As Covid-19 sweeps across the world, health care workers have become prime victims of it, accounting for up to 20% of cases in the U.S. Infections and deaths among physicians, nurses, and support staff are straining the ability of hospitals to respond to the disease. The very people who are taking care of patients are becoming patients themselves and spreading the virus to others, including to their own families.
“I feel like we’re all just being sent to slaughter,” Thomas Riley, a nurse at Jacobi Medical Center in New York, told The New York Times. Riley and his husband both contracted the virus. At this scale, current efforts to protect health care workers from infection simply can’t be effective, especially with equipment shortages.
The age of the health care workforce is a problem. More than half of physicians are over age 50, and the average age of a nurse is 51 — putting them at risk of severe manifestations of Covid-19. So far in New York, patients in their 60s were 37 times more likely to die than those in their 20s.
And yet states are imploring older health care workers to fill hospital ranks to fight Covid-19. New York City, Connecticut, and Alabama, for example, have special initiatives to recruit retired medical staff. The Wall Street Journal highlighted a 60-year-old retired nurse who returned to help battle Covid-19 despite having to return each evening to her husband, a cancer survivor. The New York Times profiled seven retired doctors and nurses heading to hospitals “to reinforce systems in crisis” around the country. Their average age? Sixty-seven.
While the dedication of older health care providers is admirable, these plans are short-sighted. The odds that these retired health workers will become infected, pass the virus to family and friends of similar age, and together rapidly add to the hospital burden is high.
Instead of sending older workers into the fray, we need to deploy virus fighters who are less likely to die or get very sick. We also need a two-layer system of medical quarantine, not just for the patients themselves but also for the people who are treating them.
There are two rich sources of workers with less risk of becoming seriously ill: the thousands of individuals who have recovered from infections and thus have antibodies that provide immunity, and healthy members of the military under age 30.
Mobilizing large numbers from these groups can help hospitals care for patients and can staff alternative care facilities such as field hospitals, repurposed hotels, and empty college dormitories where patients with milder illness are isolated and treated. These health workers could live in the same alternate care facilities or be isolated in nearby buildings.
The military is already playing a role in fighting the Covid-19 epidemic but, with the exception of hospital ships that have taken a limited number of patients, that role has mainly been logistical. There aren’t enough military medics to take on these tasks. What we are advocating is training young members of the military to assume positions in isolation centers and assist in hospitals so they can relieve doctors and nurses for more important work, reduce their cumulative exposure to infection and allow them needed time to rest.
There’s no question that military men and women would be assuming a risk by doing this, but it is a far lower risk than when they are deployed abroad or even training on U.S. bases. Some will get sick and recover and join others with immunity, who can work without the protective gear needed to protect older and disease-naïve doctors and nurses.
Service members already work and live in communal units, and so would be used to isolation in alternate care facilities or dorms. Community volunteers with immunity need not be quarantined. If at all possible, quarantine quarters should be provided for current hospital staff caring for the sickest patients to support them and protect their families.
China, which moved thousands of health workers from around the country into isolation centers in Wuhan, has demonstrated how successful this kind of two-layer patient and caregiver quarantine can be.
The media, politicians — in fact all Americans — have been lauding the courage of hospital staff. But praise is not enough. As much as possible, we must keep them out of harm’s way while making it possible for them to continue to provide life-saving care. Let’s let the military and immune volunteers come to the rescue.
Bruce E. Wexler, M.D., is professor emeritus of psychiatry at the Yale School of Medicine and a winner of the NIH Director’s Award for high innovation. James K. Glassman, former under secretary of state for public diplomacy, advises health care companies and nonprofits.