Over the last week, COVID-19 has progressively made its way deeper into our communities, and we have reached a tipping point. American medical personnel and epidemiologists tracking the disease both agree—we aren’t prepared. Our response as a medical community is inconsistent, much like the messaging from the federal government. We do not have enough tests, the criteria to be tested is far from consistent, and results can take 4-7 days.
Though we aren’t a population prone to panic, the thousands of healthcare workers and other public servants like firemen and policemen are facing a new insidious risk in their jobs. While the 2% mortality rate and comparisons to the flu are the constant refrain of anti-alarmists, we as health care workers know better. Based on epidemiological data, we know the mortality rate for the elderly is closer to 15%. It is also higher for infected health care workers and the immunosuppressed. We desperately need an objective, evidence-based response, yet our local hospitals and health departments are operating on vastly different plans. The United States, which constantly touts itself as a leader in the world, has thus far failed in its response.
Now, imagine trying to develop a plan for 2,000 people living in tents crammed together on the border with Mexico. With an average of four people per tent, communal cooking, meal distribution, and porta-potties, any quarantine—self or enforced—is nearly impossible.
Global Response Management—a US-based, veteran-led medical non-profit organization—runs the only clinic servicing asylum seekers in a tiny stretch of muddy land along the Rio Grande. We are combat veterans, physicians, physician assistants, nurse practitioners, nurses, paramedics, and EMTs. We have served our country and communities and now we find ourselves responding to a pandemic on two fronts—our day jobs in United States healthcare facilities and our time volunteering to care for a largely forgotten population.
Seven days per week, GRM’s medical volunteers see an average of 40-50 patients per day, already weakened by respiratory and gastrointestinal ailments as a result of their perilous journey and the conditions of the camp itself. A large number of them are already immunosuppressed, which puts them at higher risk for infection. More than 50% of the people in the camp are under the age of 15. 25% are under the age of 5. Many of the infants have not been vaccinated. One sobering statistic is the lack of people over 60 years old in the camp. A win in the battle against coronavirus, an overall loss knowing that the elderly perished during the journey North.
While there are no confirmed—or presumptive—cases of COVID-19 in camp, we are watching the cases in the US and Mexico creep closer to our geographic locale. If facing coronavirus in the US healthcare system is perilous, fighting an outbreak in an outdoor, close-quartered community of asylum seekers is akin to the proverbial “walking to school in the snow, ten miles, uphill both ways.” After weeks of prep and processing the data and recommendations being published, we have spent the last several days working around the clock to put measures in place for prevention, fortification, and treatment.
Each challenge is a parallel exercise in creativity and utilitarianism. How will COVID-19 affect a population worn down from stress and the elements? We don’t know, but we are pretreating everyone with multivitamins containing Vitamin D and Zinc to boost their defenses. How do we test? We can’t. Instead, we’ll use handheld ultrasound to monitor lung pleura, rapid flu tests to rule out the Influenza A and B, and clinical presentation to do the rest. How do we follow the recommendations of early intubation and ventilatory management when we have no ventilators? We don’t. But we will be aggressive in identifying those with underlying conditions before infection and making sure that we increase their baseline status if we can.
As an organization, we exist to bring the best possible medical care to people displaced by conflict, war, or disaster in high-risk, low-resource areas. We pride ourselves on our elite training, partnerships, and donors who allow us to deliver this care. On top of our domestic work, we have served as an organization in Iraq, Yemen, Bangladesh, Northeastern Syria, The Bahamas, and Mexico.
Yet, despite our history of going where others won’t, to do what others can’t, this might be the greatest challenge we face. Our MASH-style infirmary tent for the sickest patients looks nothing like an American Intensive Care Unit. And, in the middle of a muddy field with no running water and limited electricity, it certainly won’t have the amenities of one. What it will have is a team of dedicated professionals relentlessly pushing themselves to deliver innovative, evidence-based solutions and compassionate care to 2,000 people fleeing violence and trauma, people who deserve dignity even in their largely invisible state.