I have only read about or watched devastating pandemics in science fiction novels or movies. I never thought I would experience any in my lifetime, but I am living one in realtime, right now, and it is scary!  Even though I am a neurosurgeon, I am not on the frontlines dealing with the pandemic as the heroic ER, ICU, pulmonary, and infectious diseases doctors and nurses, as well as, the first responders of all stripes. I cancelled all my elective surgeries even before there was a recommendation from the National Surgical Associations, to prevent my patients from exposure to the virus and to avoid taking up necessary protective equipment or ventilators needed for COVID 19 patients. I only have to go to the hospital and do surgery in a situation of life and death from brain trauma or hemorrhages. In spite of being a doctor, I can not even imagine or comprehend the degree of fear, anxiety, suffering and loss of life of all those who are engaged in the battle against this invisible enemy that is ravaging the globe. 

To add fuel to the fire of emotional angst of healthcare workers, we have hospitals scrambling for basic life saving Personal Protective Equipment (PPE), ventilators and even swabs for testing kits. The virus is inflicting unprecedented loss of healthcare professionals of all categories and first responders. Their numbers are dwindling; many from getting sick and some even dying due to lack of necessary vital protection at a time when their services are badly needed more than ever. How is this even possible in the nation that is the richest economy and spends the highest amount of money for healthcare in the world; 3.5 trillion dollars annually, yet is leading in the number of COVID 19 cases and possibly will also lead in fatalities in the world? Is it because most of that money has been going to greedy profit driven healthcare businesses as profits rather than for preventive and public health leaving many uninsured or underinsured. Consequently many with untreated underlying diseases have become susceptible to the virus and perished. Thanks to the powerful private health insurance and pharmaceutical companies, medical equipment manufacturers and profit driven entrepreneurs controlling healthcare in America, the doctors and nurses are standing on the sidelines, helpless! 

To make matters worse, we have a President who ignored the early warnings of potential medical disaster of pandemic proportions, relied heavily on his “hunch” and told the nation and the world that the virus would disappear like magic. He trusts private enterprises to save the country from the ravages of the pandemic rather than the need for and power of a well organized and coordinated governmental effort based on science based recommendations. His labeling the invisible enemy that is running rampant as political democratic hoax might have and continues to cost many lives. Delay to prepare, test, contain and suppress the virus in a timely manner is the consequence of the political gamble and utter disrespect for the disease as mere flu. Meanwhile the frontline doctors, nurses and first responders are afflicted by the highly contagious as well as deadlier virus and are dying from inadequate and ill-fitting personal protection equipment. It is hard to believe we are facing this in America and not in a third world country as is usually seen, and unfortunately expected.  It is a sad scene to see the helplessness of the healthcare and first responder soldiers in this unprecedented war against the virus. 

How can the doctors and nurses who are in the trenches alleviating suffering and saving lives, be dictated by these businessmen and not be in control themselves?

Our Commander in Chief, who did label this a “war against the invisible enemy,” is missing in action. He is dragging his feet to fully activate the Defense Production Act that could make a life or death difference for many citizens and healthcare workers fighting to save the sick as well as themselves. Physicians and nurses, who are voicing their concerns about the deplorable lack of life saving equipment to fight this war against the virus, are either being silenced or fired by the non-medical MBA hospital administrators. I am not sure if any of those Masters of Business Administration graduates even dare to enter a COVID 19 ward donning the personal protective equipment (PPE). The for profit hospital administrators consider caring for patients a commercial business rather than the sacred calling doctors have taken Hippocratic Oath for. How can the doctors and nurses who are in the trenches alleviating suffering and saving lives, be dictated by these businessmen and not be in control themselves? 

The virus is forcing doctors to rethink their role as not only healers but leaders in delivering necessary and optimal healthcare. Unfortunately, for decades physicians were not leaders and gave the reins of healthcare delivery to the greedy profit driven special interest healthcare businessmen who took the reins and ran. No! They galloped with millions of dollars in profits, laughing all the way to the bank. The time is now for the doctors to take charge and to cure the illness of greed that is eating away our healthcare and is responsible for the dire straits the pandemic has pushed the nation into. But first the virus has to be contained, suppressed and defeated, which will be a monumental task under the current medical and political conditions. There will be millions infected and tens, if not hundreds, of thousands of citizens succumbing to the wrath of the virus. There will be unimaginable and prolonged grief.  When we come out of this disaster the doctors and nurses and other healthcare workers have to roll their sleeves up, lead and change future healthcare delivery, including public health. It will be criminal on the part of the physicians to follow or allow the greedy profiteers and corrupt politicians to continue the healthcare business. Of course, that can’t be achieved without the involvement of grass roots citizen political participation to replace the current uninformed and incompetent politicians beholden to the special interest lobbyists for their personal political and financial benefit. A transparent, well organized, co-ordinated, science based and well funded governmental support is imperative to fight the current pandemic and prevent any in future.

In the effort to bring much needed future change to the current pathetic healthcare situation in America, it is well worth for the doctors to remember the past and not make the same mistakes the American Medical Association (AMA) made through out the history of American healthcare reform. From the very beginning of 20th century AMA took a stance against any governmental involvement or effort to provide universal health insurance, calling it Communism and Socialism. The leaders of AMA told the government to stay away from their professional lives. They fought hard against FDR’s wish to bring health insurance to the elderly and sick, warning they would even prevent Social Security legislation from being passed. Later, AMA fought even harder against Truman’s effort to provide health insurance to all the citizens. In 1945 AMA mandated its members to contribute $25 each to resist national health insurance. They spent $1.5 million on the most expensive lobbying effort in American history at that time to defeat government’s effort to make health insurance available to all Americans. The AMA leadership and members claimed to care more about their own professional freedom from government and possibly their bottom line rather than the health and well being of the citizens. 

President Trump and many of the current politicians beholden to the special interests will not bring any healthcare reform. In fact Trump’s policies are destroying Medicare and Medicaid and many current provisions and protections of the ACA. They are not allowing enrollment to ACA exchanges even in these frightening times of healthcare apocalypse for millions of the citizens. It is high time for doctors to remember their calling and fight for universal healthcare that allows them provide adequate quality care for patients when they are sick, and also help them prevent sickness.  It is sad that a viral infection of pandemic proportions had to shine light on the pitiful state of affairs of public health infrastructure in America. Hopefully we have learnt the lesson and make effective public health a reality in our nation. It is critical to create and put a public health machinery in place where true scientists can implement the necessary prevention, containment and  mitigation steps, free of influence from uninformed, science bashing, go by their “hunch” politicians. 

For physicians all across our land the time is now to speak out, join forces, inform ourselves as well as the general public and lead the healthcare reform movement. Holding the greedy, opportunistic health insurance, PHRMA and medical equipment manufacturer companies accountable is a must, but is going to be difficult in this relatively uncontrolled, unregulated capitalistic dog-eat-dog world. When doctors, nurses and first responders on the front lines are risking their lives to heal the sick on the daily and begging for protective masks, selling a life saving face mask for 7 dollars that actually costs 75 cents is not only criminal but down right evil, but is accepted as capitalism. Even Adam Smith, considered the father of Laissez faire market economy, is rolling in his grave; he said prices have to be just in such economy. There is good capitalism that is essential for creativity, innovation and meeting the demand of necessary equipment and then there is greedy capitalism. A nudging hand of government that wields necessary influence in times of devastating pandemic to mandate production of necessary life saving equipment and prevents price gauging is not socialism; it is humanism. As James Madison said, “If men were angels there is no necessity for government.” But then many CEOs of health insurance, PHARMA, medical device and equipment manufacturer businessmen are not angels. Hence the necessity for the role of a responsible government as well as masks and Medicare for All.

An unprepared, negligent surgeon is a dangerous surgeon and harms one patient at a time but a negligent, unprepared president is more dangerous as he harms thousands, if not millions, of citizens at a time. In 21st century, with all the available advanced technology and communication capabilities the fact that the richest and the most powerful laissez fair capitalistic America is relying on exports of life saving masks from a communist China that exported COVID 19 (knowingly or unknowingly) is as unbelievable as the pandemic itself. 

The irony cuts like a knife or should I say, kills like COVID 19!