Opinion: Public Health Inequities Exist at Home and Abroad, but We Can Fix Both Without Sacrificing One for the Other

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Opinion - Dr. Caputo

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Opinion: Public Health Inequities Exist at Home and Abroad, but We Can Fix Both Without Sacrificing One for the Other

Nicholas D. Caputo, MD

By Nicholas D. Caputo, MD

Associate Professor of Emergency Medicine, Weill Medical College of Cornell University; Associate Chief of Emergency Medicine at NYC H+H/Lincoln; Major, U.S. Army Reserve assigned to the 947th Forward Resuscitative and Surgical Team.

Note: The opinions expressed are solely those of Dr. Caputo and do not express the views or opinions of Dr. Caputo’s employers.

The COVID-19 pandemic has taught us many lessons learned through loss and despair. Hard truths. One of those hard truths for me is the understanding that there are no real experts out there. That our leaders can and often do make mistakes, including our leaders in public health. That although I am well-trained and highly accomplished in my field, I am no expert—and I can and sometimes do make mistakes.

I’m an emergency medicine physician who has had the privilege of serving the underserved in the South Bronx for the past 10 years. Daily, I wake up at 5 am, hit the gym, and then hop on my motorcycle to go to work, crossing the Harlem River into one of the poorest congressional districts in the country. Working in this environment has exposed me to some of the starkest of contrasts one can experience in this life, where the extremes of extravagance and poverty are separated by only a few hundred feet. I should not have been surprised that when the pandemic hit, these disparities would be amplified exponentially.

It’s hard for me to describe the level of chaos and carnage brought on by those early days of the pandemic in our city. Like many of my colleagues working on the front line, I contracted COVID during the first wave. Luckily, I had a robust antibody response with measurable natural immunity that lasted for many months. When the vaccines first became available, I initially deferred my turn to be vaccinated. I thought I was doing my part because, with limited vaccine supply, those without any defense and at high risk for exposure—specifically, my frontline colleagues—should get vaccinated first. When my postinfectious immunity waned, and with the vaccine supply thankfully a nonissue in the U.S., I finally elected to receive the vaccine.

After becoming vaccinated, like many of my colleagues, I thought the worst was behind us. The second wave in the U.S. came and went, brought on by the Alpha variant. Then a third wave ensued, this time dominated by the Delta variant. At first, I thought we would be okay. It would be nothing like it was back in the first wave in NYC. The ICUs would not be overrun, we would not be shutting down elective surgeries and clinics and converting labor and delivery wards to flex ICUs. We would not be hunting desperately for ventilators and PPE. I felt that maybe life would get back to normal. I was wrong. With newer, stronger variants, and with the potential for waning vaccine-induced immunity, there’s a risk that those bad times can return. And I am once again scared for my colleagues.

So now the debate has come up about whether or not boosters are necessary. Last week, the director of the CDC overruled recommendations from the CDC’s own advisory panel of outside experts. Now those at high risk for exposure to COVID-19 can receive a booster, including frontline healthcare workers. Many of my colleagues in emergency medicine are relieved by this ruling. Some have disagreed with the decision because they believe it will mean less vaccine supply for the rest of the world that still has yet to receive even a first dose. I understand both sides, and I think the hard truth is that none of us are experts. We can and do make mistakes, and no one is absolutely right or wrong. A piece of advice I learned as a resident is that if you think you’re 100% right, you’re probably at least 50% wrong.

In fact, it’s not about right and wrong, but about responsibility. Just as I did before, I feel a responsibility not only to my patients but to my fellow providers. I want to keep them all safe. Allowing them to take a booster when they are putting themselves at high risk every day on the job is the responsible thing to do. And if we are going to talk about global inequities, we need to acknowledge we have huge problems with inequities right here in our own backyard. There are essential workers in the South Bronx who have no choice but to put themselves at risk every day going to work, just like those of us in emergency medicine. There are public health inequities both at home and around the world that need solutions, and I believe that as a country with vast resources, we can solve both without sacrificing one for the other.

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