Gongol.com Archives: February 2022

Brian Gongol

February 17, 2022

Health Surge capacity

Suppose you could see into the future and be highly confident that we were likely to see an annual or near-annual cycle of Covid-19 outbreaks for a significant time to come, perhaps for a decade or more. If you had that knowledge, what would you do at the policy level to prepare for those high-stress periods that we aren't obviously doing today? ■ This question is important, because we don't know whether we will ever return to the status quo ante. What if short but very intense stress waves on the medical system become chronic? We have long rather unconsciously accepted that influenza will put stress on our society and our health-care systems every winter. What if we should also anticipate periodic Omicron-like spikes in hospitalizations -- maybe every 9 to 12 months -- despite having outstanding vaccines? ■ For now, the systemic pressure comes mainly from the unvaccinated, but we're still so new to this challenge that we don't know whether it will subside or remain with us effectively in perpetuity -- a problem unlikely to be permanently eradicated. Maybe it will, but we can't really count yet on that hope. ■ One possibility is that we might want to set up policies to permit (and train) something like a medical reserve corps. We have reserves in the military, as well as police auxiliaries and volunteer fire departments. Their presence doesn't diminish the full-time professionals in those fields, but it does give them options in times of acute need. What if we trained people to supply reserve capacity for medical care, too? ■ People respond to incentives -- as well as to disincentives. The United States has unusually high barriers to entry into the medical profession, including educational training that takes two years longer than most of our peer-group countries. It's likely those barriers disincentivize people from becoming doctors. In the typical six years required to become a PA (physician assistant) in the US, one could have completed a typical full medical degree in Sweden, the UK, Germany, Japan, Switzerland, or many other wealthy countries. ■ For the number of times we have been told in the last two years about medical systems "near collapse", it seems prudent to look for answers that might give us surge capacity in times of crisis. It seems even more prudent to do so in light of the widespread concern about burnout and emotional exhaustion among health-care professionals. ■ The Army trains combat medic specialists in 16 weeks. They are not supposed to be substitutes for doctors or nurses, but rather to be the best-available assistance between the point of crisis and a more thorough standard of care. If pandemic (or endemic) surges are going to return often and for the foreseeable future, maybe we need to make room both legally and logistically for people in the civilian world who can be called up from time to time to backstop doctors and nurses. At the very least, we ought to give the system a close examination.

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