# 746
It's a problem for which, I admit, I have no solution.
What should HCW's (Health Care Workers) do in a pandemic?
Should they work, exposing themselves to the virus and risk death, or risk taking the illness home to their families? Or should they simply withdraw until the pandemic passes?
Roughly a quarter of doctors polled, and nearly half of nurses, state they might not be willing to work during a pandemic. Much will depend on how lethal, and contagious, the next pandemic will be, and the availability of PPE's (Personal Protective Equipment).
Those who are on the side of not working during a pandemic point out that sacrificing our medical personnel during a pandemic will leave us with a huge personnel deficit in a post-pandemic world. HCW's would likely take a huge hit in terms of mortality, and even those who survived might opt to leave the profession.
The concept that doctors take an oath to work, despite the risks, is a common misconception. While once this was a tenet of the AMA's code of ethics, that was repealed in 1979, and doctors may now make their own decision on such matters.
Nurses, technicians, aides, and other health care professionals take no oath that requires them, legally or morally, to work in hazardous situations. In fact, most are trained that their first duty is to protect themselves, then provide care to their patients.
Last year Ontario Canada attempted to pass into law a bill that would have required `any any person reasonably qualified to provide services in a declared emergency'. The penalty for violating the proposed law was a fine of up to $100,000 and a year in jail for each day the order isn't obeyed.
Outcry from health care workers forced their legislature to change the bill, changing the word `required' to `allowed'. Still, it is an indication that some lawmakers believe that forced conscription of workers may be needed in a pandemic.
Draconian legislation such as this is unlikely to work during a crisis, and will likely drive many HCW's out of the profession entirely.
Most HCW's do feel a duty to work during a pandemic, and any decision to bail will be a difficult one for them to make. Hospitals and EMS services could go a long way towards convincing their employees to stay if they'd only take pandemic preparation more seriously. A lack of PPE's (Personal Protective Equipment) during a pandemic may well be the tipping point for many workers.
Personally, I've decided to work during a pandemic. But I'm divorced, my children are grown, and I've only myself to consider. Were I a family man, my decision might be different. I honestly don't know.
Certainly, many health care workers will work, despite the risks. Exactly how many is unknown. These people deserve whatever protection we can afford them. We've had nearly two years of warnings, and hospitals have had ample time to prepare.
Sadly, few appear to have done so.
If a pandemic comes, and half of our HCW's refuse to work, and 40% of the remaining workers fall ill, we will be left with only 30% staffing at a time when demand for services will be astronomical. This is a disaster in the making.
It won't just be flu patients that will go unattended. Heart attacks, strokes, cancer patients, women in labor . . . the list is endless, for those needs will continue during a pandemic.
Thus far, very few people want to talk openly about this crisis-within-a-crisis. It requires that something be done today, and most organizations are reluctant to deal with the issue. Preparation takes money and resources that few are willing to spare.
The idea that, should a crisis erupt, we can simply order people to work is simplistic, and unlikely to produce the intended result. The backlash this would create would likely be as bad, or worse, than simply allowing reluctant HCW's to return after the crisis has passed.
Even though having adequate PPE's won't induce all HCW's to work during a pandemic (their effectiveness is unproven), not having them will most certainly dissuade many from even attempting it.
As I stated, there are no easy answers here. But there are some choices we could make today that would make the choices needed to be made later, easier to make.
