​To the Government of the United States of America.  Writing as a physician in New York City, I want to thank the House, the Senate, and the Executive branch for their recent passing of a 2 trillion dollar bill aimed at protecting the economy.  I would also like to impress on the three branches of government that this money will go completely to waste unless they make more efforts to sure up New York City’s healthcare.  All the hospitals in New York City are already beyond capacity.  We are now counting deaths due solely for lack of resources.  That includes healthcare workers without masks.  Unfortunately, we don’t just need money; we need ventilators, we need masks, we need gowns.   Period.  
 

I am writing in support of shelter in place if done properly.  It should be used as a makeshift vaccine.  
 
There are many long-standing problems in our healthcare market stemming from the fact that, as a market and not a system, we lack the efficiency that comes with centralized coordination.   Our healthcare is also delivered by for profit and disparate non-profit groups who are incentivized to limit waste.  For example, our ICU beds in NYC are 80% full because the groups who run those beds don’t want to waste empty space in order to survive the market.  Now we face a situation where we need not only 100% of those beds, but folds more.
 
NYC healthcare workers fret every flu season as an almost insurmountable number of patients flood emergency rooms because we don't have the capacity to treat them appropriately.  Acutely, we have a lack of infrastructure in terms of physical space, beds, ventilators, and healthcare providers necessary to deal with what is an almost incomparable but predictable surge in illness when compared to seasonal flu that has a vaccine. There is money to fix this situation, but seemingly no time.  The time it takes for a virus to spread through a city is predictable, but also can be manipulated.  
 
To that end, right now, shelter in place should be extended to the entire population of NYC aside from those who can build the infrastructure we need as soon as possible and to those who can deliver healthcare now despite our limited capacity.  Once the infrastructure is in place, SIP should then be limited to those most at risk of significant morbidity or mortality from a COVID 19 infection.  At that point, people no longer under SIP could go back to work.  To be clear, the virus would spread amongst those people, but they would be the population most likely to not only survive COVID 19, but also be most likely to obtain immunity.  Once the most severe cases amongst that initial cohort released from SIP dwindle, having been treated adequately by the new infrastructure in place, people who are most at risk could be released from SIP and would benefit from herd immunity.  That is the same benefit that flu vaccination provides every season for those who cannot obtain vaccination, they are surrounded by those who will not get infected and pass the virus unto them.
 
Shelter in place has trade offs.  But it makes sense if it is utilized as a strategic healthcare policy.  SIP as a policy in a vacuum will not lead to the corona virus disappearing from NYC.  During SIP, healthcare workers will continually come into contact with new cases and will, in turn, be infected by corona virus.  Indefinite SIP for all without thought to how to build herd immunity will only prolong this crisis until we can obtain a vaccine in maybe 18 months by most estimates.  Embrace SIP, because it will reduce the burden on our ill-prepared health care market and our hardworking healthcare workers no matter how it’s handled. But if it is done with a plan to create herd immunity, we can get out of this situation before we hopefully obtain a vaccine.
  



​To the Government of the United States of America.  Writing as a physician in New York City, I want to thank the House, the Senate, and the Executive branch for their recent passing of a 2 trillion dollar bill aimed at protecting the economy.  I would also like to impress on the three branches of government that this money will go completely to waste unless they make more efforts to sure up New York City’s healthcare.  All the hospitals in New York City are already beyond capacity.  We are now counting deaths due solely for lack of resources.  That includes healthcare workers without masks.  Unfortunately, we don’t just need money; we need ventilators, we need masks, we need gowns.   Period.