Ignorance Is Not Bliss: the Consequences of How Little We Know About Covid-19
| Publication year | 2020 |
| Author | Craig B. Garner |
Craig B. Garner
Craig Garner is the founder of Garner Health Law Corporation as well as a health care consultant specializing in issues pertaining to modern American health care. Craig is also an adjunct professor of law at Pepperdine University School of Law. He can be reached at craig@garnerhealth.com
"Those who can make you believe absurdities can make you commit atrocities." - François-Marie Arouet (Voltaire)
Following the 1994 Northridge earthquake, California passed legislation requiring hospitals to upgrade their physical infrastructure to survive future seismic events. Twenty-six years and multiple extensions later, California hospitals face a 2030 deadline with an eleven-figure price tag.2 Spending money on what may occur is not uncommon in health care. A 2017 study commissioned by the American Hospital Association estimated that hospitals and health systems spent as much as $2.7 billion the year before to prepare for, and respond to, the threat of violence at work.3 California law requires hospitals to rehearse disaster plans at least twice each year.4
An expensive endeavor, hospital disaster preparedness focuses on a rapid response to an unexpected event, designed to protect, stabilize, and bring calm to shaken communities following a disaster's aftermath. The 2019 novel coronavirus disease (COVID-19) has presented a different type of disaster, necessitating just as novel a response. In the pandemic's early days, it moved in slow-motion as the health care community initiated disaster protocol over a period of weeks, not hours. While mobilizing any hospital to battle a pandemic is not easy, legally at least, hospitals benefitted from unprecedented support by practically every federal and state agency. The assistance from these dual agencies eliminated most barriers overnight so hospitals could establish and maintain momentum in the face of an epic disaster that, over several months, has moved forward, backward, and forward again.6
Charged with protecting a health care system from a new disease while treating millions of patients without much in the way of established protocol is a formidable task for even the most seasoned health care practitioner. These practitioners also faced, and continue to face as of the date of this article, challenges in maintaining stockpiles of the personal protective equipment ("PPE") for treating a new virus against which the human body has no known internal protections,7 not to mention a government order for all residents to remain at home,8 which has since gone back and forth.9 Restaurants, small businesses, and most larger counties in California remain stuck on a viral string looped around two disks, not to mention school children around the nation who may not enter an actual classroom until at least 2021.10 What remains unchanged, however, is the six feet between most people.11
This is the environment in which health care practitioners must work, and in some ways over a painfully extended period of time, for tactical planning and re-planning. While news outlets, statements from state and federal officials, and the trusted information disseminated on social media portrayed COVID-19's siege on New York City as apocalyptic,12 Governor Newsom's projection regarding the later May surge13 has been replaced by fear from the pandemic's forthcoming "second wave."14 Monitoring of this fear and of similar, predictions tests the ability of any hospital to maintain the necessary vigilance during an unprecedented time with mortal employees.
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Hospital leadership can only be as effective as the workforce over which they serve, and preventing employees from abandoning posts16 may ultimately depend upon not just how well California survives COVID-19, but how long the pandemic lasts. With no end in sight, hospital leaders may consider a crash course in psychology, although there are plenty of studies on how people respond in a crisis.17 Fortunately, hospitals have relied upon the Hospital Incident Command System ("HICS") since the pandemic began.18
HICS is a system based on principles of the Incident Command System ("ICS") that assists hospitals and health care organizations to improve their emergency management planning, response, and recovery capabilities for both unplanned and planned events. ICS is a management system designed to enable effective and efficient domestic incident management by integrating a combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure.19 However, the effectiveness of HICS in response to COVID-19 remains largely unknown.
With trusted resources upon which hospital leaders can rely, coupled with the unprecedented waivers in what many once considered a heavily regulated industry, these institutions have remained on the front lines as California battles COVID-19, one hospital at a time, month after month. As medical science learns more about this virus, recent studies indicate that the overall case fatality ratio may be somewhere between 0.3% and 1.5% (including unreported cases),21 far below the original estimates in the pandemic's early days.22
As a practical matter, what if the statistical information upon which the world leaders relied was wrong? More specifically, what is the significance of 650,000 COVID-19-related deaths by the end of July 2020?23 Before the global economy plunges even deeper into depression, entire industries disappear overnight, and every boy and girl born in the past decade miss out on that rite of passage commonly known as childhood, those responsible for connecting the statistical information with the effect of the pandemic should double check their calculations.
Like it or not, the United States still remains a powerful nation, a true democracy capable of leading other nations around the globe deep into the abyss. Today our health care system, a product of partisan politics fifty-five years in the making, faces its greatest challenge in an order of magnitude above the constitutionality of the individual mandate25 or safe harbor expansion under the fraud and abuse laws.26 The story changes considerably, however, if COVID-19 data deviates in accuracy by its own order of magnitude, such that the number of those infected increases exponentially, thereby pushing the overall mortality rate down. If it turns out the overall mortality rate is below 1%, it may still never answer whether the global response should be any different. To be sure, no one likes to suffer from ordinary influenza, but at a certain point the numbers may fail to justify the wreckage caused each day to the global economy or the mental stress caused by isolation and social distancing, much less the possibility that children may someday vaguely remember when teachers existed beyond a computer...
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