A friend (I’ll call him Dave) who works at an inpatient psychiatric facility writes that he is “honestly terrified to go back to work” and wrote me for advice. His story gets at the complexities of life that make genuine isolation from risk practically impossible. He lives in a rural area where has two sons and “a complex custody schedule”. His initial note goes on to describe his working situation.

We are in close quarters on floors with between 10-20 patients and 6-12 staff who are coming and going from 3 states. The patients’ hygiene is generally pretty poor and they do spit at us from time to time. Also, air circulation is almost nonexistent. The hospital is still admitting patients as well. We have received very little guidance from the admin about what will happen when someone tests positive or becomes ill which seems to be a matter of time. Am I right to be cautious to enter such an environment at this time? I am 50 and healthy but while this virus tends to affect the elderly and infirm harder, I have read about plenty of young healthy people getting hit hard as well.

My first thought was that this sounded like a recipe for an outbreak. Close quarters, poor hygiene, and poor air circulation raised major red flags even before the whole business about spitting patients. Add to that the fact that Dave could bring the virus home, infect his family, and his boys could easily pass it on in the families of their moms. Then multiply this times all those workers from three states.  He understood this risk and had been staying home. He had some savings, but money was a serious concern.

I was busy when I got the note, so I told him he was right to be concerned, but I needed some time to think about it. A week passed before I could get back to him. When I did, I told him I wouldn’t go near the place without a respirator and probably a face shield. Fortunately, he had been wise enough to stay away. He updated me.

They had an RN in admissions working for a week with active symptoms who has now tested positive for covid. They currently have a patient in quarantine in one of our seclusion areas. They fired a friend of mine for self-quarantining after being exposed to a person who tested positive. In short a near total dumpster fire.

I share this story because it encapsulates for me the daunting challenges being faced by people all over the country. Like another friend I have been advising as she struggles to keep her small business afloat, the pandemic forced Dave to navigate impossible choices. The choices between protecting the lives and health of yourself and those you love and preserving economic well-being is a microcosm of the debate we see on the national stage being played out millions of times over. Only there is nothing abstract about the stakes.

These challenges are just beginning. The stakes will rise with the death counts and, as the lock downs persist, people will make desperate choices. Those choices will spread the disease. Unscrupulous employers will make policies that force these decisions. We need to actively engage in the debate now as to how we will get out of our holes and return to life. The stakes could not be higher.

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