In the thoughtlessness that has become the hallmark of his presidency, Donald Trump stated at a rally this week that doctors are falsely inflating the numbers of coronavirus deaths for financial gain. These are fabricated musings, seemingly designed to shift blame from his own lack of competence by creating a false narrative for the American public.
As an emergency medicine physician treating patients with Covid-19, these words are piercing. Back in May, I wrote about the mental health toll that Covid-19 was having on health care providers. Five months later, I wish I could say things have gotten better. With 9.2 million cases and over 230,000 deaths, the stress we face in our field has not abated — we have just grown accustomed to its presence. No amount of cash could outweigh the negative impacts this pandemic is having on doctors.
Frontline health care workers have suffered from increased rates of post-traumatic stress syndrome, anxiety, and depression since the pandemic began. Most notorious was the death of Dr. Lorna Breen, an emergency physician in New York who committed suicide after treating patients with the disease as well as after contracting the illness herself.
One study found that over 1,300 health care workers in the United States have died from Covid-19. A Facebook group dedicated to the memory of some of these physicians now has over 8,000 members who regularly share their grief. Many of the casualties in the medical profession are young and in the prime of their life, such as Dr. Adeline Fagan, a resident physician who died after a prolonged course of the illness in Texas.
Health care workers have a significantly increased risk of contracting Covid-19 compared to the general population. Those who are Black, like me, have 21 times the risk of contracting the disease. These same workers undoubtedly played a role in ensuring that Trump’s own hospital stay went smoothly.
Trump’s claims about doctors inflating Covid-19 cases are unfounded. While the Coronavirus Aids Relief and Economic Security Act provides additional reimbursement to hospitals for cases of Covid-19, this applies only to a small subset of patients with the disease — those covered by Medicare and all cases must be confirmed by a documented positive Covid-19 test. Falsely claiming otherwise would constitute fraud.
Billing is based on a complicated mix of severity, diagnosis and the intensity of treatment. Trump should know this as it is based on an algorithm developed by the Centers for Medicare and Medicaid Services, part of the federal government structure that he was elected to lead. Trump’s own publicly funded care cost an equivalent of $100,000. Perhaps his own expensive medical care is the basis of his misconception about health care profiteering, even as he seeks to cut the Affordable Care Act to limit similar access for everyday Americans. Many physicians have actually taken pay cuts and lost benefits due to organizations trimming salaries in response to a decreased number of elective procedures.
Most public health experts believe that deaths due to Covid-19 are in fact undercounted by as much as 36%. Not only is there additional unrecognized mortality attributed to the disease process itself, but also due to delays in seeking care for other conditions such as heart attacks and diabetes.
Back in March, Trump compared doctors to warriors fighting a medical war. Now, just like the insults he previously hurled upon those who died on battlefields, labeling them as “losers and suckers,” he is disparaging those of us who risk our lives in the fight against Covid-19.
It’s no wonder then that the prominent New England Journal of Medicine made a strong political statement last month, for the first time in its 208 year history, arguing that Trump should not be reelected. Let’s hope that the rest of the country takes their advice.