The COVID-19 pandemic has gripped modern medicine in unprecedented ways. As a young anesthesiologist, I am not as likely to suffer complications or die from COVID-19 compared to my older colleagues. Data from China and Korea report a 15 to 18 fold greater risk of mortality from COVID-19 in people aged 60-69 compared to age 30-39 years old. Some anesthesiologists are thinking twice about who should continue to work during the pandemic.
The American Society of Anesthesiologists is the major society of American anesthesiologists, and it is estimated that 37 percent of its members are 55 years and older. Many sources recommend that the most experienced anesthesiologist available should perform tracheal intubation for patients with COVID-19. But does this advice make sense when the most experienced anesthesiologist happens to be most at risk for complications of this highly infectious disease? In the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, transmission to health care workers accounted for 37 to 67 percent of the SARS cases in highly affected countries. Anesthesiologists are among some of the highest risk for becoming infected with the disease. They are essential physicians in the intensive care unit tending to the sickest patients and are the ones called upon to place life-saving breathing tubes when patients are struggling to breathe. Intubation is one of the highest risk procedures, aerosolizing infectious particles with the anesthesiologist’s face closest to the patient’s virus-shedding mouth. In Santa Clara County in California, one of the United States’ COVID-19 epicenters, some of the experienced, older anesthesiologists question if they should be in the pool of doctors to intubate COVID-19 patients. Large academic hospitals have an anesthesiology workforce with a wide range of ages and may have the ability to substitute a younger anesthesiologist. Other senior anesthesiologists have asked for additional personal protective equipment (PPE) when performing an intubation.
As a young, female anesthesiologist, I have argued for special accommodations for my health and the health of my children: avoiding teratogenic radiation exposure when I was pregnant, bargaining for maternity leave, and later, begging for adequate time to pump breastmilk for my infant child. In the last decade, parents have become more vocal in their needs of balancing family and work life. In July 2019, The American Board of Anesthesiology (ABA) revised its Absence From Residency Policy to allow for up to 8 weeks of maternity leave that does not need to be made up. The ABA also granted an additional 20 minutes of break time during the board examination for breastfeeding mothers for lactation purposes. Many medical conferences now offer designated space for the sole purpose of women to express breast milk. Some senior anesthesiologists may be critical of these accommodations for young anesthesiologists.
This pandemic presents a unique opportunity for senior anesthesiologists to see the benefit of accommodating the health care needs of our workforce. Just as I tried to avoid the teratogenic effects of certain cases when pregnant, we should consider the most effective ways to protect senior anesthesiologists from a life-threatening infection. When the pandemic has passed, anesthesiologists of all ages can take into account times when each of us is more susceptible than others. I hope that we will work to accommodate the age dynamics of our profession and protect each other. For now, while we still have a full roster of healthy anesthesiologists, an effort should be made to spare older colleagues who are at higher risk. After all, this is at the heart of what we do as physicians: care for and protect those who are in need.
Becky Wong is an anesthesiologist and can be reached on Twitter @BeckyWongMD.
