Opinion | Where There’s Smoke, There’s Fire

So, this week, something else horrible happened here in New York City.

Just as we were starting to feel like we’ve come out from the pandemic, the fallout from Canadian wildfires turned our skies orange/gray/pink/brown for a few days, and the air filled with acrid smoke. Walking outside became pretty much intolerable.

Here I am on my way up to the deli to get a sandwich for lunch on Wednesday:

As things go, it was bad but it wasn’t truly awful; our colleagues in California have been commenting that this isn’t such a big deal; they’re used to this; their days are often filled with smoke and fire.

But here in New York City, it felt a little bit like the end of days, the apocalypse, yet another plague falling upon us. Maybe that’s a bit dramatic, and I’m not saying this is foretelling anything cataclysmic, but it clearly had health implications, and once again demonstrated the failures of our public healthcare system.

Throughout the pandemic, our voices were raised trying to shout about how unfair the system is, how it isn’t built for those often the most in need, that there exist multiple worlds of healthcare with different levels of access for the haves and the have-nots. Over and over, we’ve raised a clarion call that things need to change, and that we need to make a healthcare system that works for everybody, every time.

There was a lot of noise about change, about creating equity and social justice — that we’re going to make sure we reach out to every community, hear every voice, and take care of everybody.

Now, as public health emergencies go, this was fairly short-lived, and it seems like we got through it pretty much unscathed. There are certainly reports of people with underlying health conditions, such as respiratory diseases like asthma and COPD, having acute exacerbations, and increased calls for ambulances and people admitted to the hospital with pulmonary complications. Almost everybody was adversely affected to some degree, in one way or another.

But already we’ve seen a lot of criticism of the systems that are supposed to be in place to help us help everybody. There has been lots of commentary and criticisms about the state’s and the city’s responses, the lack of an organized system that was nimble enough to do something before it was all over.

Sure, there were advisories online, health alerts that went out, and notices that masks were recommended and would be made available. But a lot of this probably didn’t have much impact, and didn’t reach the people who needed it right when they needed it.

At our practice, on the first afternoon when things started to get bad, a lot of patients started canceling their appointments, and a number of people who work at our practice asked to go home early due to their underlying health conditions and other concerns they had. It’s easy to look back in hindsight and say we should have done this, or we should’ve done that; we should have canceled appointments; we should’ve converted everyone to video visits.

But as things continue to change, as more and more of these events occur, as we see more emerging infections spreading across the globe, as we see those once-a-century storms happening every few years, as wars and famine and other geopolitical issues displace populations and force people into migration, we’re going to need a local public healthcare system on the ground that’s monitoring things and responding to things in real time, making tough decisions, creating opportunities and options to protect and anticipate and improve the health of everyone.

Rather than an email that said, “Conditions are expected to be bad tomorrow. Consider wearing a mask, or consider working from home if you can,” we should have had a system that kicks in automatically, that flips every appointment to a virtual one whenever possible, that plans to keep people at home safely, and keeps providers at home so they can do video visits remotely. We all need all the resources we can get, all the smart systems helping us plan these things, and all the dedication from the government, including federal and state and local, so that we can get this stuff done.

Just as COVID-19 caught us back on our heels, and knocked us for a loop, that things took such a long time to get so we had things under control, that everybody had the PPE they needed, the ventilators they needed, the medications and the vaccines, we need to start thinking and supporting those doing the work to prepare for the next one. And the one after that.

We may not be able to know exactly what the next coming threat will be, but we should’ve learned our lesson, many lessons, enough to know that there’s going to be another one, and that we’re much better off if we get ready now.

Timed to get fired up, or else we’re all just blowing smoke.