Consider This from NPR - 'Battlefield Medicine' In Los Angeles ICU As Biden Launches 'Wartime Effort'

Episode Date: January 22, 2021

More than 400,000 Americans have been killed by the coronavirus. That's more Americans than were killed in all of World War II, President Biden pointed out this week. He calls his new plan to fight the pandemic a "wartime effort."That effort begins with taking charge of a bottlenecked vaccine rollout. NPR pharmaceutical correspondent Sydney Lupkin reports on several factors that are slowing the process down. And NPR's Yuki Noguchi explores why it may take some time for pharmacies to become major vaccine distribution sites.The need for more vaccine is a national story, but the wait is especially excruciating in Los Angeles. NPR's Leila Fadel visited one hospital pushed to the brink, where doctors compare their work to "battlefield medicine."In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

The good news is that the rate of new infections might be slowing down. Right now, it looks like it might actually be plateauing in the sense of turning around. On Thursday, Dr. Anthony Fauci, in his first White House briefing as the Biden administration's chief scientific advisor on the pandemic, said case growth appears to be slowing slightly, but scientists need more data to say that for sure. He also appeared to joke about how much easier it is now to be honest with the press. One of the new things in this administration is if you don't know the answer, don't guess. Just say you don't know the answer. Yeah. Yes.

When asked to expand on that joke later, he said, You said I was joking about it. I was very serious about it. I wasn't joking. No, actually, It was a striking moment. The government's top pandemic scientist admitting he could now speak to the American people honestly without repercussions. So if the good news was a plateau in infections, the bad news is that the number of people dying each day in America is still between 3,000 and 4,000. Again, that's each day. At that pace, the U.S. will easily eclipse half a million people dead in about a month, and our supply of vaccines appears to be running short. Our national plan launches a full-scale wartime effort to address the supply shortages by ramping up production and protective equipment, syringes, needles, you name it.

Thursday at the White House, the president laid out more details about his administration's pandemic response plan and tried to emphasize the scale of the death toll. 400,000 Americans have died. That's more than have died in all of World War II. 400,000. This is a wartime undertaking. Consider this. A new administration has promised an honest, scientific view of the pandemic. A new president's view is that America is at war. We'll take you inside a Los Angeles ICU, where doctors say it feels just like that. Give me another crash cart. I'm trying to get a car. From NPR, I'm Adi Cornish.

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as Biden takes the reins in Washington. It's Consider This from NPR. Earlier this week, Dr. Anthony Fauci got his second dose of the COVID-19 vaccine. I did have a degree of achiness and maybe feeling a little chilly. And the thing that I think was the most about it, I felt quite fatigued. He told NPR on Friday that the side effects were more noticeable after the second dose, lasting about a day. But it will be a while before most Americans experience that for themselves. Fauci said the hiccups in vaccine

distribution need to be addressed. We need to realize and admit that it is a problem and we need to make sure we do something to fix it. Despite the rocky rollout, Fauci says Biden's goal of 100 million vaccine shots administered in his first 100 days should be doable. And maybe then some. We are all hoping, and I think it is quite reasonable to think, that we'll surpass it. But just put a goal out there. Put a marker out there. Go for it if you surpass it. That's wonderful. The two leading vaccine manufacturers, Pfizer and Moderna, are already working at top capacity. And due to a lack of supplies, it may take them

months to ramp up to an even higher gear. The government has yet to grant emergency use authorization for other vaccines, though one made by Johnson & Johnson is expected to be authorized soon. Not to mention, pharmacies are still not ready to be a point-of-care destination for anyone who wants a shot. A lot of patients have asked, you know, can I just put my name down? So we're working on being able to set up a way so that we can get that information separately. Rena Shaw, vice president of operations for Walgreens, told NPR's Yuki Noguchi this week that vaccine inventory is not consistent across the country. There's no central database to rank residents by eligibility.

CVS and Walgreens are working to set up their own software to track and notify local residents when they're eligible and schedule appointments for both the initial shot and the follow-up booster. And then only then after they scheduled it do they know the location of where to go. But that isn't happening. Not yet. The Biden administration says it has a plan to launch a new pharmacy coordination effort run by the CDC. And that will happen in a couple of weeks. The wait for a vaccine is a national story, but it's really excruciating in Los Angeles. In the most populous county in the U.S., one in three people has been infected with COVID-19. Thousands have died.

And at the center of this surge is a community hospital in South Los Angeles that's serving the most vulnerable. NPR's Leila Fadl went inside that hospital, where she saw firsthand deadly consequences of our health care system's inequities. Inside one of several triage tents in front of the Martin Luther King Jr. Community Hospital in Willowbrook. It's an unincorporated part of South L.A. near Compton and Watts. Heart rate monitors beep as COVID-19 patients are cared for while they wait for space inside. In the emergency department, patients lay in beds that line the halls.

An older woman says in Spanish, please, no, she's confused, alone. Nurses calm her. Some patients wait for rooms. Others are treated right in the halls. So we're living through a surge on a surge on a surge. That's Dr. Ryan McGarry. He's watching entire families come in with severe symptoms of COVID-19. And sometimes one leaves and one doesn't, you know, and that's brutal.

He compares this moment to battlefield medicine. We're surrounded here by multiple tents and tubes and lines and, you know, effectively temporary structures to handle, you know, overflow on overflow. This is a crisis. But this nonprofit, Safety Net Hospital, has always served more than it was built to. Since the day the gleaming facility opened in 2015 to replace its predecessor, shut down in 2007 over deadly conditions. We've been seeing a bit of a public health crisis in this community for the past five years. That's Dr. Elaine Batchelor, the CEO in her office upstairs.

The public health crisis? An epidemic of chronic illnesses. Heart disease, pulmonary disease, heart disease, pulmonary disease, kidney disease, diabetes at much higher rates, as well as higher mortality rates. Here, she's working to get through this crisis, but also using it to highlight the need to bring the same quality of care to this underserved, largely Black and Latino community that, she says, more affluent communities get. This is where the essential workers live. These are the people that are stocking the grocery stores, driving our buses, cleaning up after the rest of us. And they are continuing to be exposed to COVID on the job.

Add the dense housing where multi-generations of families live together, the poverty, the secondary health conditions, plus COVID, and it's an explosion of people getting sicker and dying more often. Our small hospital now has more COVID patients than hospitals that are three to four times larger. From this office, she wrote to the governor on Christmas Eve asking for help. The state sent three National Guard medical strike teams, travel nurses, respiratory therapists. She also made a plea for fundamental change. We have a separate and unequal system of funding, and we see the results here. COVID preyed on the inequities.

The majority of patients that come into this hospital are on public health insurance. That pays a supplemental amount for inpatient care and makes hospitals sustainable. But that's only if a patient is so sick they have to be admitted. Meanwhile, public health insurance pays a fraction of what private insurance does for outpatient care. And that includes the emergency room that's triaging below her office. They're in our emergency department a lot because they don't have adequate access to care in the community.

And we are paying for it. They show up because there's a shortage of 1,200 doctors in South L.A. Primary care doctors, specialists, don't set up where they can't make money. You know, we've created a tiered financing system for health care with commercial at the top and Medicaid and uninsured at the bottom. And we need to change that, you know, because that's where many of our black and brown communities are.

The most common procedures at her hospital are completely preventable diabetic amputations and wounds. And the irony is... We're getting paid adequately to amputate someone's leg, but we're not getting paid adequately to prevent that leg from being amputated. So this small hospital leans heavily on philanthropy to bridge the gap and show what's possible. It's why it can pay nurses and doctors competitive salaries and bring in cutting-edge technology. But Batchelor says it's not sustainable without changes to the way health care is funded. On the fifth floor, the temporary ICU is inundated.

After New Year's, the staff relocated it and converted half this floor to treat more patients. Every room is doubled up. All but four of the patients on this floor are on ventilators, many on dialysis, and most came in with secondary conditions that make COVID a much more severe disease. Bigger hospitals threw money at travel nurses. This community hospital turned to the state. We were hit really hard, so tough. It's like an understatement. It's been horrible. That's the ICU charge nurse, Maria Adachika. She grew up in Compton. I know the community.

So potentially, you know, this could be any of my family. On top of supervising nursing staff, tending to patients, she finds herself translating for doctors because so many of the sick are Latino and Spanish speakers. I have to sit there or one of the nurses that speak English and Spanish with a straight face and tell them your family member is going to die. Plastic tarps with zippers hang in the doorways to convert regular hospital rooms into makeshift negative pressure rooms to keep the airborne virus particles out of the hallways. I feel like this time around, people are becoming sicker, and they unfortunately die quicker.

As if on cue, Arachiga has to run off. An alarm is sounding, a patient crashing, their organs failing. Give me another crash cart. I'm trying to get a bunny down here. She hands supplies through the unzipped tarp to doctors and nurses frantically trying to resuscitate a patient in the room. They're in bunny suits, masks, and face shields. Then the patient in the neighboring bed goes into cardiac arrest. They call a code blue, a medical emergency. Two people arrive with more protective gear and more nurses and doctors suit up and go in to help get a pulse back.

Let's do a pulse check. He has a pulse. He has a pulse. There is practice calm in the urgency. The staff work in tandem. And then Dr. Jason Prasso exits, walks away on the phone, and comes back. One patient, unfortunately, did not make it. And I think, realistically speaking, the second patient,

while we did get her back, is probably not going to make it either. And so I just want the families to have an opportunity to, like, you know, spend some time with them. Behind him, Maria Adachigo, with the help of other nurses, rolls the bed with the man's body out of the room and into another for privacy when the family arrives. Despite all they've learned, Preso says the virus has proven difficult to manage. There isn't a whole lot that I can offer besides supportive care as an ICU doctor and trying to prevent things from getting worse and all too often that isn't enough. It hurts as a doctor to say that but a lot of times there's not a lot I can do for patients who have COVID.

Presso rushes off. Another cardiac arrest. By the end of this shift, five people are dead. Four Latino, one African American. A bad day. a familiar day. That's NPR's Leila Fadal. You're listening to Consider This from NPR. I'm Adi Kornish.