’ political alignment but also with their preferred news sources and which social media they follow.

    Last week, President Joe Biden took aim at Facebook and other social media giants for failing to police vaccine misinformation that amplifies conspiracy theories and discourages people from getting vaccinated. “They’re killing people,” he said, directly blaming the platforms. On Monday, he recast the accusation to say it was specific individuals posting dangerous information who are culpable.

    On Tuesday, U.S. Sen. Mitch McConnell, R-Ky., pleaded to “anyone out there willing to listen: Get vaccinated.” While not mentioning skeptics specifically — including those in his own party — the Republican leader urged the unvaccinated to ignore “demonstrably bad advice.”

    COVID-19 cases are now surging in every state, with new hospitalizations and deaths almost entirely occurring among the unvaccinated. “This is becoming a pandemic of the unvaccinated,” Centers for Disease Control and Prevention Director Rochelle Walensky warned last week during a White House briefing.

    In May, CMS began requiring weekly reports on vaccinations of residents and staff at nursing homes and other long-term care facilities. The emerging data confirms many health care experts’ worst fears, especially for Southern states.

    Louisiana has the lowest statewide average: Just 44.5% of the staff at its long-term care facilities have been at least partially vaccinated, according to CMS data released last week.

    Florida, the second lowest-vaccinated state, had a rate of just under 46% among its nursing home and long-term care staff, with Missouri, Oklahoma, Tennessee, Georgia, Mississippi and Wyoming all showing rates of less than 50 percent, according to the data.

    Vaccination rates in assisted living facilities are not included in the data.

    A separate American Association of Retired Persons analysis, released last week, showed that only one in five of the nation’s more than 15,000 nursing homes were able to hit a goal, set by two industry trade groups, of vaccinating 75% of their staff by the end of June.

    While cases in nursing homes have recently slowed, and most of the new COVID-19 infections are among younger people, some experts still worry of a return to darker days.

    The CDC recently launched an investigation into deaths of residents at several western Colorado senior facilities possibly linked to unvaccinated staff, the Associated Press reported Wednesday.

    “We need to sound the alarm,” said Susan Reinhard, senior vice president of AARP and director of its Public Policy Institute. “Nursing homes were devastated by COVID-19, and many residents remain highly vulnerable to the virus.”

    Nationally, more than 89% of people 65 or older have received at least partial vaccination, the CDC reported this week. Still, public health experts have warned that even if fully vaccinated, the elderly may be vulnerable to “breakthrough” coronavirus infection because of compromised immune systems and other underlying health problems.

    In Missouri’s southern region, the overall rate of full vaccination in some rural counties is less than 20%, according to state health department and CDC tracking. The latest surge of the delta variant has turned the area into a “tinderbox,” Steven Edwards, CEO of the CoxHealth hospital system in Springfield, recently told reporters.

    On Thursday, 160 patients were being treated for COVID-19 at CoxHealth, a spokesperson told ProPublica. On May 14, there were 18.

    Heidi Lucas directs the Missouri Nurses Association. She is pro-vaccine and has been pushing hard for nurses to get vaccinated, especially those on the front lines of patient care.

    Lucas said it is impossible to separate the lack of vaccination among staff from the lack of vaccinations in individual communities. “Nurses are people too,” she said. “They are on social media and are inundated with false information. How do you fight it?”

    Her sister, Ashley Lucas, lives 900 miles away in Orbisonia, a small town of around 500 people about an hour south of State College. She’s a traveling certified nursing assistant at area nursing homes and chose to skip the vaccine.

    Her fiance and her children, ages 12 and 13, are also unvaccinated. “I don’t consider myself an anti-vaxxer,” she told ProPublica, bristling that some might see her as reckless or ill-informed.

    Instead, she said her decision was carefully considered. It never made sense to her, she said, that the virus seemed to strike randomly, with some residents getting sick while others did not. She said she is not convinced the vaccine would change the odds.

    She’s also concerned after hearing that the vaccine could interfere with fertility — a contention that has been deemed false by the Centers for Disease Control and Prevention and the World Health Organization. It all leads her to believe more research is needed into the vaccines’ long-term effects.

    “This is just a personal choice and I feel it should be a free choice,” she said. “I think it’s been forced on us way too much.”

    ***

    Certified nursing assistants make up the largest group of employees working in nursing homes and other long-term care facilities, providing roughly 90 percent of direct patient care. They are typically overworked and underpaid, most earning about $13 per hour and receiving no paid sick leave or other benefits, said Lori Porter, co-founder and CEO of the National Association of Health Care Assistants.

    Porter said she is not completely surprised by the low vaccination rate. It comes down to trust, she said, both of the vaccines and of facility administrators who now say staff must get vaccinated. Refusal may feel like empowerment. “It’s the first time ever they have had the ball in their court,” Porter said.

    On March 31, Houston Methodist Hospital mandated that all of its 26,000 employees be vaccinated by June 7 or lose their jobs. Jennifer Bridges, a nurse, sued along with 116 other employees, claiming the health care system had overstepped its rights and that she and the others refused to be “human guinea pigs,” evoking the Nuremberg Code, a set of ethical standards established in response to Nazi medical experimentation in concentration camps.

    On June 12, U.S. District Judge Lynn N. Hughes dismissed the closely watched case, taking offense to likening the vaccine to the Holocaust, which he called “reprehensible.” Ten days later, 153 Houston Methodist employees either were fired or quit after refusing the vaccine. The judge’s ruling has been appealed.

    A handful of long-term care chains have similarly sought to mandate worker vaccines, but such action is far from widespread in the industry. One sticking point has been whether vaccination can legally be required, since all three available vaccines have only emergency use authorization, not full approval from the U.S. Food and Drug Administration.

    The thornier issue, though, is whether the facilities can risk losing staff when they’re already short-handed. Many workers have vowed to quit rather than be forced into vaccinations.

    Aegis Living, a long-term senior care provider in three Western states, made vaccines mandatory for its roughly 2,600 employees on July 1. Dwayne Clark, founder and CEO, said initially 400 employees refused but when the deadline arrived, only about 100 left rather than be vaccinated.

    “We lost some staff that we didn’t want to lose,” Clark told ProPublica, “but it felt like the right moral protocol to impose.”

    Recently the U.S. Equal Employment Opportunity Commission issued guidelines stating that employers can require workers to be vaccinated as long as medical or religious exemptions are permitted.

    “Nursing home workers certainly have the right to make decisions about their own health and welfare, but they don’t have the right to place vulnerable residents at risk,” said Lawrence Gostin, a health law professor at Georgetown University. “Nursing homes don’t just have the power to require vaccinations, they have the duty.”

    Still, the issue is far from resolved.

    “America is a highly litigious country,” Gostin said, “I expect the courts to consistently uphold nursing home mandates, because they are entirely lawful and justified. But there will likely be lawsuits at least until it is quite clear they are futile.”

    ***

    Diane Peters is a registered nurse in the Chicago suburbs who last year worked at a nursing home and is now working at a senior rehabilitation center. She does not trust the science behind the vaccine and is unvaccinated. So is her fiance.

    Everything about the rollout felt like propaganda, she said. Development was too rushed. Clinical trials typically take years, she said, not months. “I don’t think it’s safe right now, it needs more time,” she said she tells patients if they ask.

    Most don’t, she said. Neither do her co-workers. She has only been asked once by her employer if she was vaccinated, she said, declining to name the company.

    Peters guesses about 40 percent of her colleagues are also unvaccinated, but said no one likes to talk about it because the divide surrounding the vaccine is “surreal.” Staff members are tested regularly and are required to wear masks, she said.

    She is doubtful mandates would stick. “They can threaten,” she said, “but a lot of nurses would walk.”

    She trusts her instincts and her own research for now. When asked what would change her mind, she had one word: “Nothing.”

    This post was originally published on Latest – Truthout.

  • Physicians Have a Duty to Confront the Exploitative Industry That Employs Them

    Registered Nurses conduct a demonstration held by National Nurses United (NNU) in Lafayette Park to read aloud names of health care providers who have contracted COVID-19 and died on April 21, 2020.

    As physicians and trainees, we take an oath to do no harm. While this orientation may have practical applications within individual treatment plans, it begs some questions: Why stop at the passive “do no harm” rather than actively confronting harm? What is the physician’s duty to their patients and communities they serve? What role can we have in addressing the structural violence that causes harm to patients, such as homelessness and displacement, food insecurity, or trauma from the police and the prison system?

    To adequately address these questions, we must make the ideological shift from neutrality to intentional, politicized community engagement to confront harm. Confronting harm can take many forms, including fighting back against corporations and pharmaceutical companies that prey on patients; working to end medical practices that serve as social control and exploit marginalized people; advocating for reparations and reinvestment in communities (including but not limited to health care infrastructure); resisting colonization and state-based repression, even in the face of institutional backlash; and fighting for the liberation of Indigenous communities, both in the United States and globally.

    One role the physician can take on when confronting harm is that of witness. Physicians are uniquely positioned to be witnesses to the physical and psychological manifestations of structural violence. In these cases, we must move beyond reactionary practices and begin to see patients’ concerns, symptoms and trauma as not just problems to diagnose but the outcomes of a larger sociopolitical context. It is important for us to not lose sight of the whole picture when dealing with everyday issues like struggling to provide care to a patient who cannot afford medication; while this is an opportunity to advocate for an individual patient, it is also important to note this instance as a manifestation of the harms inflicted by insurance companies and pharmaceutical companies. For many patients, their diagnosed diseases may also be in large part due to structural oppression, with food insecurity, environmental racism, and lack of access to services due to segregation and disinvestment leading to physical harm.

    On an interpersonal level, the physician can serve as a witness for patients and work to address these harms through treatment and care that centers the needs and lived reality of the patient. On a structural level, the physician must work to amplify the voices of the most marginalized rather than speaking on behalf of patients. This work must be community-aligned and in service of addressing the structural roots of oppression. The group Doctors 4 Camp Closure is a good example of physicians using their social capital to witness and confront inhumane detention of migrants and refugees who experience harm at the hands of the U.S. immigration prison system. Health Justice Commons is a group that centers the voices of those most impacted by the harms of the medical-industrial complex, and they call into question the lines and implicit hierarchies between providers, patients and community members. These are just some examples of the ways in which physicians can use their position as witness to drive structural change.

    A second role that physicians can take on, beyond bearing witness, is that of a worker for wages. As health systems continue to grow, most physicians are workers in an industry increasingly operated by large hospitals, health systems, insurance companies, pharmaceuticals and medical technology companies. This nexus of health care capitalism allows for the exploitation not only of patients and communities, but also us as workers as well. There is a reason there is such severe physician burnout, and it comes to the lack of power we have to make the best decisions for care. These groups that hold power benefit from physicians not organizing as workers and demanding change collectively — health care workers lose power by not building together, and it takes away from the ability to advocate as effectively as we could for ourselves, our patients and communities we serve.

    While our wage work may demand that most of us work within large institutions to care for patients, we must make an active choice to align ourselves with the communities we serve over the institutions we work in. Aligning ourselves as a labor force opens radical possibilities of change by giving us greater bargaining power. Take the issue of police in hospitals and emergency rooms during the uprisings of 2020. Many physicians and health care workers took issue with the fact that the police could make arrests in the ER — individually, any one physician may not have the power to escalate this issue. An organized labor force would be able to draw the attention of health care administration and demand the removal of police in the ER and in the health system at large. Organizing collectively also protects workers from institutional backlash, as seen against health care workers who speak out openly in support of the Palestinian struggle for liberation.

    This kind of organizing in health care is not new — the National Nurses Union (NNU) works because nurses see themselves as workers who are organizing for themselves and the patients and communities they serve. Just most recently, the NNU published a statement against the Centers for Disease Control and Prevention guidelines for the relaxing of the mask mandate. As witnesses to the devastation of COVID-19, and as workers concerned for their own health and wellbeing, they collectively fight for change. And while less common, resident unions exist in pockets across the country; however, as physicians move up through the hierarchy, those unions tend to disappear. As physicians move through their careers, it is crucial to keep in mind who benefits from doctors not aligning with one another and with other health care workers: hospital systems and corporations. Ultimately, it is crucial for the care of patients and the movement toward health justice that physicians align as workers and witnesses; if not, we will be complicit in the structural harms we claim to stand against.

    This post was originally published on Latest – Truthout.

  • Canceling Student Debt Will Help Health Care Workers and Advance Racial Justice

    Medical students and staff members on the COVID-19 ward at United Memorial Medical Center gather to go over patients' status at the start of their shift on July 1, 2020.

    There’s been a lot of talk from Democrats in power about the bravery and sacrifice of health care workers and the importance of racial equity.

    Words are nice, but they don’t improve people’s lives.

    But there’s one simple policy, tantalizingly close to passing that can make things better for health care workers in an instant: canceling student debt.

    Health care workers have more student loan debt than workers in any other industry, holding approximately $9,700 more in debt per person than those who work in higher education, who are the second-highest debt holders on the list. Private health care workers and social workers hold an average of $72,800 in student debt, which is more than double the national average. It’s worth noting that more than half of health care workers employed in direct-contact, home and community-based service positions are people of color. Average debt for nurses ranges from $19,928 for an associate’s degree to $47,321 for a master’s degree. Average debt from medical school is a staggering $215,900.

    The entire health care industry is stitched to higher education and thus to student debt. So instead of offering a free coffee or a yard sign thanking health care workers, how about we cancel all student debt and dramatically improve their lives, and millions of others, immediately.

    Though he would likely face challenges, President Biden could undertake this action via an executive order. And it’s not just a higher education problem; it’s also, as Congresswoman Ayanna Pressley stated, “ a racial justice issue.”

    Black college graduates are more likely to receive federal loans and hold an average of $25,000 more in student loan debt than white borrowers.

    Forty percent of Black grad school graduates hold student loan debt compared to 22 percent of white students, and over 50 percent of Black borrowers reported that their student loan debt is higher than their net worth. This is a textbook example of systemic, structural racism, which is something that the Biden administration has repeatedly pledged to address.

    Before President Biden assumed office, 325 organizations — including many prominent labor unions, civil rights organizations and advocacy groups — sent a letter to the president-elect urging him to cancel all student debt with an executive order on day one. Obviously, that didn’t happen, but as the pandemic and all of its associated trauma has continued to spin on, the pressure for action has grown.

    On February 4, Senate Majority Leader Chuck Schumer (D-New York), Sen. Elizabeth Warren (D-Massachusetts), Congresswoman Ayanna Pressley (Massachusetts-07), and others put forth a resolution calling for the president to cancel $50,000 in student debt for all borrowers.

    Now is the time. Total student loan debt has now reached $1.7 trillion. Only nine countries have a GDP that surpasses that total. In the United States, student loan debt is growing at six times the rate of the economy. Canceling all student debt would make an enormous impact, clearing the debt of 43.2 million borrowers. By contrast, Schumer and company’s $50,000 forgiveness plan — which has a $125,000 income threshold for qualification — would eliminate debt for 36 million borrowers. It’s certainly better than nothing, and a significant improvement over the $10,000 Biden floated during the campaign. But what better time to be bold than right now? Why go three-fourths of the way?

    Over 200,000 health care workers have been infected with COVID-19 over the past year, and at least 3,500 have died. They have dealt with insufficient personal protective equipment, overcrowding, underfunding, and an ever-present air of chaos, uncertainty and death. A survey on the well-being of health care workers conducted by Mental Health America found that 93 percent reported experiencing stress, 86 percent reported anxiety and 76 percent reported exhaustion. Many experienced insomnia and an array of physical ailments, in addition to being burdened with the constant fear of potentially exposing a family member. And, as with many aspects of U.S. society, the health care workers most impacted by infection, hospitalization and death — due in large part to the aforementioned prevalence in direct contact and home health positions — are disproportionately people of color. In fact, health care workers of color are nearly twice as likely to contract COVID-19 than white workers.

    It has been an extraordinarily tough year to work in health care — and it’s an industry all but defined by tough years. Though there is a faint light flickering at the end of the tunnel due to widespread vaccinations occurring across the country, we have not defeated this pandemic just yet — and there is a mental health crisis looming just beyond it.

    Health care workers aren’t going to get a break. They never get a break. A small respite between crises perhaps, some snapshots of catharsis, but never a real break.

    While canceling student debt is certainly not a long-term fix (as it doesn’t address the pervasive problems with our higher education system), it would provide some instant relief for people who could really use it right now.

    This post was originally published on Latest – Truthout.

  • More Than 3,600 US Health Care Workers Have Died in the Pandemic’s First Year

    A nurse fills up a syringe with the Moderna COVID-19 vaccine at a vaccination site at a senior center on March 29, 2021, in San Antonio, Texas.

    More than 3,600 U.S. health care workers perished in the first year of the pandemic, according to “Lost on the Frontline,” a 12-month investigation by The Guardian and KHN to track such deaths.

    Lost on the Frontline is the most complete accounting of U.S. health care worker deaths. The federal government has not comprehensively tracked this data. But calls are mounting for the Biden administration to undertake a count as the KHN/Guardian project comes to a close.

    The project, which tracked who died and why, provides a window into the workings — and failings — of the U.S. health system during the covid-19 pandemic. One key finding: Two-thirds of deceased health care workers for whom the project has data identified as people of color, revealing the deep inequities tied to race, ethnicity and economic status in America’s health care workforce. Lower-paid workers who handled everyday patient care, including nurses, support staff and nursing home employees, were far more likely to die in the pandemic than physicians were.

    The yearlong series of investigative reports found that many of these deaths could have been prevented. Widespread shortages of masks and other personal protective gear, a lack of covid testing, weak contact tracing, inconsistent mask guidance by politicians, missteps by employers and lax enforcement of workplace safety rules by government regulators all contributed to the increased risk faced by health care workers. Studies show that health care workers were more than three times as likely to contract covid as the general public.

    “We rightfully refer to these people without hyperbole — that they are true heroes and heroines,” said Dr. Anthony Fauci in an exclusive interview with The Guardian and KHN. The covid deaths of so many are “a reflection of what health care workers have done historically, by putting themselves in harm’s way, by living up to the oath they take when they become physicians and nurses,” he said.

    Lost on the Frontline launched last April with the story of Frank Gabrin, the first known American emergency room doctor to die of covid-19. In the early days of the pandemic, Gabrin, 60, was on the front lines of the surge, treating covid patients in New York and New Jersey. Yet, like so many others, he was working without proper personal protective equipment, known as PPE. “Don’t have any PPE that has not been used,” he texted a friend. “No N95 masks — my own goggles — my own face shield.”

    Gabrin’s untimely death was the first fatality entered into the Lost on the Frontline database. His story of working through a crisis to save lives shared similarities with the thousands that followed.

    Maritza Beniquez, an emergency room nurse at Newark’s University Hospital in New Jersey, watched 11 colleagues die in the early months of the pandemic. Like the patients they had been treating, most were Black and Latino. “It literally decimated our staff,” she said.

    Her hospital has placed 11 trees in the lobby, one for each employee who has died of covid; they have been adorned with remembrances and gifts from their colleagues.

    More than 100 journalists contributed to the project in an effort to record every death and memorialize those who died. The project’s journalists filed public records requests, cross-connected governmental and private data sources, scoured obituaries and social media posts, and confirmed deaths through family members, workplaces and colleagues.

    Among its key findings:

    • More than half of those who died were younger than 60. In the general population, the median age of death from covid is 78. Yet among health care workers in the database, it is only 59.
    • More than a third of the health care workers who died were born outside the United States. Those from the Philippines accounted for a disproportionate number of deaths.
    • Nurses and support staff members died in far higher numbers than physicians.
    • Twice as many workers died in nursing homes as in hospitals. Only 30% of deaths were among hospital workers, and relatively few were employed by well-funded academic medical centers. The rest worked in less prestigious residential facilities, outpatient clinics, hospices and prisons, among other places.

    The death rate among health care workers has slowed dramatically since covid vaccines were made available to them in December. A study published in late March found that only four of 8,121 fully vaccinated employees at the University of Texas Southwestern Medical Center in Dallas became infected. But deaths lag behind infections, and KHN and The Guardian have tracked more than 400 health care worker deaths since the vaccine rollout began.

    Many factors contributed to the high toll — but investigative reporting uncovered some consistent problems that heightened the risks faced by health workers.

    The project found that Centers for Disease Control and Prevention guidance on masks — which encouraged hospitals to reserve high-performance N95 masks for intubation procedures and initially suggested surgical masks were adequate for everyday patient care — may have put thousands of health workers at risk.

    The investigation exposed how the Labor Department, run by Donald Trump appointee Eugene Scalia in the early part of the pandemic, took a hands-off approach to workplace safety. It identified 4,100 safety complaints filed by health care workers to the Occupational Safety and Health Administration, the Labor Department’s workplace safety agency. Most were about PPE shortages, yet even after some complaints were investigated and closed by regulators, workers continued to die at the facilities in question.

    The reporting also found that health care employers were failing to report worker deaths to OSHA. The data analysis found that more than a third of workplace covid deaths were not reported to regulators.

    Among the most visceral findings of Lost on the Frontline was the devastating impact of PPE shortages.

    Adeline Fagan, a 28-year-old OB-GYN resident in Texas, suffered from asthma and had a long history of respiratory ailments. Months into the pandemic, her family said, she was using the same N95 mask over and over, even during a high-risk rotation in the emergency room.

    Her parents blame both the hospital administration and government missteps for the PPE shortages that may have contributed to Adeline’s death in September. Her mother, Mary Jane Abt-Fagan, said Adeline’s N95 had been reused so many times the fibers were beginning to disintegrate.

    Not long before she fell ill — and after she’d been assigned to a high-risk ER rotation — Adeline talked to her parents about whether she should spend her own money on an expensive N95 with a filter that could be changed daily. The $79 mask was a significant expense on her $52,000 resident’s salary.

    “We said, you buy this mask, you buy the filters, your father and I will pay for it. We didn’t care what it cost,” said Abt-Fagan.

    She never had the opportunity to use it. By the time the mask arrived, Adeline was already on a ventilator in the hospital.

    Adeline’s family feels let down by the U.S. government’s response to the pandemic.

    “Nobody chooses to go to work and die,” said Abt-Fagan. “We need to be more prepared, and the government needs to be more responsible in terms of keeping health care workers safe.”

    Adeline’s father, Brant Fagan, wants the government to begin tracking health care worker deaths and examining the data to understand what went wrong. “That’s how we’re going to prevent this in the future,” he said. “Know the data, follow where the science leads.”

    Adeline’s parents said her death has been particularly painful because of her youth — and all the life milestones she never had the chance to experience. “Falling in love, buying a home, sharing your family and your life with your siblings,” said Mary Jane Abt-Fagan. “It’s all those things she missed that break a parent’s heart.”

    KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

    This post was originally published on Latest – Truthout.

  • CDC Insisted Surgical Masks Were Enough. Caregivers of Color Suffered Most.

    A medical worker looks onward, wearily

    Since the start of the pandemic, the most terrifying task in health care was thought to be when a doctor put a breathing tube down the trachea of a critically ill covid patient.

    Those performing such “aerosol-generating” procedures, often in an intensive care unit, got the best protective gear even if there wasn’t enough to go around, per Centers for Disease Control and Prevention guidelines. And for anyone else working with covid patients, until a month ago, a surgical mask was considered sufficient.

    A new wave of research now shows that several of those procedures were not the most hazardous. Recent studies have determined that a basic cough produces about 20 times more particles than intubation, a procedure one doctor likened to the risk of being next to a nuclear reactor.

    Other new studies show that patients with covid simply talking or breathing, even in a well-ventilated room, could make workers sick in the CDC-sanctioned surgical masks. The studies suggest that the highest overall risk of infection was among the front-line workers — many of them workers of color — who spent the most time with patients earlier in their illness and in sub-par protective gear, not those working in the covid ICU.

    “The whole thing is upside down the way it is currently framed,” said Dr. Michael Klompas, a Harvard Medical School associate professor who called aerosol-generating procedures a “misnomer” in a recent paper in the Journal of the American Medical Association.

    “It’s a huge mistake,” he said.

    The growing body of studies showing aerosol spread of covid-19 during choir practice, on a bus, in a restaurant and at gyms have caught the eye of the public and led to widespread interest in better masks and ventilation.

    Yet the topic has been highly controversial within the health care industry. For over a year, international and U.S. nurse union leaders have called for health workers caring for possible or confirmed covid patients to have the highest level of protection, including N95 masks.

    But a widespread group of experts have long insisted that N95s be reserved for those performing aerosol-generating procedures and that it’s safe for front-line workers to care for covid patients wearing less-protective surgical masks.

    Such skepticism about general aerosol exposure within the health care setting have driven CDC guidelines, supported by national and California hospital associations.

    The guidelines still say a worker would not be considered “exposed” to covid-19 after caring for a sick covid patient while wearing a surgical mask. Yet in recent months, Klompas and researchers in Israel have documented that workers using a surgical mask and face shield have caught covid during routine patient care.

    The CDC said in an email that N95 “respirators have remained preferred over facemasks when caring for patients or residents with suspected or confirmed” covid, “but unfortunately, respirators have not always been available to healthcare personnel due to supply shortages.”

    New research by Harvard and Tulane scientists found that people who tend to be super-spreaders of covid — the 20% of people who emit 80% of the tiny particles — tend to be obese or older, a population more likely to live in elder care or be hospitalized.

    When highly infectious, such patients emit three times more tiny aerosol particles (about a billion a day) than younger people. A sick super-spreader who is simply breathing can pose as much or more risk to health workers as a coughing patient, said David Edwards, a Harvard faculty associate in bioengineering and an author of the study.

    Chad Roy, a co-author who studied primates with covid, said the emitted aerosols shrink in size when the monkeys are most contagious at about Day Six of infection. Those particles are more likely to hang in the air longer and are easier to inhale deep into the lungs, said Roy, a professor of microbiology and immunology at Tulane University School of Medicine.

    The study clarifies the grave risks faced by nursing home workers, of whom more than 546,000 have gotten covid and 1,590 have died, per reports nursing homes filed to the Centers for Medicare & Medicaid since mid-May.

    Taken together, the research suggests that health care workplace exposure was “much bigger” than what the CDC defined when it prioritized protecting those doing “aerosol-generating” procedures, said Dr. Donald Milton, who reviewed the studies but was not involved in any of them.

    “The upshot is that it’s inhalation” of tiny airborne particles that leads to infection, said Milton, a professor at the University of Maryland School of Public Health who studies how respiratory viruses are spread, “which means loose-fitting surgical masks are not sufficient.”

    On Feb. 10, the CDC updated its guidance to health care workers, deleting a suggestion that wearing a surgical mask while caring for covid patients was acceptable and urging workers to wear an N95 or a “well-fitting face mask,” which could include a snug cloth mask over a looser surgical mask.

    Yet the update came after most of at least 3,500 U.S. health care workers had already died of covid, as documented by KHN and The Guardian in the Lost on the Frontline project.

    The project is more comprehensive than any U.S. government tally of health worker fatalities. Current CDC data shows 1,391 health care worker deaths, which is 200 fewer than the total staff covid deaths nursing homes report to Medicare.

    More than half of the deceased workers whose occupation was known were nurses or in health care support roles. Such staffers often have the most extensive patient contact, tending to their IVs and turning them in hospital beds; brushing their hair and sponge-bathing them in nursing homes. Many of them — 2 in 3 — were workers of color.

    Two anesthetists in the United Kingdom — doctors who perform intubations in the ICU — saw data showing that non-ICU workers were dying at outsize rates and began to question the notion that “aerosol-generating” procedures were the riskiest.

    Dr. Tim Cook, an anesthetist with the Royal United Hospitals Bath, said the guidelines singling out those procedures were based on research from the first SARS outbreak in 2003. That framework includes a widely cited 2012 study that warned that those earlier studies were “very low” quality and said there was a “significant research gap” that needed to be filled.

    But the research never took place before covid-19 emerged, Cook said, and key differences emerged between SARS and covid-19. In the first SARS outbreak, patients were most contagious at the moment they arrived at a hospital needing intubation. Yet for this pandemic, he said, studies in early summer began to show that peak contagion occurred days earlier.

    Cook and his colleagues dove in and discovered in October that the dreaded practice of intubation emitted about 20 times fewer aerosols than a cough, said Dr. Jules Brown, a U.K. anesthetist and another author of the study. Extubation, also considered an “aerosol-generating” procedure, generated slightly more aerosols but only because patients sometimes cough when the tube is removed.

    Since then, researchers in Scotland and Australia have validated those findings in a paper pre-published on Feb. 10, showing that two other aerosol-generating procedures were not as hazardous as talking, heavy breathing or coughing.

    Brown said initial supply shortages of PPE led to rationing and steered the best respiratory protection to anesthetists and intensivists like himself. Now that it is known emergency room and nursing home workers are also at extreme risk, he said, he can’t understand why the old guidelines largely stand.

    “It was all a big house of cards,” he said. “The foundation was shaky and in my mind it’s all fallen down.”

    Asked about the research, a CDC spokesperson said via email: “We are encouraged by the publication of new studies aiming to address this issue and better identify which procedures in healthcare settings may be aerosol generating. As studies accumulate and findings are replicated, CDC will update its list of which procedures are considered [aerosol-generating procedures].”

    Cook also found that doctors who perform intubations and work in the ICU were at lower risk than those who worked on general medical floors and encountered patients at earlier stages of the disease.

    In Israel, doctors at a children’s hospital documented viral spread from the mother of a 3-year-old patient to six staff members, although everyone was masked and distanced. The mother was pre-symptomatic and the authors said in the Jan. 27 study that the case is possible “evidence of airborne transmission.”

    Klompas, of Harvard, made a similar finding after he led an in-depth investigation into a September outbreak among patients and staff at Brigham and Women’s Hospital in Boston.

    There, a patient who was tested for covid two days in a row — with negative results — wound up developing the virus and infecting numerous staff members and patients. Among them were two patient care technicians who treated the patient while wearing surgical masks and face shields. Klompas and his team used genome sequencing to connect the sick workers and patients to the same outbreak.

    CDC guidelines don’t consider caring for a covid patient in a surgical mask to be a source of “exposure,” so the technicians’ cases and others might have been dismissed as not work-related.

    The guidelines’ heavy focus on the hazards of “aerosol-generating” procedures has meant that hospital administrators assumed that those in the ICU got sick at work and those working elsewhere were exposed in the community, said Tyler Kissinger, an organizer with the National Union of Healthcare Workers in Northern California.

    “What plays out there is there is this disparity in whose exposures get taken seriously,” he said. “A phlebotomist or environmental services worker or nursing assistant who had patient contact — just wearing a surgical mask and not an N95 — weren’t being treated as having been exposed. They had to keep coming to work.”

    Dr. Claire Rezba, an anesthesiologist, has scoured the web and tweeted out the accounts of health care workers who’ve died of covid for nearly a year. Many were workers of color. And fortunately, she said, she’s finding far fewer cases now that many workers have gotten the vaccine.

    “I think it’s pretty obvious that we did a very poor job of recommending adequate PPE standards for all health care workers,” she said. “I think we missed the boat.”

    California Healthline politics correspondent Samantha Young contributed to this report.

    This post was originally published on Latest – Truthout.

  • Owners of Hospital Conglomerate Made Billions as Health Care Workers Lacked PPE

    Nurses stage a protest with support from the registered nurses union, SEIU Local 121RN, outside the West Hills Hospital on June 18, 2020, in West Hills, California.

    Not everyone is suffering during the pandemic.

    The Frist family of Tennessee are the founders and biggest shareholders of Hospital Corporation of America (HCA), the largest for-profit hospital conglomerate in the U.S. Thomas F. Frist Jr. and his family have seen their personal wealth increase from $7.5 billion on March 18, 2020 to $15.6 billion on March 8, 2021, an increase of $8.1 billion or 108 percent, according to an analysis by the Institute for Policy Studies.

    Almost half of these gains — $4 billion — have come since September 2020, when Forbes reported the Thomas F. Frist Jr. family wealth at $11.5 billion. The Frists have an estimated 20 percent ownership stake in HCA.

    Of the 27 U.S. billionaires whose wealth comes from the health care sector, the Frists have seen the single greatest pandemic wealth gains, even compared to fortunes from big pharma and bio-tech. HCA is the only hospital owner on the list of 27 health care billionaires.

    Pandemic Profiteering

    The surging wealth gains of the Frist family come as health care workers and their patients face enormous strains. As Francesca Newton writes in her Tribune piece, “10 Ways Corporations Have Exploited Covid-19,” “While key workers put their lives on the line to keep the country running, and mutual aid groups desperately tried to plug the holes created by decades of cuts to our social fabric, billionaires and big corporate interests have made a killing.”

    HCA has reaped enormous profits by squeezing workers and cutting costs, while showering top management with lavish compensation.

    Profits

    HCA made nearly $4 billion in profits in 2020 during the pandemic, up more than $200 million from 2019. At the same time the company cut supply costs by $112 million, even though workers spoke out for months about inadequate PPE and having to reuse single use equipment like masks and gloves.

    CEO Pay

    HCA CEO Sam Hazen was paid $27 million in 2019, making him the highest paid CEO in the hospital sector for that year (2020 figures will be released in mid-March). Hazen’s 2019 compensation was higher than the CEO of Humana, $16.7 million. His pay is 478 times the median HCA employee, up from 383 times in 2018. His pay is over 1,038 times the lowest paid worker at HCA, which is $12.50 at its El Paso facility. Hazen is paid roughly $13,000 an hour. According to the Economic Policy Institute, the average ratio of U.S. CEO pay to median worker was 320 to 1 in 2019.

    Staffing Levels

    In 2019, HCA’s staffing levels were 29 percent below the national average. HCA’s low staffing levels have been linked to poor patient outcomes. For example, low staffing levels at HCA’s Colorado hospitals may have contributed to patient death as well as other preventable harm.

    Impact on Frontline Health Care Workers

    In addition to inadequate staffing levels and insufficient supplies for PPE, poor wages have been the focus of HCA critics for some time. But the issue worsened during the pandemic as frontline health care workers were forced to take much greater risks. Meanwhile, HCA continued to push back on worker demands. For example, it successfully delayed the vote to unionize 1,800 nurses at its Mission Hospital in Asheville, North Carolina for six months, claiming that delay was necessary during a pandemic.

    Frist Family Wealth and U.S. Billionaires

    The surge in wealth flowing to Frist family is extraordinary, even for U.S. billionaires who have seen their wealth accelerate during the pandemic. U.S. billionaires have seen their wealth increase $1.3 trillion, or 44 percent, over the 11 months since the beginning of the pandemic lockdowns in March 2020, according to an analysis by Americans for Tax Fairness (ATF) and the Institute for Policy Studies (IPS). The combined wealth of 660 U.S. billionaires now tops $4.2 trillion.

    For perspective, the $4.2 trillion in wealth is nearly double the collective $2.4 trillion in wealth held by the entire bottom half of American society, or 165 million people.

    This post was originally published on Latest – Truthout.

  • Millions of Unpaid Caregivers Are Currently Ineligible for COVID Vaccine

    Before her stretched a line of people waiting to get covid-19 vaccines. “It was agonizing to know that I couldn’t get in that line,” said Davidson, 50, who is devoted to her father and usually cares for him full time. “If I get sick, what would happen to him?”

    Tens of thousands of middle-aged sons and daughters caring for older relatives with serious ailments but too young to qualify for a vaccine themselves are similarly terrified of becoming ill and wondering when they can get protected against the coronavirus.

    Like aides and other workers in nursing homes, these family caregivers routinely administer medications, monitor blood pressure, cook, clean and help relatives wash, get dressed and use the toilet, among many other responsibilities. But they do so in apartments and houses, not in long-term care institutions — and they’re not paid.

    “In all but name, they’re essential health care workers, taking care of patients who are very sick, many of whom are completely reliant upon them, some of whom are dying,” said Katherine Ornstein, a caregiving expert and associate professor of geriatrics and palliative medicine at Mount Sinai’s medical school in New York City. “Yet, we don’t recognize or support them as such, and that’s a tragedy.”

    The distinction is critically important because health care workers have been prioritized to get covid vaccines, along with vulnerable older adults in nursing homes and assisted living facilities. But family members caring for equally vulnerable seniors living in the community are grouped with the general population in most states and may not get vaccines for months.

    The exception: Older caregivers can qualify for vaccines by virtue of their age as states approve vaccines for adults ages 65, 70 or 75 and above. A few states have moved family caregivers into phase 1a of their vaccine rollouts, the top priority tier. Notably, South Carolina has done so for families caring for medically fragile children, and Illinois has given that designation to families caring for relatives of all ages with significant disabilities.

    Arizona is also trying to accommodate caregivers who accompany older residents to vaccination sites, Dr. Cara Christ, director of the state’s Department of Health Services, said Monday during a Zoom briefing for President Joe Biden. Comprehensive data about which states are granting priority status to family caregivers is not available.

    Meanwhile, the Department of Veterans Affairs recently announced plans to offer vaccines to people participating in its Program of Comprehensive Assistance for Family Caregivers. That initiative gives financial stipends to family members caring for veterans with serious injuries; 21,612 veterans are enrolled, including 2,310 age 65 or older, according to the VA. Family members can be vaccinated when the veterans they look after become eligible, a spokesperson said.

    “The current pandemic has amplified the importance of our caregivers whom we recognize as valuable members of Veterans’ health care teams,” Dr. Richard Stone, VA acting undersecretary for health, said in the announcement.

    An estimated 53 million Americans are caregivers, according to a 2020 report. Nearly one-third spend 21 hours or more each week helping older adults and people with disabilities with personal care, household tasks and nursing-style care (giving injections, tending wounds, administering oxygen and more). An estimated 40% are providing high-intensity care, a measure of complicated, time-consuming caregiving demands.

    This is the group that should be getting vaccines, not caregivers who live at a distance or who don’t provide direct, hands-on care, said Carol Levine, a senior fellow and former director of the Families and Health Care Project at the United Hospital Fund in New York City.

    Rosanne Corcoran, 53, is among them. Her 92-year-old mother, Rose, who has advanced dementia, lives with Corcoran and her family in Collegeville, Pennsylvania, on the second floor of their house. She hasn’t come down the stairs in three years.

    “I wouldn’t be able to take her somewhere to get the vaccine. She doesn’t have any stamina,” said Corcoran, who arranges for doctors to make house calls when her mother needs attention. When she called their medical practice recently, an administrator said they didn’t have access to the vaccines.

    Corcoran said she “does everything for her mother,” including bathing her, dressing her, feeding her, giving her medications, monitoring her medical needs and responding to her emotional needs. Before the pandemic, a companion came for five hours a day, offering some relief. But last March, Corcoran let the companion go and took on all her mother’s care herself.

    Corcoran wishes she could get a vaccination sooner, rather than later. “If I got sick, God forbid, my mother would wind up in a nursing home,” she said. “The thought of my mother having to leave here, where she knows she’s safe and loved, and go to a place like that makes me sick to my stomach.”

    Although covid cases are dropping in nursing homes and assisted living facilities as residents and staff members receive vaccines, 36% of deaths during the pandemic have occurred in these settings.

    Maggie Ornstein, 42, a caregiving expert who teaches at Sarah Lawrence College, has provided intensive care to her mother, Janet, since Janet experienced a devastating brain aneurysm at age 49. For the past 20 years, her mother has lived with Ornstein and her family in Queens, New York.

    In a recent opinion piece, Ornstein urged New York officials to recognize family caregivers’ contributions and reclassify them as essential workers. “We’re used to being abandoned by a system that should be helping us and our loved ones,” she told me in a phone conversation. “But the utter neglect of us during this pandemic — it’s shocking.”

    Ornstein estimated that if even a quarter of New York’s 2.5 million family caregivers became ill with covid and unable to carry on, the state’s nursing homes would be overwhelmed by applications from desperate families. “We don’t have the infrastructure for this, and yet we’re pretending this problem just doesn’t exist,” she said.

    In Tomball, Texas, Robin Davidson’s father was independent before the pandemic, but he began declining as he stopped going out and became more sedentary. For almost a year, Davidson has driven every day to his 11-acre ranch, 5 miles from where she lives, and spent hours tending to him and the property’s upkeep.

    “Every day, when I would come in, I would wonder, was I careful enough [to avoid the virus]? Could I have picked something up at the store or getting gas? Am I going to be the reason that he dies? My constant proximity to him and my care for him is terrifying,” she said.

    Since her father’s hospitalization, Davidson’s goal is to stabilize him so he can enroll in a clinical trial for congestive heart failure. Medications for that condition no longer work for him, and fluid retention has become a major issue. He’s now home on the ranch after spending more than a week in the hospital and he’s gotten two doses of vaccine — “an indescribable relief,” Davidson said.

    Out of the blue, she got a text from the Harris County health department earlier this month, after putting herself on a vaccine waitlist. Vaccines were available, it read, and she quickly signed up and got a shot. Davidson ended up being eligible because she has two chronic medical conditions that raise her risk of covid; Harris County doesn’t officially recognize family caregivers in its vaccine allocation plan, a spokesperson said.

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    This post was originally published on Latest – Truthout.