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Many �鶹Ӱ�� alumni in health-related fields are responding to the coronavirus (COVID-19) pandemic.

Johanna Glaser '10 shares her story.

“I'm a fourth-year medical student, one month away from receiving my M.D. Medical schools across the country have made different decisions about the role of medical students during the COVID-19 crisis. Some have offered early graduation for fourth-year students in order to bolster the medical workforce, while others have required all medical students to cease clinical activity to minimize the possibility of transmission of SARS-CoV-2 [the novel coronavirus that causes COVID-19]. My school, UCSF [the University of California, San Francisco School of Medicine], is considering all third-year and fourth-year medical students to be essential personnel in caring for patients who are not suspected of having COVID-19 or exposure to the virus. This means that my classmates and I can still help to manage other acute needs in our hospitals and medical clinics while maintaining low risk of exposure to SARS-CoV-2. 

“I just finished a rotation in a skilled nursing facility at the local VA [Veterans Affairs] hospital. All of my patients during this time, men over 70 years old with comorbidities, were among the highest risk for serious illness and death if exposed to SARS-CoV-2. It’s been devastating to see the fatality rate of this pandemic among the elderly, especially those residing communally, with about a fifth of all deaths in the U.S. due to COVID-19 being linked to nursing facilities. Luckily, not a single occupant of the facility where I was on rotation had any worrisome symptoms nor had tested positive for the virus.

“This, however, came at the cost of extreme isolation for this otherwise highly sociable group of men. All non-essential visitation and all group activities, such as communal dining, games and group exercise sessions, were suspended. Even the ability of patients to traverse the floors of the facility was debated, meaning that one of my patients nearly lost the ability to feed the fish in the lobby, which is one of his favorite daily routines (happily, they made an exception in this case). 

“Volunteers have worked to get donations of iPads to isolated patients in hospitals and nursing facilities. One of the more heartening moments during my rotation was a virtual Passover Seder administered by a rabbi to a spirited ex-Army colonel in his early 90s; my patient’s sparkling eyes and ear-to-ear smile in anticipation of the ceremony stuck with me all week. We were also able to set up video chats with the loved ones of our patients who had access to the necessary technology to receive a video call. This was a really nice option, but highlighted yet another way that people with more resources are faring better during this crisis. 

“In general, I’m interested to see how the COVID-19 pandemic is shining a light on the inequalities in our healthcare system. Millions of U.S. workers have lost access to health insurance due to new unemployment, highlighting the need for reforms that promote universal access to affordable care. Black Americans make up about 33% of those hospitalized due to COVID-19 despite representing only 13% of the population, further exposing the stark disparities in underlying health and access to preventive care among different racial groups. 

“I hope that we can take this moment to reexamine how we deliver health and essential services in our country, with a new focus on marginalized populations and health equity. This will mean thoughtfully approaching care for sick elders as well. The immense impact of COVID-19 among the elderly makes now the perfect time to consider how to provide better patient-centered care for those over 65. For example, we can expand palliative care services to ensure goal-concordant care, thoughtfully establish ethical guidelines for ventilator rationing that do not use age as the sole criterion, and establish protocols specific to the management of geriatric patients with COVID-19. (We currently have protocols for pediatric patients and for adults with COVID-19, but not for elders, which is important because older patients are likely to experience different presenting symptoms and disease course.) In the medical context and more broadly, let us take this unprecedented event as an opportunity to avoid unnecessary suffering and inequality in the future.”