Fighting the War on COVID-19, a PREVENTABLE pandemic

We are Fighting the War on COVID-19. It is literally a biological warzone in hospitals right now and we, health care workers, are the soldiers. I am mentally and emotionally drained from this mostly PREVENTABLE pandemic. I have been caring for 150+ (sometimes 200+) patents daily, something I have never done prior. With these numbers, it is impossible to provide optimal care to all patients with or without COVID-19. Now pharmacists are authorized to order and administer COVID-19 tests, but of course we likely will not get paid/reimbursed to provide this service since New York State does not consider pharmacists as health care providers. We all know at least one person who has been affected and/or died from this virus. I am pretty much burning out from constant fear, stress, ethical dilemmas, and exhaustion; I am sure all health care workers feel the same way. I have not been able to sleep properly for the last few weeks. I have been working beyond my limits daily, and I am still working in my dreams. I wake up unrested and proceed to another torturous day. I fear for my family, my friends, New York, the United States, the world, and myself. People of all ages are dying, even young people around my age (and even younger) without many comorbidities, and we cannot do much about it as much as we diligently and constantly try our hardest. The virus does not discriminate, and neither should we. ALL health care workers should be respected, including pharmacists, not just physicians and nurses. We are ALL frontline. ALL should be treated fairly and compensated justly. Health care workers should not be abused! This is difficult for me to write, but I have been asked to provide my personal perspective on our internal and external struggles as pharmacists and frontline health care workers in this crisis known as our current COVID-19 pandemic caused by SARS-CoV-2. I initially did not want to write this because I did not want to scare people. At this point, I do not think it matters. Everyone is afraid, and everyone deserves to know the truth. Maybe then, everyone will understand the importance of staying home, social distancing and flattening the curve. However, I do believe that we are at/near the peak and may plateau for some time. If we are not, I am sure it will occur within the next week or two. We need to implement appropriate measures to ensure that this peak/plateau is the first and only, and that our numbers only decline from here. I genuinely hope that the quarantine extends beyond April, even if we have to extend through the rest of June, as long as we can eradicate this virus. I sincerely hope that employers do not use this as an opportunity to bring workers back to work as soon as possible. We must not think that, because things are improving, we can go out again. This will lead to another surge in cases and cause another peak to occur. I truly hope that this does not become a seasonal virus. If it does, I pray that it does not mutate like influenza does. If it does, then current vaccines in development may not even be effective. We ALL need to do our part. No matter who we are, no matter how important we think we are, and no matter how important we think the things we need to do and the places we need to go are, we are all partly responsible for contributing to the spread of this disease. Just as much as people want to point blame and hold China or whoever accountable, we should hold our country’s “leaders” accountable as well for their inaction. Trump has not been proactive in taking appropriate public health measures in a timely manner. Instead, Trump’s incompetence and reactiveness has caused many unnecessary casualties. People just do not understand how serious this is until it is too late. It is already too late to save the lives that have unnecessarily been lost, yet the necessary measures have still not been taken. However, it is not too late to save future lives. Thank you to ALL the health care workers/heroes/soldiers/warriors fighting this war. Thank you to Northwell, LIJ Valley Stream, and all the other institutions that are leading the way in this pandemic, treating employees fairly, and optimizing patient care to the best of their ability. As a disclaimer, my perspectives are not specific to my institution or organization. I am talking about health care. Just a fair warning, this will probably be a long post. I apologize in advance for any disorganized structure and/or grammatical errors.

At first, we all suspected this virus would be like influenza. In some respects, it is. However, there are proven vaccines to prevent, and somewhat effective medications to treat influenza. As a result, even though many more patients contract influenza, mortality rates are relatively low. This in no way minimizes the damage and destruction that COVID-19 causes. The devastating complications that we have been seeing from this new virus, especially in the critically ill, are beyond our current level of care.

Afflicted patients may initially have minor symptoms that may include shortness of breath, a dry cough, and maybe some other non-specific symptoms of any infection. Some may have gastrointestinal symptoms, while others may have changes in their sense of taste or smell. Some may not exhibit any symptoms at all and appear completely fine. If the patient is symptomatic, and the patient’s body does not appropriately manage the infection, these symptoms may advance, and the patient may become hypoxemic due to lung damage. This prevents oxygen from getting to the patient’s vital organs. These patients then receive sedation and paralytics in order to become intubated. Even then, they still do not appropriately oxygenate their organs. It is possible that there may be tiny clots forming in their blood vessels, but we are not entirely sure yet. Slowly but surely, their vital organs get damaged from impaired oxygenation, and start to shut down. We try our best, but nothing seems to be working. Even if patients recover from the virus, we do not know what long-term complications these patients may experience.

Here comes the bigger problem. We do not know of any effective treatment to eradicate this virus. We are grasping at straws and using medications that we think may work. We do not have any strong evidence to prove that anything we are doing is working. However, we are health care workers and need to do whatever we can to try and help our patients. To make things difficult, fake news is posted everywhere. Even reputable sources are providing statements without any evidence to back them up (e.g., ACE inhibitors/ARBs, NSAIDs, steroids, etc.). Sometimes these statements get redacted, but that is not before they cause potential harm in those willing to follow whatever they hear without looking into the actual evidence, or lack thereof. Furthermore, despicable and immoral people, including health care “professionals,” are trying to make a profit off this opportunity at others’ expense. People are price gouging masks and personal protective equipment. If you want to make a profit, fine. Sell it for a penny more than you bought it for. We are in a crisis. Help one another out to save humanity. We should not have to deal with ridiculous price gougers in this crisis. I am so glad that there are philanthropists who are trying to provide these for free. Since we cannot effectively eradicate this virus, we need to focus on preventing its spread.

So, what are health care workers currently doing? We are pretty much giving every patient hydroxychloroquine. Does it work? We do not really know. We are throwing on a bunch of other medications to try and help. Do they work? We do not really know. When patients become critically ill to the point where they cannot get adequate oxygen through their bodies, even when we are providing non-invasive modalities of oxygen delivery, we are forced to intubate them. In order to humanely and appropriately intubate them, we need to give them sedatives and paralytics. These medications are on national shortage because everyone needs them. Normally, the paralytics can be removed after a short period of time once the patient is oxygenating sufficiently with the ventilator. However, most patients with COVID-19 do not synchronize with the ventilator and require extended durations of sedation and paralysis. In order to maintain this, we need to keep medicating them. Where do these medications come from? The pharmacy provides them. The pharmacy tries their best to get these medications from wholesalers and manufacturers. But now what happens when this situation presents itself in every hospital across the country, particularly in New York? Demand exceeds supply. There is a national shortage of medications that are needed to save our patients lives. This does not just apply to the sedatives and paralytics. It also applies to our “miracle,” hydroxychloroquine, and pretty much every medication we are using to try to treat our patients to the best of our ability, including chloroquine and remdesivir. Soon enough, chloroquine, azithromycin, doxycycline, lopinavir, atazanavir, umifenovir, favipiravir, steroids, vitamin C, vitamin D, thiamine, zinc, alpha-lipoic acid, N-acetylcysteine, alteplase, epoprostenol, nitric oxide, oseltamivir, baloxavir, ivermectin, ruxolitinib, and whatever else people want to try, are all going to run out. We are all trying to use investigational medications, like tocilizumab, sarilumab, anakinra, and who knows what else. Those might work to reduce the ongoing damage caused by the virus, but they have not been proven to work just yet. As with all other medications we are attempting to use, these also go on shortage since demand exceeds supply.

Why is the demand so high? Why are so many people getting COVID-19 and requiring treatment? You tell me. We have been telling everyone to stay home unless there is a real reason to leave your home. If you must leave, practice social distancing and minimize your exposure to other individuals. Does everyone listen? No. You may have done your part, but not everyone has. Therefore, so many people are getting COVID-19. As more people contract the virus, more people will spread it, the cases will continue to increase daily, and many more people will require treatment. As more people require treatment, we deplete our finite supply of medications, ventilators, and health care workers. There is no point in getting all these ventilators if we cannot get the medications to sedate and paralyze these patients.

Several times a minute, we get multiple phone calls in the pharmacy to ask if we have specific medications, or why these medications have not been verified or sent to the units. People complain that we call them too often. Imagine how many calls we are getting since we are getting calls from across the hospital, many times for unnecessary things. Sometimes, we must determine who the best candidates are for these medications. We cannot go around giving all finite medications to every single patient who sets foot into a hospital. If we are forced to give all medications to all patients, including those who do not actually need them, we will run out of our medications within a day or two. We must make phone calls every few minutes across the entire hospital to see who actually needs these medications. Some providers will tell us that the patient does not actually require the medication and be alright with discontinuing the orders. Sometimes we explain that the patient does not meet criteria for the medication. Sometimes providers want the medication despite knowing that the patient does not meet criteria and does not actually require treatment. This warrants further escalation. Now what do we do when truly sick patients come in and we do not have any medications to give them? This is what happened in Italy and is the reason why health care workers in Italy had to decide who to treat and who to give up on. If we continue down the same path we have been traveling on, we will end up in the same predicament that Italy faced. We try our best to support our patients, but we cannot work magic to create more health care workers and medications out of thin air.

This concept does not just apply to medications. This also applies to medical devices, like ventilators, and to personal protective equipment, like masks, face shields, and gowns. With regards to masks and gowns, many health care workers are forced to reuse what they have. N95 masks are being used for more than a week at a time at some facilities. This should never have to be the case. However, since we did not adequately prepare for this pandemic, there is a shortage of personal protective equipment. The more we forced to use these ventilators, the less we will have for other patients who may need them more. As we deplete our supply of personal protective equipment, we increase the risk of health care workers caring for patients unprotected, increasing the risk of the health care worker contracting the virus and subsequently spreading it to others. As more health care workers get the disease, more health care workers will die and be unable to provide care for other patients. This cycle will only continue unless we flatten the curve by staying home and practicing social distancing.

Now comes additional ethical dilemmas. Some (not all) unethical prescribers are writing prescriptions for hydroxychloroquine and/or azithromycin for their selves. Most of these prescriptions are only supposed to be used for about 5 days. Yet, prescribers have been writing 90-day supplies for their selves and their families. Many of these prescribers have not gotten tested. Many are asymptomatic and are trying to be cautious. Many feel they have the authority, because they are prescribers, to get tested even though they are not symptomatic, even though this technically is not currently allowed. Many are positive but do not have symptoms and do not even require treatment. If you are positive and have symptoms, go right ahead and take medications as needed. Please only prescribe for what is necessary. If you are writing excessive quantities, this reduces availability of these medications for many patients who need them. Whether or not the medications do anything, we do not know for sure. In addition to this, some prescribers are requesting investigational medications like tocilizumab, sarilumab, and anakinra for their selves when they do not actually meet criteria. What do we do in this situation? Do we give the medications because they are vital to health care? This would prevent a patient who really needs it from getting it. Do we not give the medication and destroy our relationship with the prescriber? It becomes a tough call that needs to be escalated up the chain of command. I have heard these situations happening in many hospitals and outpatient pharmacies. Regardless of where it occurs, administrators are sometimes nowhere to be found. Many are working from home. I am fortunate in my hospital to have administrators and strong executive presence around if the situation ever arose. In addition to this, some hospitals across the country are considering universal do not resuscitate/do not intubate orders for elderly patients and/or those patients with major comorbidities, regardless of patient/family wishes. They are considering this because they do not believe they can save these patients and/or they believe that these patients will not survive long or have a quality of life even if they are saved. If patients cannot be saved, then they do not want to deplete finite resources (masks, gloves, gowns, face shields, ventilators, medications, etc.) on these patients. They want to save them for the patients that are more likely to survive. While I understand the rationale, this is a major ethical dilemma. We are all trained to do no harm and provide optimal care in a moral and ethical manner. It honestly scares me because it makes me think of my parents and family. What would you do if this was your family/friend?

In addition to ethical dilemmas, there are exposure dilemmas. Most health care workers are not fortunate enough to have the opportunity to work from home. It is mainly just administrators who get this privilege. Technically, almost all clinical pharmacists across the country could do their jobs from home since most do not actually provide their services in the pharmacy department. Would it be more difficult? Yes. However, this is a situation that warrants allowing those who do not need to be exposed to not be at the hospital. Yet here we are, still serving at the front line, still rounding, still providing our services, still showing up and trying our best to provide optimal care for our patients. What are we being asked to do instead of working from home? We are being asked to come in more, work more, work weekends, work on our days off, and provide as much coverage as possible from within the hospital even though we do not always need to be there. Instead of reducing exposure, we are increasing exposure. Are we getting paid more for providing more services and increasing our presence and exposure in the hospital? Nope. Are we getting hazard pay? Nope. What did Trump say? He stated that employers should provide health care professionals hazard pay. Will all hospitals provide this to all their hospital staff? Unlikely. If the government decides to pay frontline health care workers hazard pay, will we get anything? Probably not since people do not want to acknowledge that we too are frontline. Because clinical pharmacists are not considered health care providers (do not ask me why; it is incomprehensible), we do not get paid or reimbursed for our services. The HHS just announced that pharmacists are now authorized to order and administer COVID-19 tests. How did this get approved all of a sudden when we’ve been fighting for years in New York State to get provider status. Since we are not recognized as health care providers, we will not be paid/reimbursed to provide these services. Most of us are salaried. Although we are always expected to work more and provide more, we never get paid more. The only incentive that we have is that we are doing our best for our patients. If we do not do more, then it is as if we are not doing our best for our patients. Should we get paid more for providing more and working more than we are supposed to? You tell me. I have been hearing that some nurses are getting paid $125/hour to work during this pandemic. That is probably more than double what most pharmacists make and more than some physicians make. Do they deserve it? Of course. Does everyone deserve a major bump in their hourly wage/salary? Yes, for sure! ALL health care professionals should be respected and fairly compensated for working during this crisis and jeopardizing their lives. I believe ALL hospital employees should receive hazard pay. This should not be an incentive to work more. This should be provided because we are forced to be exposed more than we must be, even when the opportunity to work from home exists. Some are even getting fired or losing their jobs because they are not getting any business during this time, especially those who only work in surgery. Jobs should not be lost during this time. If anything, they should be frozen without salary (maybe benefits paid by the government) until this pandemic resolves. That way people can resume working once it is all over. People can always be utilized to help in other ways. Health care workers are even flying in from other parts of the country to help New York out. While this is much appreciated, given our shortage of health care workers, we now also fear for your safety. After your kind generosity, we would not want you to become exposed, spread the virus to others, and risk your mortality as well. We hope that we all get through this.

Those who can stay home, work from home, or not work at all and still get paid, are extremely fortunate. They may not understand how bad the health care environment, particularly in a hospital setting, is right now. When I mentioned to someone (a “health care worker” who can work at home until this pandemic/quarantine is over) that most health care workers would prefer to stay home, I received an inane response. I was told that health care workers “thrive on” this type of a situation. As angry as this made me, I had to keep my composure. Not one single health care worker is thriving off providing suboptimal care to the ridiculous volume of patients we are trying to care for, constantly being exposed, and fearing for our own safety and the safety of our friends and families every single day. We are doing what we can to survive and provide the best care we possibly can until leaders make the decisions that should have been months ago.

So, what are we doing instead of the things we should be doing? People are still going out when they should not be. Health care workers are getting infected, developing COVID-19, getting hospitalized, and potentially dying. Instead of requiring these infected health care workers to stay home until they get better, New York state is minimizing the requirements to come back to work without any evidence to support that what they are proposing is safe. This increases the risk of the health care worker spreading the disease to others and increases the health care workers’ risk of death. This is happening because we have a shortage of health care workers. Patient demand exceeds the human health care worker supply. As a result, New York state is also advocating for students to graduate early and work early as an “opportunity” or an “experience” for them to grow. This just increases human exposure to the virus and increases risk of spreading the virus. People will not grow from these experiences or opportunities if they die. Health care workers are also being forced to practice outside of their normal scope of practice. Yes, this is an opportunity to grow, but it is also a major liability if health care workers are performing tasks that they are not trained to perform. Many patients may get harmed because of this. However, these are all things that we are forced to do because we have gotten to this point. We have gotten to this point because people do not stay home and practice social distancing. We have gotten to this point because our leaders did not act in a timely and appropriate manner.

What frustrates me most was that this pandemic was PREVENTABLE. We knew what was happening in China and Italy. We knew that our global world is interconnected through modern travel. Yet, our government was arrogant enough to think that we would not get this virus or, if we did, that we could easily manage it. We did not learn from the morbid conditions seen in China in Italy. If we took the strictest necessary public health precautions from the beginning, we would not be in this predicament. Even before COVID-19 first became somewhat prevalent in the United States, I mentioned to many friends, colleagues, and strangers that we could quickly and easily eradicate the spread of the virus. All we had to do was have the entire world stay home on lockdown for at least 28 days, maybe a little longer. Those who were infected would have the virus run its course. Those who were not infected would not be exposed and would therefore not get infected. The only people who should have been out and about should have been patients who needed treatment, health care workers, and emergency workers. However, I knew people would minimize the impact of this disease and go out anyway. This is why I suggested Martial Law. Everyone thought I was crazy for suggesting this. They said that some people would die. Some told me the homeless would not have anywhere to go. Some were worried that they could not get food for their families. Some, including the government, said the economy would crash. This is all true. However, the casualties we would have experienced would have been far fewer. Those who were truly sick could seek medical care. The government could have easily stepped in and provided a temporary space for the homeless. The government could mandate everyone to stay home and provide them with sufficient resources to outlast the lockdown. If the economy crashes, at least there are still humans left after this war on COVID-19 to bring it back up. What is the point of an economy if we are all dead? Money means nothing at that point. Where there is a will, there is a way. Our government was not willing to sacrifice money and the economy to take the necessary actions to reduce the spread of the virus. Look where we are now. Our economy is crashing anyway. We are spending trillions of dollars to try and bring it back up. This will undoubtedly have severe consequences in the future. Hundreds of thousands who never had to get infected are now infected. Thousands who did not need to die are dead. At first, Trump said he was not going to do anything. He was arrogant to think we would be fine. Over time, he started to realize the consequences of his inaction. Now he is taking action and pretending as if we do not remember how he initially did not want to act. We all remember how Trump downplayed this virus January 2020 through March 15, 2020, even though we knew this was present in China since November 2019. If Trump claims he always knew this would be a pandemic before it even became one, why did he not act in January 2020? Look at what happened in California. They saw how quickly their cases were progressing. They were number two in the country in terms of number of cases. Their Governor took action and shut down parts of the state. What happened as a result? Their number of cases dwindled over time. Is it still rising? Yes, but at a much slower rate. The United States has the highest number of reported cases in the entire world, and it started here much later than it started in other countries. Why our leaders still have not taken the appropriate action is beyond me. Due to his inaction, among numerous other fallacies, Trump 100% should not be re-elected as President or really into any position, political or otherwise.

At one point, I thought to myself “let me start a petition to quarantine New York at the very least.” The day after I started the quarantine, Governor Cuomo announced that all non-essential workers in New York should stay home. I am sure my miniscule petition had nothing to do with it, but I am glad the Governor did something about it since our President would not do anything about it. Cuomo did a good job by taking action, even if it was too late, but Trump did not. Our President continued to minimize the virus until it was too late. Unfortunately, Governor Cuomo’s action was not sufficient. Companies were swift to say that all their employees are essential. In a nutshell, the action did not amount to much. How is GameStop essential? How are liquor stores essential? Even now, knowing the drastic and desperate situation we are currently in, the government still fails to take the strictest necessary measures to prevent spread of the disease. Our President thinks he has done more than enough to help our hospitals and health care workers across the nation, and that we do not need any more assistance. This is a direct insult to ALL health care workers risking our lives to help our patients. What makes things worse is that hospitals and health care facilities are making our lives more difficult. If health care workers speak up, particularly regarding their work environment and lack of personal protective equipment, they are at risk of getting fired. These outrageous and nonsensical events are already happening. Why would you fire a health care worker for speaking the truth, especially when there is a shortage of health care workers to provide optimal care for patients? This is the health care environment we have in our country.

Let’s talk about Governor Cuomo’s executive order and what it means for health care workers. First off, the executive order did not even address pharmacists of any kind in the hospital setting, or really any setting aside from the outpatient community settings (e.g., CVS, Walgreens, Rite Aid, Walmart, independent pharmacies, etc.). This just goes to show that New York State still does not understand that there are pharmacists in the hospital. They probably still do not know what clinical pharmacists do. Since we are always the 49th or 50th state to adopt pharmacy practices that states across the country are practicing, we are bound to be one of the last to acknowledge all types of pharmacists. When I saw that the executive order did not address empiric use of hydroxychloroquine or use within the hospital setting, I reached out to Governor Cuomo through various platforms. I emailed him, left him a voicemail, tweeted him, and direct messaged him on Instagram. As expected, I did not get a response. He was probably on Tik Tok instead. But I get it, he is a busy man. He would not have the time to respond to me. Either way, pharmacists got a response a few days later and the executive order was amended to allow for empiric use of hydroxychloroquine and use in the hospital setting. Now what about other professions addressed in the executive order? In a nutshell, its allowing nurses, nurse practitioners, physician assistants, etc. to work beyond their scope of practice. Nurses are now seeing any more patients per nurse. Critical care nurses are now seeing 4-5 critically ill patients per nurse instead of the usual 1-2. The executive order is also removing limits on working hours for physicians, including residents and fellows. Its asking students to “volunteer” their time and energy to help with this disaster even though they are not licensed. In certain civil cases, it is providing immunity from liability. Surgical physician assistants are working on general medical floors. Medical residents and hospitalists are working in intensive care units. Everyone is working a step above their training in order to try and meet the patient demand. I am an infectious diseases clinical pharmacist. I routinely work with infectious diseases and critical care intensivists. I have rounded with both services. Now I am doing even more than just that. Do pharmacists get any credit or recognition? No, because we are “just pharmacists,” words that we hear so commonly and hate hearing. It is utterly demeaning and disrespectful, given all that we do and all that we sacrifice for the sake of others. We are all trying our best, but it is a nightmare. Additionally, the executive order has asked hospitals to increase their capacity. In other words, hospital beds will be in places where beds normally should not be. Health care workers will have to travel to areas that were previously not exposed to the virus but now are. Essentially, this executive order is allowing health care workers to be abused.

What scares me most is not getting infected, it is coming home every day after work and risking myself spreading it to my elderly parents, my family, and my friends. Since I work in a hospital, I am constantly surrounded by this virus. When I round, I am by patients who are infected with the virus and am at risk. I know that most patients in most, if not all, New York hospitals are COVID-19 positive. When I walk around the hospital, I know that the virus is everywhere in the environment, including patient rooms. The virus is everywhere. I could potentially become colonized or infected at any point throughout the day. Even if I utilize the strictest possible infection control efforts through personal protective equipment, there is no guarantee that I will not contract the disease. Many people who carry the virus are asymptomatic and cannot get tested. This does not mean that they cannot spread the virus to others who may then become infected and symptomatic. Even if health care workers do become sick, we all know that everyone is waiting for us to get better just so we can go back to continue working. Each day that I go in to work, I am honestly at risk of contracting the virus and dying, and it frightens me.

The virus does not discriminate. Patients of all ages are dying, whether they are 20 or over 100 years old. We used to think that the young are less likely to die from this disease. While that might be relatively true, and those who are older with more comorbidities (especially obesity and cardiovascular disease) are more susceptible to mortality from COVID-19, we are seeing even those without major comorbidities rapidly decompensate and die. We health care workers must live with the fact that we could not save young and old lives alike. Each life matters. Multiple codes occur across every hospital every hour. “Respiratory stat.” “Anesthesia stat.” “Rapid response.” “Code blue.” These are what health care workers are hearing and urgently responding to every single day. Each time we hear that, our stomach drops. We are anxious because we do not want to experience another death. We are all trying to save lives, but we are not always successful. I do not think many of us have experienced this sheer volume of mortality in a short period of time. There are so many patients dying daily that morgues cannot handle the volume. Bodies must be shipped out on trucks in some facilities. Since many hospitals have stopped visitors from entering the facility to reduce exposure, this means that patients cannot see their families while they are fighting for their lives. They need the support of their loved ones, but they cannot receive it because of this pandemic. Families and friends are forced to experience their loved ones dying without getting an opportunity to see them or support them.

The virus does not discriminate, and neither should we. Whether we are physicians, physician assistants, pharmacists, pharmacy technicians, respiratory therapists, nurse practitioners, nurses, nursing assistants, emergency medical technicians, paramedics, radiologic technicians, physical/occupational therapists, dieticians/nutritionists, phlebotomists, infection control, or really any health care worker in the hospital, we are ALL frontline health care workers. We also could not function without every essential worker in the health care environment, including environmental services, engineering, nutrition, etc. Every single life matters. Although this may not seem important to many, it frustrates me to see health care workers fighting amongst their selves. It hurts me to realize that some think that pharmacists and associated personnel are not frontline health care workers. We round with you and help optimize pharmacotherapy. We try our hardest to come up with treatment guidelines and protocols to figure out who to treat and how best to treat them. We collaborate with all health care workers to determine optimal medication regimens. We try our hardest to procure these medications so that you can use them. We provide you with all the medications that we can obtain so that you can use them in our patients. These medications are then taken into units and patient rooms that are completely surrounded by SARS-CoV-2. Anything that is unused is then returned to pharmacy, contaminated by the virus. Within the small enclosed pharmacy department, we are surrounded by potentially contaminated packaging from across the entire hospital that has touched every patient in some form or another. Whether we are rounding with you or in the pharmacy, we are constantly exposed and constantly at risk of contracting the virus, developing the disease, and dying. We are ALL in this pandemic together, trying to provide optimal care for our patients.

What needs to be done has been clear. I have been saying it for months. The state, country, and world needs a reboot. It needs to be temporarily shut down. People need to stay home. If people will not listen, Martial Law needs to be enacted. Other countries, like India, have shut down their states and country, and they were successful in minimizing the viral burden and threat. Before Martial Law is enacted, the government needs to prepare the country by funding grocery stores, manufacturers, and anyone else to provide essential products for two months. People should be provided two weeks to stock up on essentials. The government should also have a warehouse to store emergency essentials. The government should also provide a temporary space for the homeless. Once Martial Law is enacted, everyone without clearance should be forced to stay home for one to two months. The only people who should leave their homes are those who need urgent medical care, health care workers who TRULY need to be physically present at work, and emergency workers. If anyone urgently needs more essentials, the government should have drones go to and from the warehouse so that people do not have to. Additionally, every single payment and loan should be frozen, regardless if its private or public. Interest should also be frozen. This way, no one must worry about having to go in to work to make money to make payments on time. Heating, air conditioning, electricity, water, gas, maintenance, etc. can be automated. Once the pandemic is over, everything can resume as normal. Yes, the economy will take a major toll during this time. However, what is more important, your life or your money? After the economy crashes, the war on COVID-19 ends, and the pandemic/quarantine passes, there will be more humans left to revitalize the economy. I am sure the government will not agree because of the economy and various other nonsensical logistics that do not matter during this crisis, but just do it. Shut down the state, the country, and the world. Our government needs to be willing to step up and actually take the appropriate actions to minimize further casualties. Hundreds of thousands of people who never had to get infected are now infected. Thousands who never had to die are now dead. Once we get through this (which I pray and hope we all do), health care, government, and politics need to change significantly. We need to adapt and evolve more appropriately to our modern society. We need leaders who will take the appropriate actions to prevent problems by being proactive public health measures. We do not need incompetent leaders who do not actually acknowledge problems or care for people and are only reactive when it is too late. I truly hope that we learn from devastating pandemic and become more humane in the future. Instead of fighting one another, we should live peacefully among one another. There is never any need for violence. We have enough to deal with in the world. We should tackle these issues, like infections, climate change, global warming, etc. together. Let us work together for a better future for all. Let us advance humanity to peaks we have never seen before. I am not sorry for the long post. The United States, especially New York, needs to get it together. What is the first rule of troubleshooting? Have you tried turning it off and on again? In most cases, if a computer gets infected by a virus, a factory reset/reboot could fix it. That is what we need to do. We need a prolonged reset/reboot. World leaders need to come together and SHUT DOWN NEW YORK, THE UNITED STATES, AND THE WORLD!!!

Thank you to ALL health care workers/warriors/soldiers who are providing their services in fighting this war. Thank you to Northwell, LIJ Valley Stream, and all health care facilities who are leading the way by treating their employees fairly and providing optimal care to the best of their ability. Thank you to those who are researching medications to treat and vaccines to prevent COVID-19. Thank you to those who are supporting us, the health care workers.

Please pray for the world for SARS-CoV-2 to be eradicated, and for no other crises to ever occur again.

God, please rest the souls who have passed on to you. Please help us to manufacture and obtain sufficient medical devices/supplies and effective medications/technologies to care for affected patients who are suffering. Please help us to optimally care for our patients. Please care for those afflicted by COVID-19. Please keep our friends, family, loved ones, colleagues, strangers, all of humanity, and all life safe. Please help us and grant us the strength and knowledge to get through this difficult, chaotic, war-like time. Please help humanity grow and flourish with everlasting peace and prosperity after this pandemic passes, so that we may forever selflessly treat one another with respect, beneficence, justice, honor, and kindness, and never have to deal with violence or despair.

Thank you all for reading and for your time. Respect ALL health care workers. Eat healthy and exercise while at home so you reduce your risk of cardiovascular disease and reduce your risk of poor outcomes, including death, in case you are to ever get infected by this virus. It is great for your overall health. COVID-19 kills, but so too do cardiovascular disease and diabetes. Please practice social distancing and help us flatten the curve. Please be safe and keep us and others safe by staying home!