There is a lot to worry about in the midst of a pandemic. Information changes daily and the accumulation of cases and deaths in the United States seems beyond comprehension at times. With so much to process, concerns about working conditions among healthcare workers seems like just one more thing in this tornado of uncertainty.

There are times in this process where I stop and remind myself that this is actually my second pandemic as a healthcare professional. HIV/AIDS being my first. Since the first cases of acquired immunodeficiency syndrome (AIDS) were reported in 1981, infection with human immunodeficiency virus (HIV) grew to pandemic proportions, resulting in an estimated 75 million infections and 32 million deaths to date. I wonder if we can learn anything from that tragic experience.

In 1986, the deeply religious and brilliant pediatric surgeon C. Everett Koop was finally authorized, as Surgeon General, to write a report on the federal response to HIV/AIDS. Many were fearful given his unabashed evangelical Christian views (I can attest to these personally as I heard him speak as a trustee of my high school). Yet, Dr. Koop wrote in the report’s foreword, “At the beginning of the AIDS epidemic, many Americans had little sympathy for people with AIDS. The feeling was that somehow people from certain groups ‘deserved’ their illness. Let us put those feelings behind us. We are fighting a disease, not people …The country must face this epidemic as a unified society. We must prevent the spread of AIDS while at the same time preserving our humanity and intimacy.”

As if it is any wonder, his confidant and advisor in writing this report was none other than Dr. Anthony Fauci who said of Dr. Koop – “He was deeply driven by principle when it came to public health, not by any ideology.”

We know from survey data both in the US and Italy that 20% of COVID-19 infections are among healthcare workers. To date in the US at least 5,400 healthcare providers have been infected resulting in dozens of deaths. Researchers in Nebraska could find viral DNA in 2/3rds of air samples collected in isolation rooms in hospitals treating severe COVID-19 cases as well as in a quarantine facility for patients with mild infection. Further, a recent study published by Dr. Sutton and colleagues at Columbia Presbyterian Hospital Obstetrics ward showed that 13.7% of routine (non-COVID related) admissions were positive for COVID-19. Of these 88% had no symptoms of such. So, in reality, any healthcare worker involved in the care of any patient is ‘frontline.’

We have seen protests from nurses in our own City of Santa Monica decrying the lack of PPE. The rationale given by the hospital system is that providers caring for non-COVID-19 patients do not need N95 masks or enhanced protective equipment. However, we have emerging evidence that COVID-19 may have a lengthy ‘presymptomatic’ phase and that there may be carriers who are entirely asymptomatic. Assuming all patients have the infection until proven otherwise is the only logical manner in which to proceed.

To rephrase Dr. Koop, the country must face this COVID-19 epidemic as a unified society. We must prevent the spread of coronavirus while at the same time preserving our humanity and intimacy. John Manuel-Androite wrote in The Atlantic, “By his willingness to rise to the moment, to respond from his faith in God and his powerful belief in his calling as a doctor, as his fellow humans called out from their fear and suffering, C. Everett Koop changed the course of history. He also ensured that his honored memory will live on in history.”

We owe it to our frontline medical professionals to do the same. And, now, every single one of them is on the frontline.