NEWS USA TODAY ❚ FRIDAY, APRIL 3, 2020 ❚ 7A
OPINION
MIKE THOMPSON/USA TODAY NETWORKLast week, I woke up to the news
from a physician friend that her col-
league had killed himself. After hearing
about a physician’s suicide, another
doctor texted me saying she is having
“suicidal thoughts at times.”
As an internal medicine doctor in
San Jose, California, and a member of
my hospital’s COVID-19 team, I
too have felt helpless. And I’m
increasingly worried about the
scale of emotional trauma faced
by our health care workers.
As I considered writing this
column, I put out a call to action
on social media, asking health
care professionals all over the
country to share what they are
facing. Our traumas are overwhelming-
ly similar:
“I am an emergency medicine physi-
cian in a mini epicenter in Southwest
Georgia,” said Dr. Nilam Vaughan in re-
sponse to my call on Facebook. “We
have had 11 deaths and our ICU is full.
We have run out of (ventilators). I have
intubated multiple COVID-19 positive
patients and have positive exposures.
And I haven’t seen my three kids in
three weeks. ... I don’t sleep anymore
because I’m constantly trying to make
sense of all of this.”
We are “having panic attacks," said
Janice Tham, an ICU nurse practitioner
in San Diego. People are talking about
“making sure living wills and advanced
directives are updated.”
Their words bleed their pain.Lacking protective equipmentEvery day I talk to colleagues who
are struggling with the painful deaths
of patients and health care workers.
They work while fearing infection from
this highly contagious and fatal dis-
ease. They lack protective equipment.
As a result, they have trouble focus-
ing. They have a hard time sleeping.
When they do sleep, they wake up in
the middle of the night with an impend-
ing sense of doom and helplessness as
though their own deaths are imminent.
I can’t let another friend die.
Mental stresses such as exhaustion
and burnout drive more than 400 doc-
tors to kill themselves every year.
A survey of 1,257 health care workers
who treated coronavirus patients in
China revealed high rates of mental
health trauma — more than half report-
ed symptoms of depression, 44.6% re-
ported anxiety, 34% insomnia and
71.5% distress.
It is unrealistic to think medical pro-
fessionals can put aside stress as we
witness this horrifying disease and its
deaths on a daily basis. It’s easy for pa-
tients to see doctors on the front lines
as impersonal figures — just workers
wearing white coats, scrubs and masks
(if they are lucky) whose duty is to take
the burdens and stresses of intensivecare trauma. But behind those masks
are living, breathing human beings
with the same coronavirus fears as ev-
eryone else.
The difference is they can’t show or
acknowledge it. Those fears don’t dis-
appear; instead, they fester.
I was familiar with trauma and feel-
ings of paralysis and helplessness long
before I became a doctor.
As a child in New Delhi, I witnessed a
violent religious riot after the assassi-
nation of a prime minister.
Later in life, I survived a stroke, went
through a painful divorce and
suffered a miscarriage alone.
None of that has shaken me
as much as America’s misguided
response to coronavirus that is
burdening ICUs across the coun-
try. None of those things have
hurt me as deeply as the result-
ing trauma for health care work-
ers who are trying to cope with
fallout beyond their control.Hear my screamI recently lost my grandmother. This
month, I also lost a family member to
COVID-19 who was in his 40s. He left
behind his wife and young kids. I had to
schedule my grief after two days of
work, because in an unprecedented cri-
sis like this, where is the time to
mourn?
There is nothing familiar about what
we are enduring right now.
It is exhaustive to be strong. The col-
lective soul of front-line health care
workers is slowly and silently decaying
with no rescue in sight. We need help
carrying this massive weight because
we are weary. We feel powerless, dis-
posable, unheard and highly at risk.
In this column, I am screaming, and I
am helping my colleagues to do so as
well.Nivedita Lakhera is a doctor of inter-
nal medicine at the O’Connor Hospital
in San Jose, California.Front-line doctors are
struggling with trauma
We feel powerless,
disposable, unheard
Dr. Nivedita LakheraWANT TO COMMENT? Have Your Say at
[email protected], @usatodayopinion on
Twitter and facebook.com/usatodayopinion.
Comments are edited for length and clarity. Con-
tent submitted to USA TODAY may appear in print,
digital or other forms. For letters, include name,
address and phone number. Letters may be mailed
to 7950 Jones Branch Drive, McLean, VA, 22108.The nation received the grim news
this week that, even under the best ef-
forts to fight the new coronavirus, as
many as 100,000 to 200,000 Ameri-
cans might die.
Beyond that stunning White House
revelation lies an even darker reality:
The world’s richest and most medically
advanced country won’t have enough
ventilators to keep alive all the CO-
VID-19 victims struggling to breathe.
In the worst cases, the virus mi-
grates to the lungs, where tiny air sacs
called alveoli can be damaged, compro-
mising the ability to take in oxygen.
When breathing becomes heavily la-
bored, a tube is forced down the throat
— intubation — and a machine, a venti-
lator, infuses crippled lungs with oxy-
gen, allowing precious days or weeks
for a patient to hopefully recover.
Physicians in northern Italy’s most
advanced hospitals were weeping in
hallways because they ran out of venti-
lators and had to choose who would live
or who would die.
In America, governors are trying to
stock up on the machines, but it’s a
struggle. New York is America’s epicen-
ter of the outbreak and needs as many
as 30,000 ventilators. As of Wednes-
day morning, the Federal Emergency
Management Agency, which handles
the national emergency stockpile, pro-
vided 4,000. The New York Times re-
ports that Illinois needed 4,000 and got
450; New Jersey sought 2,300 and re-
ceived 300. Virginia requested 350 and
nothing has arrived.
It gets worse.
Thousands of ventilators in the
shrinking federal stockpile, and scores
sent to states, are broken for lack of
maintenance. States are scrambling to
buy machines on the open market but
are bidding against each other and
FEMA. “Look at the bizarre situation,”
New York Gov. Andrew Cuomo said
Tuesday. “It’s like being on eBay.”
And now the federal government is
recommending hospitals split a venti-
lator between two patients, an option
experts say is difficult and desperate,
not the least because it requires trying
to synchronize the breathing of two
desperately ill patients.
This situation ensued despite the
Trump administration anticipating
shortages nearly six weeks ago, accord-
ing to Feb. 25 congressional testimony
by Health and Human Services Secre-
tary Alex Azar. A month later, President
Donald Trump finally invoked the De-
fense Production Act to pressure car
makers to produce ventilators. They
hope to have made 50,000 by July,
weeks after the anticipated peak of the
epidemic.
There will be plenty of time to figure
out how this ventilator crisis was
botched as badly as the lack of corona-
virus testing. Right now, though, there
are three more urgent priorities:
❚Stop the bidding wars. Trump
said states “shouldn’t be doing that. If
that happens, they should be calling
us.” They shouldn’t have to call. He
needs to be proactive and coordinate
with the states so that FEMA does all
the purchasing and distributes the ma-
chines — many of them produced over-
seas, in China and elsewhere — to
states as needed.
❚Take politics (and incompe-
tence) out of decision-making.The
distribution of medical supplies has
been a mess. The Washington Post re-
ports that Oklahoma received 120,
face shields from FEMA, despite asking
for only 16,000. North Carolina wanted
500,000 medical coveralls and got 306.
Florida, which happens to be a crucial
battleground state, has received 100%
of what it wants. At some point, the
federal government will have to make
hard decisions about doling out venti-
lators to states in crisis. That must be
done with careful analysis, dispassion-
ately and without favor or partisanship.
❚Protect doctors. If the worst hap-
pens and there are more suffocating
patients than machines to keep them
breathing, medical ethicists have al-
ready circulated triage guidelines.
Those deemed medically most likely to
survive the disease would be first on a
ventilator — an awful choice to make.
But as it stands in this country, clini-
cians who withhold or withdraw venti-
lators without the consent of a patient
are exposed to criminal charges or civil
liability. A 2004 Maryland statute,
which other states should adopt, pro-
vides immunity if a health care deci-
sion was made in good faith and under
catastrophic circumstances.
Denying someone life because
health systems are overwhelmed is a
nightmare no advanced nation should
have to contemplate. But there is a very
real possibility this could happen in the
coming days and weeks, and the time
to act is now.
— By Gregg Zoroya for the Editorial
BoardTODAY'S DEBATE: SAVING LIVES
Our view: On ventilators, stop
bidding wars, remove politics
A ventilator in a field hospital in New
York City. STEPHANIE KEITH/GETTY IMAGESVentilators represent the last line of
defense for patients suffering with se-
vere COVID-19 symptoms. We are mov-
ing swiftly in Trump Time to address a
significant shortage of these lifesavers.
The Trump administration has
worked with 10 manufacturers on a
plan to deliver an additional 5,000 ven-
tilators within the next 30 days, and
more than 100,000 additional ventila-
tors by the end of June.
In a page taken out of the World War
II playbook, the Ford Motor Co., with
General Electric, is racing to produce an
additional 50,000 new ventilators in
100 days at a converted auto plant in
Michigan.
Our clear challenge is to get enough
ventilators where and when they are
most needed over the coming days and
weeks while we race to increase health
care capacity to do so. The American
public is critical to helping us win this
race. By embracing mitigation mea-
sures, such as social distancing, we will
flatten the epidemiological curve of in-
fections, so we can more efficiently use
our existing ventilator stock.
With the full force of the Trump ad-
ministration, the full partnership and
patriotism of private enterprise and the
extraordinary sacrifices of the Ameri-
can people, we will defeat this virus —
and our country will be stronger and
more innovative and more united for it.
As we face this crisis, one of the big-
gest lessons we have learned is that
America is too dependent on foreign
nations and the global supply chain for
essential medicines, like penicillin;
medical supplies, such as masks and
gloves; and medical equipment, like
ventilators. More than 50 nations have
already imposed some form of export
restrictions on the products we need to
survive, and this will only get worse.
President Donald Trump has been
right from the beginning: We must con-
tinue to buy American, secure our bor-
ders and build a strong manufacturing
base. It is essential for our economic
security, our national security, and in
this case, our public health.Peter Navarro, assistant to the presi-
dent for trade and manufacturing, is
the coordinator of the Defense Produc-
tion Act policy.Opposing view:We’re moving
swiftly to address shortages
Peter Navarro
Gannett Media Corp.
Chief Executive Officer
PAUL BASCOBERTUSA TODAY Publisher
President of News
MARIBEL PEREZ WADSWORTHExecutive Editor/News: Jeff Taylor
Executive Editor/Audience: Patty Michalski
Editorial Page Editor: Bill SternbergVice President/Local News and Audience Development: Amalie Nash
Vice President & Executive Editor/Investigations: Chris Davis
Chief Revenue Officer, sales and service: Kevin GentzelUSA TODAY
Editor in Chief
NICOLE CARROLL“USA TODAY hopes to serve as a forum for better understanding and unity to help make the USA truly one nation.” – Allen H. Neuharth, Founder, Sept. 15, 1982Dr. Nivedita
LakheraShare your story, experiences and
messages for front-line workers and
others throughout the nation on USA
TODAY Opinion’s coronavirus hotline.
Have any tips for getting through this
time of self-isolation? How are you and
your loved ones doing it? What have you
encountered at the ER? During treat-
ment? How have you coped with the
loss of a loved one?
Give us a call at 540-739-2928.
Please be sure to leave your full name,
phone number and email address. We
may publish your comments on the USA
TODAY Opinion site or in print.Coronavirus hotline