It's not just about the emergency. It's about restructuring society so we have the ability to deal with crises.

A recent article by Jennifer Sinco Kelleher and Terry Tang from the Associated Press, highlighted in Medscape, is called “Omicron Explosion Spurs Nationwide Breakdown of Services”, and is one of many pieces documenting how this extremely contagious (if possibly more mild) variant of COVID-19 is continuing to overwhelm not only healthcare, but almost all areas of our society:

Ambulances in Kansas speed toward hospitals then suddenly change direction because hospitals are full. Employee shortages in New York City cause delays in trash and subway services and diminish the ranks of firefighters and emergency workers. Airport officials shut down security checkpoints at the biggest terminal in Phoenix and schools across the nation struggle to find teachers for their classrooms.

It goes on. One of the major flashpoints has been whether schools should reopen, often ostensibly pitting parents (who not only are feeling overwhelmed with having to supervise their children’s online education, but often have to go back to work themselves and have no one to watch their kids) against teachers (who are reasonably terrified of contracting COVID infection – and transmitting it to their own families). Of course this is overly simplistic; parents want their children to be safe and remain non-infected, and teachers want children to be educated – often this is not only their job but their calling! Michelle Goldberg in the New York Times argues that American Federation of Teachers (AFT) President ‘Randi Weingarten Still Wants Schools Open’, as she wrote a month ago. But there are many who are determined to pander to their political bases (like Oklahoma senator Tom Cotton, whom she cites) by creating bogeymen to attack.

But it has been, in case you haven’t noticed, a very stressful two years. The schools may affect a huge number of people, but so does healthcare. Kelleher and Tang emphasize the impact on healthcare, including my old hospital, the University of Kansas in Kansas City, where

The number of COVID-19 patients at the University of Kansas Hospital rose from 40 on Dec. 1 to 139 on Friday. At the same time, more than 900 employees have been sickened with COVID-19 or are awaiting test results — 7% of the hospital's 13,500-person workforce.

Paramedics are working 80 hours a week. There are simply not enough skilled people to do the work. And it is getting worse as more and more of them get sick. The always-overtaxed staff in our healthcare facilities has become more and more overtaxed by the increase in demand and the decreased number of workers. ‘"Everybody's working 'round the clock, 12-hour shifts” says New York City’s sanitation commissioner, and it is true in many fields.

It is tempting to say that this is, in large part, a result of “chickens coming home to roost”, of two generations of cutbacks in staffing and “just in time” supplying, of corporate consolidation and downsizing and increasing profits to please investors by overworking those who are left, of rewarding this with huge salaries to the C-suite executives. Well, it is, largely. We have been though a long period of rapacious exploitation of the workforce, and it is a big part of why there was nowhere near enough “flex” in the system to accommodate the huge demands of the COVID pandemic.

The news has also featured stories about the increasing power of workers, given the current labor shortages, and a few recent strikes that have been won. This is good, but it is not enough. Many hospitals have lost staff; nurses have not only stopped coming to work but have even left the profession. Not all of them would still be there if they were being paid higher wages, but it would help. It has been interesting to see that hospitals are willing to pay agencies huge amounts of money -- $100-200 or more an hour – to get “travel nurses” (nurses who will travel from where they live to your town for the more money) but not to significantly increase salaries for full-time nurses. This is part of an overall approach that sees the pandemic as a temporary blip – we can pay these high daily rates for a while, but really do not want to increase actual salaries in the long term. Reward those doing the work? Isn’t that communism?

Indeed, this is kind of the approach that the government has been taking overall; Trump or Biden, Republican or Democrat, trying to say “this will soon pass”, we can get back to normal, we can “open up”. It pleases folks who are frustrated at being at home and being on Zoom and not eating out or clubbing or whatever to hear that. Until they get sick. It must please some of the members of the Tucson Racquet and Fitness Club, who despite a county indoor mask mandate and a request from the management continue to wear masks indoors, do not -- like the two young women who held a 45-minute maskless conversation 10 feet from my machine today. Until they get sick. Probably not until they make someone else sick, since they won’t know. The county is not enforcing the mandate and the Club and stores are afraid to; supermarket managers talk of verbal and physical assaults on their employees. The stock market really likes the idea that things will get back to normal, since “normal” has been a rising market; plus all the richest investors make money either way.

Of course, people with some jobs have been hit harder than others. Those who must be physically present at work have been unable to “phone (or Zoom) it in”. And healthcare workers, doctors, nurses, and others, have been exploited by a culture which knows that they will sacrifice much for the welfare of their patients, and is willing to push it to the max. Or more. This is not ok. There is no reason for any healthcare system to be making money (whether it is called “profit” or something else in not-for-profits) or paying its executives huge salaries while the staff is getting sick, doing double shifts, burning out. It is not just about paying people more (although often this is important); it is about a paradigm shift that recognizes that long-term commitment to those doing the work needs to be the priority. It is about having enough workforce to be able to cope with increased demand when it happens.

Reminder #1: The entire structure is geared to the goal of increasing the wealth of those who already have the most and have the most power.

Reminder #2: This is not how it should be.