I was a little hesitant to speak with Dr. Bernard Ashby. Ashby works in Florida, taking care of COVID patients. He is bearing witness to that state’s record-breaking surge of infections at the moment. It’s not that I didn’t think Ashby would have interesting things to say. It’s just: How many times can you repeat the exact same thing? Wear a mask indoors. Get vaccinated. Support health care workers.
But when we got on the phone, Ashby sounded just as frustrated as I am: “The transmission rate is ridiculous down here. Patients are coming in by the boatload. They’re younger, they’re sicker. And unfortunately, we weren’t really prepared for the surge that we’ve gotten”
I wanted to know who a front-line physician would hold accountable for this COVID spike, a dark rerun, complete with the same overcrowded hospitals and regretful patients we’ve seen before. Watching the news, it feels easy to find a villain: Republican Gov. Ron DeSantis. But Ashby says this blame game misses something. “Everyone’s playing politics with this,” he said. “It’s not just the Republicans. It’s the Democrats, too. And, there’s a lot of different agendas at play.”
So who does he blame? “Oh, I blame everybody. Newsflash: Coronavirus ain’t going nowhere. It’s going to be here for the rest of our lives.”
On Monday’s episode of What Next, I spoke with Ashby about what it’s like inside Florida’s surge. Our conversation has been edited and condensed for clarity.
Mary Harris: Take me inside a hospital you work at in Florida right now. What’s it like?
Bernard Ashby: I’m a cardiologist, first of all. But before I was a cardiologist, I’ve always been a general doctor, so at the hospital, in addition to consulting cardiology patients, I also take care of general patients as well. So I do take care of patients that come through the ER with COVID-19 who are very ill. And in that capacity, what you’re seeing is just a lot of sad stories. Patients tend to be less educated. They tend to be the working class. There’s a large migrant community, many of which are undocumented, who are coming in. And it’s unfortunate. When they come in, they’re sick; they’re scared. They know about the horror stories about COVID-19. And they’re just wondering if they’re going to meet that same demise.
When you tell a patient they have COVID, I’m curious how they respond.
It’s interesting. I have yet to encounter a patient that was surprised by the diagnosis. They usually know coming in the door that they have COVID-19. People are listening. They hear the stories. They probably had a friend or know someone that has had it. And so they know what COVID entails. And so they’re not surprised. The patients that I’m seeing now, a large portion of them—well, really, all of the patients I’ve seen—have been unvaccinated. And, if they have a chance to talk about it, I heard a different story almost every time. There’s certain themes, but everyone has a different story.
Tell me a couple of stories.
I had one patient, she came in with COVID-19, and she was unvaccinated. And I asked her, “Why didn’t you get vaccinated?” And this was after she made it out and wasn’t tenuous. And she basically said that she had some concerns, but she just didn’t really have the time or the opportunity to get it. And she was someone that was working in the fields, harvesting crops.
A migrant worker.
Exactly. And she wasn’t opposed to getting the vaccine. It’s just that no one really talked to her. No one presented the vaccine to her. And she clearly would have gotten the vaccine if she was targeted. And so that’s an example of how we could do better at our public health campaign and address these populations that are largely forgotten.
It’s interesting to hear you talk because it seems like Floridians are about half vaccinated, which is sort of the median. And I see so much focus on the vaccine resistant, but it sounds like you’re also seeing people who just haven’t been reached. I think some folks may have the perspective of, “Oh, you can just go to your Walgreens and get it. It’s so easy. It’s free.” What are you seeing that you would say to people like that?
This is indicative of our health care system as a whole. Vaccination rates have always been low in certain demographics prior to the pandemic. Access to care has always been an issue in certain demographics prior to the pandemic. We talk a lot about disparities, and I actually dislike those terms: disparities and inequality, all that, yada, yada.
Is it the passive voice you don’t like?
It makes it sound like it’s an abstract thing. I see it every day. I see that patients can’t afford insurance. A lot of people are uninsured. A lot of individuals are underinsured, particularly if you have Medicaid, and they get inferior care. These patients don’t get treated well. Things get overlooked.
In some ways you’re saying it makes sense that this would be the population that would be unvaccinated.
These people are not engaged in the first place. And it’s interesting that a lot of people are surprised by their hesitancy. We didn’t care about them before and all of a sudden we care about him in the context of the vaccine. This is a wake-up call and should lead to a fundamental reckoning of the failures of our health care system. We’re one of the worst, if not the worst, performing countries in the industrialized world. And that’s precisely because we’ve decided that health care is a privilege and not a right. And you can see that in how we approach the pandemic and how we approach the treatment of patients. In fact, there’s been tons of data, even a recent study that came out of UPenn that showed that your mortality rate from COVID-19 was directly tied to what hospital you went to. You know what hospitals had the highest mortality rate? Well, the county hospitals, the ones in urban areas.
The ones that serve Black and brown people.
Yes, but also rural communities as well. Poor white people. They get the crappy care as well. And we’re not talking about that at all. We’re acting like these issues don’t exist, and we’re just focusing on vaccination, vaccination, vaccination. You can’t just focus on one thing. You have to take a step back and look at the big picture because we are failing a large demographics of Americans. And as a result, we’re seeing a large portion of our population die unnecessarily from preventable illnesses. And now just add COVID-19 to the equation, and you got your stew. And so it’s unfortunate.
Can we talk about you and your colleagues? I heard an emergency physician in Miami quoted, basically saying staffing is a huge issue because after a year and a half of treating patients with COVID, everyone was surprised by what’s happened now. So how are you seeing that in your hospital? What’s the conversation like in the break room?
You’re going to get me in trouble. But, people are angry. People are tired. People are stressed. And, yes, staff is an issue. But Florida, compared to other states, we have a relatively good nurse-to-patient ratio. And I think that is one of the main reasons why we had a lower case fatality rate, meaning when people actually get sick and get hospitalized, their chances of dying were lower than most of the country. That’s something that was a good thing. However, people are tired, people are burned out, and we need to address the mental health implications of this.
The entire world has had collective PTSD from this pandemic, but particularly the front-line workers, particularly individuals like nurses, like respiratory therapists, like phlebotomists—these people are in these patients’ rooms, they hear them coughing, and they know they’re sick, so they’re much more likely to encounter the virus, but they’re much more likely to experience the pain and the suffering that these patients are going through. And I just don’t think they get enough credit, enough appreciation. And frankly, I don’t think they get paid enough. So, I think we need to focus on that.
I’ve seen you on CNN and MSNBC speaking out against Gov. Ron DeSantis’ lack of coordination when it comes to this latest surge. You’ve said you want the governor to be more proactive, less reactive.
So what can I say about our governor? I got to laugh and cry because it’s so, so reckless. Specifically, about two weeks ago, myself and some of my colleagues did a press conference because we saw everything surging and we were like, “Hey, what’s the plan?” And we expressed our concerns. We wanted some action, and we laid out some specific things. But in general, our message was let’s be proactive here. And instead of that being met with some positive response, the governor just got all political on us. They released a statement saying that we don’t know what we’re talking about. He gave a press conference that alluded to us saying that these physicians basically want lockdowns and mandates, and he’s opposed to all of those.
Is that what you want?
No, we never said any of that. We didn’t talk about mandates. I just said we needed to do something.
What did you want?
We wanted proactive measures. We wanted this to be to be made an emergency situation. We wanted him to reinstate the emergency order that was in place, not necessarily the same measures, so that we can be on high alert and start distributing and allocating resources appropriately. In addition to that, we wanted masks to be used. Obviously, that’s very important. And this predated the CDC recommendations. But DeSantis didn’t do anything. He just talked about politics, and made fun of masks and Fauci, and was traveling to other states and fundraising for his campaign. Basically not taking it seriously.
And then, DeSantis did start to act. But not in the way the doctors would have recommended. DeSantis started by issuing an executive order limiting the use of masks in schools.
The governor might say, “I’m not against masks, I’m against mandates.”
Yeah, but you can’t speak out of both sides your mouth, because he’ll say he’s not against masks, but he’s selling campaign merchandise making fun of masks. You have him saying that masks are detrimental to kids.
Do you ever talk politics with your patients?
Oh, my goodness. Yes. A lot of them see me on TV, and my patients love me, man. I have very different demographics. In Miami, largely Black and Latino. In the Treasure Coast, largely white rural folks. And I have some diehard Trump-licans who are my patients.
Talking about Florida right now, I’m really reminded of this conversation I had with a reporter in South Dakota a month or two ago. We were talking about how the governor there, similar to DeSantis, didn’t want to put in mask mandates and has been really trying to pump herself up nationally because of her stance. And what he said was from the outside, it might look like South Dakota doesn’t have the best COVID response. But if you’re in South Dakota, people really like this freedom that the governor’s given them. When you talk to your patients, can you see that? This perception that even if the COVID numbers are going up, the government’s doing a good job. Or is it different in Florida?
It really depends on how old they are and how they assess their risk. And so my older patients, who are vulnerable, they think DeSantis is reckless. But my younger patients, particularly my white male patients, they love what DeSantis is doing.
What would you tell your patients in Florida right now who are hearing the news about this surge and maybe feel a little bit helpless?
I would tell them that we are experiencing a crisis now, but you’re not helpless. There are things that you can do as an individual to protect yourselves and protect your community. We know that masks work. We know that avoiding indoor spaces is important. Being outside is a better idea because it’s safer. I do understand that is hot, but just keep that in mind. Get vaccinated. That’s extremely important. In terms of the public health message to our leaders, we can do things like focus on providing early, aggressive care for people that do get sick. We’re underutilizing the monoclonal antibody therapy. The government has already paid for that, and we’re not giving it to people at anywhere near the rate that we should be. And that’s a message for our leaders and for the public. Know that this therapy exists. And if you get it early, you’ll do very well. Donald Trump got that therapy, and that’s a big reason why he did well.
We just need to be proactive, work together as a community, and not be so ideological about things. We’re all Americans, we’re all Floridians, and we just need to realize that. The sooner that we do realize that, the better we can move on with our life because the coronavirus isn’t going anywhere. There will be flare-ups in the future. And it really is incumbent on us to work collectively to protect our entire community, particularly the most vulnerable among us.
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