Constructing--and deconstructing--the COVID-19 ghetto

Entering the post-pandemic world.

I had my annual physical this past week—delayed by 5 months. During the visit, my internist, asked me how I was doing. He is a very nice man, a respected teacher of internal medicine residents, and reminded me he has a Masters of Public Health. Yet, when I replied that it had been a stressful year, and that I had spent 4 months sleeping in the basement, away from my wife (until we figured that the personal protective equipment [PPE], despite rationing, really worked), he expressed surprise.

It was yet another reminder that for physicians, nurses, respiratory therapists, and all COVID-19 frontline workers, we have spent the better part of a year working in a COVID-19 ghetto.

I don’t use the word ghetto lightly, and I know, like all language, it can morph over time. As Jews, we have a historical relationship with the word. “This current use of ‘ghetto’ is also curiously mismatched to the history of ghettos,” as given context by the NPR Code Switch team. I mean an area where the “other” is segregated. The COVID-19 ghetto is mindspace, not just physical space.

The contours of the ghetto were easy to see from within, but from the outside, could be overlooked—or ignored. The people working in the ghetto are Emergency Medicine physicians, Intensive Care staff, Hospitalists and Residents who volunteered (or not) to work on COVID-19 units, and a select group of specialists—mostly Infectious Disease, Nephrologists, some Cardiologists and OB/GYNs and a few surgeons and anesthesiologists, and all of the nurses, aides, housekeepers and other staff who support this work. We feared for our own lives, as well as our loved ones, should we bring COVID-19 home. We stripped off our scrubs and took hot showers upon arrival home—if we even went home.

The physical location of the COVID-19 ghettos were the special COVID-19 units—even hospitals—where we cared for the patients. There were figurative and literal controlled entrances to don and doff PPE. NO ENTRY without a respirator.

Many healthcare workers did not enter the ghetto. I recall an ICU physician leader tell me, “You don’t really need to be here. Just call us or see the patient on an iPad.” While I embrace the advancements of telemedicine, I feel there are some elements of the initial assessment and interacting with patients that do not lend to that modality. However, many were more than happy to embrace it. I know of one specialist physician assistant who missed an obvious diagnosis of cholecystitis, because she did not want to enter the room of “rule out” COVID-19 patient. Instead, she relied on the physical exam skills of others—essentially undercutting or minimizing her own specialty training. We cared for pregnant women with COVID-19 in medical ICUS-with makeshift warmers and incubators for STAT deliveries or C-sections, should that unthinkable event happen.

Whole surgical specialties did not enter the COVID-19 ghetto. Early in the pandemic, elective surgeries were delayed, in the interest of preserving limited PPE. Later, when surgeries were restored, all the patient received pre-operative screening for COVID-19. Any positive patients again had surgeries delayed, unless truly emergent.

A year ago, I was sitting in the Doctor’s Lounge at one hospital. I struck up a conversation with an anesthesiologist colleague. I asked how he was doing, knowing that many surgeries had been cancelled. He told me had filed for unemployment insurance. He, too, expressed surprise at how busy I was in the hospital, or how full the ICUs were. From his perspective, COVID-19 had decimated his business. This same dynamic played out in many other specialties and clinics.

Now our COVID-19 hospital is closed, converted into a homeless shelter. At the other hospitals, where PPE is more plentiful, and staff are immunized (if they wish—that’s another story), patients with COVID-19 are no longer on specialized units.

Finally, we are discussing how to de-escalate the precautions, screening tests, PPE. We are deconstructing the COVID-19 ghetto—the otherization not just of the patients with COVID-19, but the healthcare workers who cared for them.

As the pandemic fades, in fits and starts and more inconsistently than we would like, the COVID-19 ghettos become deconstructed, and COVID-19 becomes just another respiratory disease, like influenza—dangerous but accepted into the course of all our lives.