When the doctor found out she’d be working in the COVID-19 ward in a Boston hospital, she was so terrified that she printed out a document: “Last Will and Testament.” She worried about the shortage of N95 respirator masks, the kind that used to cost a few bucks at Home Depot. Her hospital didn’t have enough of them.
But then her husband remembered that he’d bought a box of those masks a few months before, intending to use them for a sanding job. Now he handed her the precious box, believing that she’d have enough to get her through the next week on duty. She sent her husband a photo from the hospital, wearing an N95 and giving him a thumbs up.
Her relief didn’t last long. She received an email that outlined a new set of rules: doctors and nurses could only use N95 masks certified by the Food and Drug Administration. The masks her husband had given her looked almost identical to the single mask she’d been issued by the hospital. But she wasn’t allowed to use them. She would have to wear the same “hospital grade” mask every day, storing it in a cubby while she slept, and strapping it on again when she returned to the COVID-19 patients.
She wondered who had made this rule and why. Was it coming from the hospital leaders? The state government? The FDA? Or from someone in the supply room?
The doctor, whose identity I’m not at liberty to disclose, said she was exhausted by the confusion and lack of coordination, the blizzard of emails, and constant policy updates. She’s not the only one distressed by the chaos and lack of leadership. A group of Massachusetts medical workers drafted an open letter Wednesday calling on Governor Charlie Baker to create a “clear, statewide plan for the public health response” in order to save lives.
We often talk about the pandemic as a kind of war. If it is, then each Massachusetts hospital is a battleship. Without a clear chain of command, the battleships drift about and may even end up crashing into one another. In order to work as a fleet, the battleships must be united under one admiral and a team of captains.
What Massachusetts desperately needs is a COVID-19 czar working with a dream team of experts. The leadership should have a direct line to hospitals, issuing guidelines and fielding questions about how they should function. Each hospital, along with its front-line health care workers, should have the benefit of receiving clear guidance from a Massachusetts COVID-19 central authority.
But we’re far from that scenario. People who work in hospitals around the state have told me that they’re following contradictory rules about masks and other procedures.
"Our own suppliers can’t give us anything right now,” according to Dr. Stephanie Osiecki, a physician in Northampton. "Each doctor’s office and hospital and police department is struggling. Meanwhile, people and businesses want to help. So we need someone to step in and lead a coordinated effort.”
The failure of leadership begins at the top: the Trump administration hasn’t effectively responded with a national plan to contain the pandemic. The Centers for Disease Control and Prevention isn’t determining best practices in hospitals, providing guidance to state public health officials, or tracing contacts to see where hot spots are likely to surface next. And without clear federal leadership, state governors are running the show. Massachusetts has become a sort of nation-state unto itself, competing with New York for shipments of personal protective equipment and other supplies.
Baker has assembled a task force of advisors to help him handle the pandemic response. But that has been inadequate. The open letter calls for the Massachusetts government “to provide strong public health leadership” where it is now lacking — for example, to manage the supply chain so that equipment is “equitably distributed” among hospitals. The letter has been endorsed by the Massachusetts Nurses Association.
If the Baker administration beefed up its COVID-19 command center and made it clear who’s in charge of supplies, hospital policies, and such, doctors would know whom to call with their questions. They could follow clear policy directions. And they would know that equipment is being directed to the workers who need it most, instead of the current system in which hospitals are sometimes pitted against one another as they beg for resources.
We’re blessed with a wealth of particularly relevant talent in Massachusetts. We could tap a COVID-19 czar who has fought Ebola and malaria in nations with weak health care infrastructure, which means they know how to cope with supply shortages. To run the state’s supply chains and coordinate the hospitals, we need to give one of these brilliant, experienced people the wartime powers needed to tame the chaos and, ultimately, save lives.
Pagan Kennedy is a contributing writer for the New York Times and author of several books about science and technology.