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An Open Letter from a Healthcare Worker to the Federal Government

It’s important to start out this post by saying that my views are entirely my own, not meant to be representative nor endorsed by my employer, my medical directors, or anyone other than myself as an individual. (Although my employer posted this on instagram today, which bears consideration.)

Hello everyone,

My name is Taylor Sloan, and I’m a paramedic. I was a paramedic years before the  pandemic started and I will likely be a paramedic for years to come. In the time of COVID-19, I’ve been a supervisor of a large ambulance service, and worked in both 911 and inter-facility transport settings. I’ve seen hundreds of some of the sickest COVID-19 patients. Gratefully, as one of the millions of “healthcare heroes” (your words, decidedly not mine), I was one of the first in my community to be able to receive my first dose of the Pfizer vaccine on December 21, 2020 (time flies).

At the time, I thought this would be a red letter moment marking the departure from this godforsaken plague. What has happened since is not at all what I had hoped. That said, if I’m being honest, the pragmatic part of my mind predicted at least some of it. I accepted the reality that as grateful and excited as I and many of my healthcare worker compatriots were to receive that first dose of what felt like the way out of this pandemic, there would be those who would refuse vaccination.

A Washington Post article from just six days before my first shot brought forth a concerning poll from the Kaiser Family Foundation stating that a full fifteen percent of Americans would refuse the vaccine. What was then terrifying seems utterly quaint. As of writing this, according to the Mayo Clinic, only 61.9% of Americans of all ages are fully vaccinated, and only 51.9% of my home state of Indiana’s 6.7 million people are fully vaccinated. We are nowhere near herd immunity.

A screen-grab from the Joe Rogan Experience YouTube channel, showing Joe Rogan sitting behind a microphone.
figure 1.1

Aside from mandating federal employees and contractors be vaccinated, and the too-little-too-late requirement for companies employing over 100 full-time individuals to either mandate vaccination or require proof of weekly negative tests, what exactly has the federal government done to convince Americans to get vaccinated? In what way has the government gone beyond “it’s just the right thing to do” in its efforts? I can assure you that the mechanizations of weaponized unreality (see figure 1.1) which are convincing tens of millions of Americans not to be vaccinated are presenting a much stronger—if much less factual—argument.

As a healthcare worker, and perhaps specifically as a paramedic, I have the responsibility to ensure that a patient capable of self-determination makes an informed decision regarding their care. Where this most commonly applies is in the case of a patient for whom someone else has called 911 and they do not wish to be treated or transported to the hospital. In many such cases, our initial patient assessment can reveal very serious findings such as a heart attack, signs of a stroke, or vital signs indicative of possibly life-threatening illness.

In those circumstances, my duty as a paramedic is to ensure that this patient fully understands the gravity of their injury or illness, and that frankly I feel that they would be making a serious mistake to not allow us to transport them. Initially I will appeal to logic, failing that I’ll turn to emotion (e.g. “I believe you’re having a heart attack, and if you don’t go with us you might be leaving your wife a widow.”), and failing that I resort to essentially trying to terrify them into going. I’ll describe in excruciating detail what exactly they might feel as they die of a heart attack, or how they may become so physically disabled from a stroke that they can’t even feed or bathe themselves.

Among healthcare workers—and again, EMS in particular—this is called the “duty to terrify.” It stems in part from the significant legal consequences we could face for the negligence of leaving a seriously ill or injured patient to possibly die or become severely disabled. For those of us who truly care about our patients and got into healthcare to make people’s lives better, we see this as an ethical duty to convince people who are maybe scared or just stubborn to see the bigger picture. A paramedic who is a burn-out, poorly trained, or simply bad at their job will not do their due diligence in ensuring their patient makes an informed decision. They do a disservice to the patient, their family, the community, and their fellow healthcare workers.

What we have in America right now is demographic of unvaccinated people who are just like those patients for whom someone else called the paramedics and they don’t want to go to the hospital. They don’t understand the threat COVID-19 poses to their body. Maybe this is because they are stubborn, scientifically-illiterate, just plain scared, or some combination of the three. Unlike a good paramedic, who recognizes their ethical imperative, the leaders of our national pandemic response seem to have chosen the route of apathy, not just for the people who have contracted and will contract this disease, but for the healthcare workers who treat them.

The executive branch of our government has not kept its promises to do many things which could have dramatically slowed the progression of this pandemic: using the DPA to produce durable medical goods and test kits, creating a public organization to mobilize civilian and military healthcare professionals to work in the fight against the disease, and provide financial and material aid to the hundreds of millions of Americans who face economic hardship because of inability to work safely.

Most recently the CDC has taken steps to reduce the amount of time which people are supposed to quarantine, making claims that seem to be refuted by peer-reviewed data published in the British Medical Journal. CDC Director Dr. Rachel Walensky made a statement on Good Morning America which borders on eugenics, suggesting that people who have comorbidities (such as pregnancy, high blood pressure, diabetes, and organ transplants) are more likely to die of COVID-19, and that this was encouraging news:

“The overwhelming number of deaths — over 75 percent — occurred in people who had at least four comorbidities, so really these are people who were unwell to begin with — and, yes, really encouraging news in the context of Omicron.”

The response of the current administration to this pandemic should have been swift and decisive. The public health infrastructure of this country should have been mobilized in a way unlike ever before, but perhaps more importantly the information media infrastructure should have been mobilized to present the reality of this pandemic to the people who have not seen it the way those of us in healthcare have.

The media should have presented daily and nightly stories highlighting the human cost of the pandemic in real and raw ways, people should have seen inside the ICUs which are currently overflowing across this country Omicron patients. People should have heard the impassioned pleas of families of dead, seen the pictures of their last moments on earth. People should have  seen the mask-branded faces and tear-reddened eyes of the healthcare workers charged with caring for COVID-19 patients.

Everyone should have been made aware of the often-encountered experience of provider hearing a person’s last living words before placing an endotracheal tube in their throat and assigning them to one of the dwindling supply of ventilators. That process of a patient quickly going from awake and speaking to being dependent on a machine should have been described to and understood by every American.

The familiar course of often-futile treatment in the ICU should have been shared as well: steroids and novel drugs to fight the virus and it’s most serious effects at first, vasopressors to keep the blood flowing to the vital organs when systemic inflammation sets in, and finally the hours of healthcare workers watching the vitals of their patient trend down despite all of their efforts, knowing soon they would have to code them and they would almost assuredly not get them back.

Perhaps if a better effort to fulfill that duty to terrify had been made, many less Americans would have died, perhaps our hospitals and healthcare workers wouldn’t be pushed to the brink of collapse, and perhaps we could even be turning those resources used to overtake this pandemic in our own country to provide aid to the other nations of the world with less resources than our own.

Instead, those in charge of the response have chosen the mentality of the burnt-out paramedic who doesn’t really care if his intent-on-refusing patient makes an informed decision and dies at home. They have chosen that the wheels of capitalism must keep turning despite the human cost. They’ve chosen to downplay the severity of one of the most serious diseases of our lifetime so that people will go back about their lives as if everything is “back to normal.” What they and everyone uninformed about this pandemic doesn’t seem to understand is that a path has been chosen that will mean we may never see “normal” again.

This is my message to the people in charge of this response—specifically the Biden administration and the CDC leadership: you were charged to protect and provide care for the people of this nation, in the same way that I and my healthcare colleagues are charged with providing care and protection to the patients in our communities. You pledged to take decisive action to end this pandemic, and you have not taken those actions. You have failed us. This disease and its serious consequences (despite your assurances of its mildness) will be with us likely for generations. It will become endemic with no guarantee of a decrease in severity or deadliness, and you will be remembered as the leaders who made no serious attempt to stop it.

Published inopinionpoliticspublic health

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