Point of no return: COVID-19 and the U.S. healthcare system: An emergency physician’s perspective

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Science Advances  26 Jun 2020:
Vol. 6, no. 26, eabc5354
DOI: 10.1126/sciadv.abc5354
Maia Dorsett

In medicine, we examine our errors closely. Since the publication of To Err Is Human by the Institute of Medicine at the end of the past century, patient safety and quality are priorities (1). One core principle is that we cannot improve care if we do not examine our errors and use them to change our processes. Errors are destined to be repeated, and risk to patients further magnified when we do not learn from mistakes.

The past few months have tragically left us with ample opportunities to improve. The coronavirus disease 2019 (COVID-19) pandemic has amplified preexisting deficiencies and inequities of our healthcare system. U.S. healthcare is incentivized to react to sickness rather than proactively focus on health maintenance. As an emergency physician, I witness the impact of this approach daily. Far more money and effort are expended on minimally impactful interventions than addressing social determinants of health such as housing, food security, and safety from violence. Collectively, these have a greater impact on healthcare outcomes than any pill. Procedures to manage illness are well compensated, but public health systems to improve population health are underfunded and understaffed. On any given day, emergency departments (EDs) operate near or over capacity. A lack of inpatient beds forces EDs to hold admitted patients until space is available. ED care is then shunted to suboptimal conditions, leaving us to care for patients in waiting rooms, chairs, and hallways (2). Such reactionary systems fail spectacularly in the face of time-sensitive emergencies, because they lack the plasticity to respond quickly (3). Our healthcare and public health systems have faltered in the face of the COVID-19 pandemic. The question remains, will we learn from our mistakes?

COVID-19 is a slow-moving mass casualty incident (MCI). An …

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