It has been almost a year in s SARS-CoV-2 arrived in the United States and started its rampage across the country. Millions of children left school for their spring breaks around St. Patrick’s Day and manny have not seen the inside of their classrooms since. For nearly 12 months the country’s head of state has vacillated on whether the epidemic within our borders is a hoax, a foreign bio weapon, totally controlled or politically motivated hysteria. Our lawmakers at nation and state levels, many of whom have done nothing but sacrifice science and citizens upon the altar of The Economy, have suddenly embraced the promise of medicine and shoved their way to the front to receive a vaccine that has itself been the subject of intense disinformation campaigns. We have seen insurrectionists conspire to overthrow state governments because requiring masks and making bars close is tyrannical. We have witnessed a rabid mob, flying the flag of their champion in the White House, scale the walls of the US Capitol and threaten the representatives and senators conducting the people’s business within. All of this has transpired in what simultaneously seems a moment and an eternity while a would-be emperor plotted in plain view to wreck the electoral process and assume total control. 2020 will certainly be remembered as a pivotal year to future students of the American experiment, a year when countless societal, economic, political and religious forces converged within the crucible opened by a deeply misunderstood and poorly handled global health crisis.

But, as trying and stressful as 2020 was, as difficult and painful it was for so many, 2021 might well be an even more critical year because we are still facing the same obstacles as we were three, six, or nine months ago. Donald Trump still reigns in Washington (for another week) and there remains no shortage of Republican lawmakers and Trumpist disciples queuing up to throw themselves upon his political funeral pyre. The events of 6 January on Capitol Hill demonstrate there are plenty of individuals driven to sickening displays of idolatry and disgusting efforts to hand Trump despotic powers by playacting as revolutionaries to undermine the republic they allegedly adore. What happens in the coming weeks might well determine whether the United States remains an ostensibly democratic country or succumbs to the weakening and machinations of a political party hellbent on keeping a toxic and loathsome man in office for its own political and material gain. That combined with the fact the coronavirus vaccine rollout is dragging, states are reporting ever increasing numbers of sick and a new variant of the COVID-19 causing virus has emerged, have only underscored that a night of fireworks and a change of the calendar are insufficient to correct all the previous year’s problems.

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On the whole, we have learned a great deal in the past 12 months, not just about coronavirus but about ourselves, our relationships, our fellow citizens and about the vast systems that somehow keep our fragile society from splintering or collapsing entirely. It is that last category, particularly the healthcare system, that will be the focus of this meditation going forward. That system is currently under extraordinary stress at a moment when its resources are unequivocally vital. In many way, this is not unexpected — of course a viral pandemic that has left virtually no recess of the Earth untouched would increase demand for hospitals and the skills of medical practitioners. Similarly, it is not unexpected that those hospitals and professional healers would be hard pressed to meet those demands. The country has experienced a chronic shortage of nurses since time immemorial, partially due to increased education and licensure requirements that have not translated into better working conditions or significantly higher compensation.

Additionally, the consolidation of healthcare systems and the widespread merging of insurance companies have placed premium on cost savings and revenue cycles among the former and minimizing reimbursement rates among the latter. This has created an atmosphere in which hospital staffing is tightly controlled and physicians are forced to dedicate hours of their time to charting in hopes of maximizing billable activity. None of this is conducive to forward thinking or preparedness. To be fair, it’s unclear if any hospital system could have been completely prepared for the flood of patients brought on by pathetic crisis management from the federal government and by many states’ governors. That being said, it is abundantly clear that many facilities were underprepared, even if the epidemic had been less severe. There are countless articles, reports, anecdotes and videos of the turmoil facing hospitals in towns and cities across the United States. Emergency departments diverging ambulances due to lack of treatment rooms, inpatient nursing units packed to the brim, ad-hoc COVID wings with hastily installed negative pressure equipment and even entire campuses being repurposed to exclusively treat the sickest of the sick have become a regular occurrence and a sobering testimony to the need for radical and swift action to reinvent healthcare in this country.

It occurred to me recently that many small to medium sized hospitals, the ones that serve modest sized cities or miles of rural area, would be faced with certain chaos if just one mass casualty event took place nearby. How would a 200 bed facility, already struggling to triage thirty plus people in the waiting room, manage a train derailment that injured dozens of people, some of them severely? How would a regional hospital 50 miles from the nearest trauma center handle a sudden influx of gunshot victims from a local elementary school without so much as a staff pediatric specialist? These questions have taken on added gravity in the current maelstrom, yet they are not being asked, at least not in the mainstream press or answered publicly by healthcare system administrators.

There is no excuse for so many executives, regulators, politicians, practitioners and even ordinary citizens to have allowed the system to move so close to the cliff’s edge, yet here we are peeking over the precipice as the virus mutates and the death toll climbs while we debate whether accepting a novel vaccine against a novel organism is a scientifically sound, ultimately positive action or an invitation to mind control and capitulation to the New World Order. Here we are, with overflowing lobbies and nurses enduring endless hours in stifling protective equipment, trying to explain to a certain segment of the population that there is no ‘corona bounty’ that rewards physicians for diagnosing anyone with so much as cough as COVID positive. Our healthcare heroes are fighting a multi front war in our hospitals against disinformation, dear, misplaced suspicion, partisan politics and the injuries and ailments they trained and studied so long to treat. This kind of war cannot end once the pandemic abates, the masks come off and families can once again visit their hospitalized loved ones — it is a war that must culminate in the complete transformation of Americans’ healthcare relationship and understanding of healthcare, sickness, living and dying.