I clocked out from my final COVID shift last week. For the past two years, I have done it all when it comes to the patients in our COVID inbox: screening for who gets tests when tests were rationed, triaging who should stay home when care was rationed, prioritizing who gets vaccines when vaccines were rationed, and deciding who gets treatments when treatments were rationed. Decisions made by those in power have affected every aspect of the health care we could offer, and the resultant toll on health care workers has been immeasurable. Health care workers are not OK.
As the transition back to “normal” begins, our clinics — echoing the rest of the nation — are moving toward a new stage of the pandemic. A stage where the role of the COVID-19 care provider is dissolved and absorbed into the umbrella of primary care, where a collective problem gets shoved onto the individual, and where the Centers for Disease Control and Prevention, our nation’s foremost health protection agency, places the burden of risk calculation onto millions of immunocompromised people by advising them to “talk to their health care provider” about masking and what measures they should take to stay safe. The CDC is essentially washing its hands of any policy-level responsibility to support or protect those who are most vulnerable.
Never mind the millions of uninsured people who don’t have primary care providers. Never mind the fact that talking to your provider first requires overcoming the barriers of a visit and a copay. In other words, in place of guidelines, it’s “talk to your health care provider.”
So we have moved on to the “live with it” part of the pandemic, even though more than 1,000 Americans a day are still in the “die with it” part of the pandemic. And with this push toward individual responsibility, we shift the burden onto individual clinics and onto already overstretched primary care clinicians who face the daunting task of trying to get antivirals to patients with COVID within the first five days of symptoms. It’s a task that can be achieved in well-staffed, patient-centered, functional health care systems. Ask your doctor whether we have one of those.
“The reach of the powerful continues to do harm, including Florida Gov. Ron DeSantis and his recent mask tantrum in front of high school students, in which he accused them of COVID theatrics.”
For two years, I have watched in horror as the people in charge of this country have presided over close to 1 million dead from COVID and counting, as charlatans and grifters occupy the halls of power. Never have I regretted so profoundly that I was not a person with influence, with a perch, pulpit, podium and power, like the morally barren have in abundance.
I have wanted to amplify the voices of those who are most vulnerable because countless decisions have disregarded their lives — those who are the least powerful, the most at risk and the least represented. Over the last two years, the mediocrity displayed at the top of our political hierarchy has been a shock to the system.
Rep. Matt Gaetz wore a gas mask on the House floor in the early days of the pandemic. It’s an image emblazoned in my memory. His mocking of a respiratory virus that would go on to kill millions worldwide set the tone for Donald Trump’s endless lies about everything from face masks to hydroxychloroquine and ivermectin. These lies were then given a platform and amplified in an endless cycle by the likes of Tucker Carlson, the grotesque frozen fish heir masquerading as a journalist and others.
The reach of the powerful continues to do harm, including Florida Gov. Ron DeSantis and his recent mask tantrum in front of high school students, in which he accused them of COVID theatrics. Casey DeSantis, his wife, was diagnosed with breast cancer and underwent treatment during the pandemic. Cancer patients have increased risks of poor outcomes if they catch COVID, and having family members with cancer myself, I know all too well the bullets you have to dodge to keep them safe. Thus, I have watched in horror as Ron DeSantis has paraded around maskless with his adoring, sycophantic crowds, a more polished mirror image of Trump, nudging children at podiums to parrot anti-mask talking points. I have worried about Casey DeSantis every time I see Ron DeSantis at another presser, putting more lies out into the world about vaccines and masks ― making the world less safe for her and people like her.
We have a saying in my culture: “Bhanela, pan ganela nahi,” which means “educated, but lacking sense.” Perhaps that applies in this case. But more than likely it is a choice, a choice to do whatever it takes to aggregate power — a thirst for power so acute, you are willing to make the world more dangerous for everyone, including your own wife.
These thoughts were swirling in my mind as I reflected on the past two years with another doctor who had to fight to get basic safety protections for her and her colleagues during that first year of the pandemic. The feeling of powerlessness, the lack of agency and the sense that she was too small to change anything had transformed her deeply. The clear sense of her disposability and the overwhelming vulnerability of her position was a shock that made her turn inward and pivot to feeling that she could only care for “me and mine” and let everything else go. Her emotions were raw as we spoke, as if she were still reeling, startled at how powerless she was made to feel.
I, too, felt like I had to take care of me and mine. But for me as an immunocompromised person, for better or for worse, my “mine” felt like it had expanded to 7 million people, a likely undercount of the total number of immunocompromised people in the United States. My “mine” had been told in a thousand ways, big and small, that we were disposable.
The more I think about it, the more I feel like my “mine” has expanded to people over the age of 65, 1 out of 100 of whom have succumbed to COVID. Being older shouldn’t make you disposable, regardless of whether a windbag out of Texas advocated for seniors to sacrifice their lives for the economy, knowing full well his position and wealth would insulate him from any such sacrifice. My “mine” has expanded to all people of color, whose disproportionate death rates have made it clear who benefits from the policies in our country ― and whose lives matter in our society. My “mine” has expanded to kids, who have lost so much over the past two years but have gained so many alleged local well-wishers willing to be out in front when it came to unmasking them. Unsurprisingly, these supporters were nowhere to be found this past weekend at the rally against school closures in Oakland, California. These kids’ lives matter as long as they are political pawns for antimasking initiatives, but their mattering is conditional on who they love and what their gender identities are.
As an immunocompromised doctor on my clinic’s COVID team for the past two years, I want everyone — especially our most vulnerable — to live and thrive through whatever this next period looks like. Everyone, especially the most at risk, deserves to have access to the antiviral Paxlovid as soon as they test positive for COVID. People who are severely immunocompromised should have access to Evusheld, the pre-exposure prophylaxis shot of monoclonal antibodies that can protect them from getting COVID in the first place. This should be available and accessible to all 7 million-plus immunocompromised Americans, and this should have been available before this push for “back to normal” was made. Instead, there is only enough for 850,000 people to be protected, and even that is not being distributed due to systemic dysfunction.
“Clinicians don’t have the luxury of staying in our lane anymore after politicians have rammed their way into ours.”
I have wanted a megaphone to drown out the voices of those who are educated but lack sense, educated but lack humanity, educated but lack decency, who didn’t seem to mind if their policies landed me in a body bag.
So I am taking this moment, here and now, to say loud and clear that while there are many things I will be doing as we “get back to normal” ― including continuing to advocate for vaccine equity, pushing for access to therapeutics for everyone, pushing to prioritize the immunocompromised and most vulnerable in this effort to reopen ― there is one thing I refuse to do: stay in my own lane.
Clinicians don’t have the luxury of staying in our lane anymore after politicians have rammed their way into ours. Politicians have inserted themselves into our clinic rooms, violating that sacred space between clinician and patient, and we must act and react accordingly.
When COVID policies reflect a disregard for the lives of those most vulnerable of all ages, we must speak out and demand different policies. Just as we have to speak out when policies are put in place that threaten the lives of our LGBTQ+ youth ― kids whose lives are being upended by so-called leaders in states such as Texas, Idaho and Florida. Just as we have to speak out when forced birthers continue to threaten the lives of people and their bodily autonomy. We must continue to advocate for those who will be gravely affected by these policies and laws. We must push back when decisions are being made that undermine the health of our communities ― decisions that directly hurt our patients.
Politicians and their policies shoved their way into our lane when we were forced to protect ourselves with trash bags, reusing limp N95 masks that we stored in brown paper lunch bags labeled with our names on them, shift after shift. Their actions and lack of actions have led us to nearly 1 million dead. These past two years have shown clinicians that staying in our narrow lane of old is no longer an option. If we care about the health and well being of all people, then in our lane, no lives are disposable.
Dipti S. Barot is a primary care doctor and freelance writer in the San Francisco Bay Area. You can follow her on Twitter at @diptisbarot.