Cough. Fever. Body aches. One after another, hundreds of underserved and homeless patients have passed through my emergency room this winter with similar symptoms suggestive of the flu. The past few weeks, however, have included a heightened sense of anxiety and fear. Any travel outside the country? Exposed to sick contacts? But before I can attempt to ease their concerns, I’m bombarded with questions on the latest national emergency: Covid-19, the novel coronavirus.
Last week the World Health Organization declared it a pandemic. The sluggish federal response, rapid community transmission, and inadequate testing have no doubt already cost the United States dearly. And as an emergency room physician who spends his nights treating patients and his days on Beacon Hill as a state representative, I find that the oath I swore to protect the public health has never been more relevant than at this critical moment.
Already there has been much talk of scaling up testing, social distancing, stockpiling supplies, and the like. All of these are paramount. However, we must not underestimate the difficult decisions and, quite honestly, the imperfect trade-offs that will be undertaken by those of us in government and the medical community. No decisions will be made lightly. No outcome will be without unintended consequences. And that is why, no matter what lies ahead, we must be particularly attentive and sensitive to the needs of the most socioeconomically vulnerable populations when implementing policies.
As a physician treating underserved communities in Boston’s busiest emergency department, and as an elected official who represents an urban district, I’m deeply concerned about what my patients and neighbors will assuredly endure. For when tragedy strikes, it’s these folks who are hardest hit. So I find myself often reflecting on this reality and how Covid-19 will manifest itself in not so obvious ways.
The scenarios are countless. Can we morally evict someone who must undergo self-quarantine? How will we provide food security to children who cannot return to classes but depend on free school meals? How will families afford mortgages and bills if they are forced to stay home with school-age children or undergo quarantine? Do undocumented immigrants feel safe enough from Immigration and Customs Enforcement to seek medical care? Are homeless shelters and jails adequately prepared, given their population density and unique medical conditions?
I don’t know how well these questions can be fully answered. But it is precisely in these trying times that we must confront fear with boldness and stagnation with innovation. Let us seize this opportunity forced by federal ineptitude to broaden public health goals and protect our most vulnerable communities. Doubling down on our commitment to paid family and medical leave is a start for families who will undoubtedly have to care for themselves or others. Moving forward with innovative technologies like telemedicine can help prevent further viral spread, increase access to care in rural settings, and lay the foundation to expand mental health services in the near future. Establishing a robust safety net for families suffering from food and housing insecurity will be imperative given the virus’s pervasive effects and the nation’s gross inequality. Supporting small businesses impacted by declining revenues, disruptions of the supply chain, or sick employees would also be wise. And encouraging policies that ensure safety from ICE and access to medical care for undocumented immigrants is crucial for public health efforts.
ER physicians are taught to be cool, calm, and collected in moments of crisis. And during my time in the Massachusetts Legislature, I have been proud to be a part of a body that has shown similar resolve and compassion while moving ahead deliberately in spite of failed leadership from the White House. Just this week we expedited a $15 million infusion to confront the pandemic, designated an internal task force, and have met regularly with a wide swath of stakeholders.
No doubt that the situation will worsen before it improves. But I have faith in our elected officials, local public health authorities, and medical community to shepherd us through this pandemic so long as we don’t forget the most vulnerable among us.
Dr. Jon Santiago is state representative for the Ninth Suffolk District and a practicing emergency room physician at Boston Medical Center. Follow him on Twitter @iamjonsantiago.
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