Dr. Rishi Rattan is a trauma and critical care surgeon at Jackson Memorial Hospital in Miami, Florida, one of the largest public hospitals in the nation. He is currently working at the frontlines of the COVID pandemic epicentre. He has also channeled this experience into his activism with Right to Health Action, a grassroots movement of thousands of experts, health works, and activists spread throughout the country in response to the pandemic and to the current Administration’s disastrous response. Associate editor Sophia Crabbe-Field spoke with Dr. Rattan on August 13th.
Sophia Crabbe-Field: My first question to you is: Can you briefly describe what it’s been like these past few months working as an ICU doctor in Florida?
Dr. Rishi Rattan: It’s been like nothing else I’ve experienced in my life, and I specialize in disaster and austere medicine, working in humanitarian zones, and global health, and working in places that are resource poor. This has really been a very unique stressor to individuals and to the system, to be involved in a pandemic that really affects the entire world and affects our societies and to be involved in a context in which our government really is failing its citizens in terms of pandemic response to Corona. The U.S. is a failed state, as far as I’m concerned, on the frontlines.
SC-F: And so why were we so under-resourced in hospitals across this country both in terms of PPE, but even in terms of ICU beds and hospital rooms? And what has been your experience working with patients under these kinds of conditions?
RR: I think that a pandemic is always going to overwhelm the system. So there’s an understanding amongst health-care workers that at some point you’re going to have more patients than beds, and that’s not necessarily anybody’s fault in that moment, but what really matters is how someone responds to that. Or, also importantly, if you understand that there’s going to be a coming wave because you’re seeing what’s happening in Italy, and you’re seeing what’s happening in New York City, to understand that that’s going to come to you and your doorstep and to not do anything to prepare is really unconscionable. It’s immoral, it’s unethical, it’s abandoning your constituents and the citizens of America. It’s really a complete and total failure of moral and ethical leadership. And I think that’s what we saw here in the United States at the state level and the national level. We’ve known what was coming years in advance as we had administrations that invested in a comprehensive response to pandemic prevention, which is not just health care focused; it’s focused on global economy, it’s focused on climate change, it’s focused on justice around the world, it’s focused on health disparities. We’ve had those things in place and they’ve been systematically dismantled by our current Administration. And then when there was an opportunity for them to step up and really prepare for this, they chose, oftentimes, their own political and financial gain instead.
SC-F: So I heard you speak recently at a virtual town hall as part of your work with the group Right to Health Action. In light of all of this, why did you choose to join this particular group and what are the goals that you are trying to achieve with this work?
RR: The focus of the town hall was to really capture the general sentiment among health-care workers, doctors, nurses, people on the frontline, about what needs to be done to really respond to this pandemic and prevent this from ever happening again, not just on our soil, but on anybody’s soil. And when you look at what has been outlined and what’s been done in the past by the two presidential candidates, Joe Biden is the only candidate right now that has any sort of experience, track record, and plan. And while his plan is good, it could be better. I think it could serve to incorporate some of the recommendations from public health experts, pandemic experts, global health experts. And so that’s what that goal is—to get everybody at the table so that we can make a good plan even better.
SS: I’m just wondering, a bit more specifically, what are the recommendations that you have for the Biden campaign in terms of their pandemic response? And could you tell me about more about the letter [Right to Health Action] sent to the Biden campaign?
RR: So we’ve been working both behind the scenes and publicly with leadership in the Biden campaign about really drilling down on deliverables that can be tangibly measured. There are a couple of big ones that the Biden campaign has already started working toward that we really would love to see solidified. And one of them is, as he has mentioned, the public health corps, which is around 300,000 public health jobs for community health workers. But what we want to make sure is that to help the most vulnerable, [these workers] are not being exploited in the process. This is not a volunteer position. This is not a temporary job. These should be paid, unionized, permanent jobs. I think that’s really the sort of ethical, conscientious way to approach not just pandemic response, but the public health response in general. This goes well beyond the pandemic to other epidemic situations that are facing these vulnerable communities.
Second, I think that access to medicines is really important. Biden has a track record of supporting efforts to make sure that medicines that are developed with taxpayer funding, basically medicines that we have already paid for the development of, that we will not be priced out of them. And so what we really want to be able to see is that Biden will publicly support protecting those taxpayer-funded medicines to make sure that our citizens will be able to access them. And also that that isn’t just happening in America, but that we join the rest of the entire world that has almost unanimously signed on to a medicines patent pool to allow the sharing of lifesaving medicines between countries; 193 of 194 countries have endorsed it. We are the one missing link, and so for Biden to really come out there and say, “We will sign on to this, and we will make sure that everybody gets lifesaving treatment at a reasonable price,” I think will be really important.
The third one is again about making sure that what we’re doing isn’t just limited to our citizens—making sure that we’re really helping out the world. And Biden has a long history of putting his money where his mouth is and funding global health efforts that not only improve the health of people abroad, but also improve our own health, improve global security. But we just want to make sure that that’s done in a way that holds all of us accountable. So rather than throwing money at a problem, we want to make sure that we meet actionable and tangible and measurable goals. And the WHO’s international health regulations is, I think, a great start. And that would just give us a set of milestones to make sure that we’re headed in the right direction and that we’re spending this money responsibly.
And then, finally, again, a pandemic by its very definition is something that affects everybody in the world. And you can’t stop a pandemic anywhere until you can stop it everywhere. And if you really look at the upstream causes of a pandemic, it’s not just about a single bat, for example, transmitting an infectious disease to a human population, but about all the intersections of a globalized world and economy that create that situation. When we look at the top areas for zoonotic transmission, things are very tightly connected to corporate responsibility, or the lack thereof in this case, and climate change. And so we really need a strong leader to say: We are not going to tolerate or accept corporations, whether from our country or elsewhere, being irresponsible and putting the entire world at risk for their profit. That’s just not acceptable anymore. And we have to see pandemics as a side effect of our failure to protect the environment and protect our societies.
SC-F: And what has been the response from the Biden camp so far?
RR: So far I think they have been fairly receptive. Like I said, a lot of this is giving them access to experts to drill down on measurables. Conceptually, I think that they are in agreement with this, and [Biden] has a track record, but it’s really important to have an evidence-based solution with actual logistics in there. And that’s what we’ve been wanting to provide. And I think we have a little bit more work there to do, but so far, I think it’s been a powerful collaboration that I hope continues to grow.
SS: How do we focus both on improving our own public health infrastructure in the United States while we’re maintaining a global focus in addressing the pandemic?
RR: I think it’s one and the same. Whether you’re looking at it from a fiscally conservative viewpoint, and looking at in terms of a financial bottom line, or you’re looking at it in terms of the right to health, if we are able to create and put back this infrastructure that Biden has already funded one time before as vice president, both on the domestic and international level, it’s actually not only going to secure the right to health of our own citizens, but it will increase the health indices of people abroad and it will also save money in the end. The economic costs of the COVID pandemic for the United States due not only to loss of income and loss of economy when we’ve had to shut down, but also the costs of the health care and the PPE right now, is just absolutely immeasurable. And all that could be wiped clean if we had a government that would respond to both pandemics here and abroad in a thoughtful and preemptive way.
SC-F: Going back to the issue of access to medicines: How do you make sure that everyone has access to the COVID-19 vaccine when it becomes available? What are the most important steps to end the pandemic once we do have a vaccine?
RR: That’s a good question. I think that the efforts of the Medicines Patent Pool, through the WHO endorsement, is really sort of a good umbrella because, number one, it allows for global open access licensing. So that means it doesn’t matter if the vaccine is developed in Germany or India or Africa or the United States; we are saying that we are as one world responding to this pandemic. And so that allows for that sharing of information and that production of the vaccine in various manufacturing facilities throughout the world. And then what we also want to do is revoke patent monopolies and allow the compulsory licensing of generic production when needed. And we’ve already heard from several generic companies, including specifically in India, that they will make sure that this vaccine is manufactured and sold at a price point that is both viable for them, but also ensures that governments across the world are going to be able to purchase it. It’s notable again that every government except the United States has signed onto this and is trying to be a global citizen here to protect these medicines and access to them.
SC-F: So just jumping back now to your more personal experience as a physician working with COVID patients, what kind of long-term effects have you been seeing? It seems to be more and more clear that there are many people suffering from them.
RR: We’re just beginning to scratch the surface of what these life-altering effects of coronavirus will be, but what we are seeing, and have been seeing since the beginning of the pandemic, are patients, even those who did not have a severe illness, those who did not require a breathing tube, those who were not in a life-threatening situation, they now have lifelong lung problems, breathing problems. If they were active before, they’re not able to be active now. Say they were a young person that played sports. They don’t have the lung capacity to play sports anymore and their lungs have turned into scar tissue. And so that’s not something that’s necessarily going to improve. We have people with heart problems, and they’re 30 years old walking around with an 80-year-old’s heart that isn’t going to recover. And again these are people who did not necessarily have a very severe form of coronavirus. And that’s just the physiological. There’s lots of, I think, psychological effects of being in this constant high-stress environment, or being exposed, or being in an ICU on a breathing tube, the cognitive effects on people’s ability to function and their brain power. All of these are still being measured, but they are there.
SC-F: And how do you think we could do a better job of getting the message out there about what’s really happening to those people who still don’t believe it, who are unlikely to take the vaccine, who are protesting mask wearing?
RR: We don’t even have to reinvent the wheel. We have example after example of countries who are diverse, who have a range of backgrounds, that have been able to absolutely and definitively quash this virus with minimal loss of lives. And if you look at all of those countries, they have at least one thing in common, and that is strong and powerful leadership from the top down that supports public health and science efforts and communication and functions as a comprehensive and conscientious leading force. And unfortunately, the U.S. government lacks all those leadership qualities from competency to communication, to evidence-based, to strength in leadership.
SC-F: Have you seen any state governments that you think have done a better job?
RR: Well, unfortunately I’m here in Florida, in one of our hotspots, led by a governor who really follows in lockstep behind President Trump. And so we have had, I think, an absolute failure of leadership here with data manipulation, flip-flopping, censoring of government employees and contractors who are trying to tell the public the truth, lack of consistent laws across the state to treat us like a unified force and community trying to stop this pandemic. There’s been incredibly frustrating inaction by the state government here that’s cost lives and the number of lives that [Governor Ron] DeSantis’s inaction and lack of competency has cost remains to be measured.
SC-F: I know that there’s also been a hugely disproportionate effect of COVID with regard to race. Have you seen this structural racism play out yourself as an ICU doctor?
RR: Absolutely, 100 percent. And this is another thing that, specifically in Florida, is very frustrating. I see it with my own eyes, on the frontlines, working at a safety net hospital in an extremely diverse county in Florida, that absolutely structural racism is creating health disparity in how deadly coronavirus is, who is affected by coronavirus, who is forced to be an essential worker putting themselves at risk without adequate protection. And the reality is that when you look at it from a structural racism standpoint, coronavirus is not really the problem. It’s yet another symptom of the underlying issue of structural racism in our society, and institutionalized racism. And it’s absolutely abhorrent. And one of the giant problems that DeSantis has intentionally done is obfuscate our state’s data on the racial disparities. He has hidden it and prevented people from disclosing it. He has stopped recording it. He has censored government bodies and public servants who have tried to incorporate that information. And so he is, right now, just absolutely whitewashing the health disparities around coronavirus in the state. And it’s really doing a disservice to those communities and to the public health experts that are trying to help them.
SC-F: I’ve heard reports of doctors not being able to speak out because, for example, their hospital didn’t allow them to, or who got in trouble for speaking out about the conditions under which they were working. Has this been your experience at all? Have you spoken to other health workers for whom this has been their experience?
RR: Yeah, I think that if you talk to any of us on the frontline, we’ve had an experience where we want to ring the alarm bells and raise the red flags about what’s happening and have gotten pushback from leadership and administrators who don’t want to make a “bad impression.” And this has created tension because we’re not really concerned with the reputation or appearance of what’s going on beyond the truth about the dire, dire situation that loved ones, your loved ones are in behind these curtains in the ICU, and the terrible situation of limited resources and the way it is affecting everybody. So absolutely I think any efforts to try to prevent that information from getting out, whether it’s from hospitals or governments, is really doing a disservice to the communities by not telling the truth.
SC-F: The widespread stigma about seeking mental health care seems to be particularly strong among those in the medical profession. So I’m wondering, have you seen the mental health state of doctors worsen during this pandemic? What do you think can be done to support the mental health-care needs of doctors or other health professionals during this time?
RR: Yeah, absolutely. I think the mental health effects of the pandemic on frontline workers, and that’s not just doctors or even just health-care providers, but you look at the first responders, like EMS, you look at essential workers, like in grocery stores, it has taken a significant mental health toll, and we really need to break through that stigma to talk about it. A lot of us are not okay; I’m not okay. This has been a really unique strain and stress that has broken a lot of us, including me and my colleagues. And honestly, it’s not the disease that I think for me personally is the biggest stress. It’s the corporate gaslighting and the social gaslighting that happens when you are going in and sacrificing and putting your life at risk to try to help people and then you go to work and you have a hospital administrator at home on Zoom telling you that there’s no shortage of supplies when you can’t get the supplies that you need. And then you leave your shift hours after you were supposed to, exhausted and tired, and you walk outside and you see people not wearing masks or making fun of you because you’re wearing a mask. And that’s really the strain that just is the icing on the cake, so to speak, where all that bandwidth spent trying to fight this pandemic and putting your life on the line feels like a waste if we are not all in this together. And it really is ripping apart people on the inside and ripping apart our sense of community on the outside.