Use Caution: Retirees & the Direct Clinical Setting

To help with the increasing surge of COVID-19 patients, there have been a number of calls to re-enlist retired physicians and nurses in the healthcare setting. These calls from those within the government and the clinical setting are understandable on the surface. However, some elements are not being fully considered and could actually have harmful effects if not implemented effectively.

In some situations, senior citizens could deploy in disaster response and recovery efforts. For example, at 80 years old, Samuel Whittemore provided vital assistance despite being the oldest known combatant of the American Revolution in 1775. However, senior healthcare and social issues must be considered. For inherent and evident reasons, healthcare and government agencies should use caution when rallying retired physicians and nurses to bolster the healthcare workforce in the time of COVID-19.

Benefits & Caveats for a Senior Workforce

There are many good reasons for retirees to volunteer or re-enlist in order to fill gaps to meet surge demands. For example, in 2010, the Federal Emergency Management Agency Urban Search and Rescue team in Texas recruited the retired physician’s organization of the Harris County Medical Society in order to enhance manpower needs. During the pre-deployment phase of multiple incidents, those retirees assisted with physicals and medical screenings. Although their efforts were impressive and inspiring, those same noble men and women would not be as well suited to respond on the front line of the current COVID-19 threat for several reasons:

• Severity of illness – Older adults and those with underlying medical conditions are at the greatest risk of severe illness should they contract the virus. The risk of severe outcomes and death increases with age.
• Comorbidities – As people age, they are more likely to develop chronic health conditions such as heart disease, diabetes, and lung disease. Coupled with COVID-19, these conditions become even more life-threatening.
• PPE shortages – Personal protective equipment (PPE) shortages have been reported around the world due to increasing demand, buying and hoarding out of fear, and misusing PPE. In some cases, shortcuts are being taken (e.g., reusing single-use resources) that increase risk of infection. Introducing retirees back into the system would increase PPE needs and deplete resources at an even faster rate.

Any one or combination of the above risk factors would increase the number of critically impacted and dependent patients. Under these circumstances, encouraging seniors to exponentially increase their contact with this very contagious virus could, in fact, counteract the intended response goal.

Recommendations for Re-Enlisting Retirees

In terms of enhancing the response, perhaps the best use of this precious intellectual resource would be in remote video oversight of junior physicians and nurses, nontraditional aide and caregiving in a virtual capacity, and home health consultation via telephone and other remote and protected situations. Additionally, if provided tele-triaging templates, these retirees could be a massive force multiplier for public health and healthcare.

Regardless of age, those considering volunteering in a direct clinical setting should review their risks. Those who are older, immunosuppressed, or recently post-surgical, or those having moderately or poorly controlled medical conditions should consult their trusted healthcare providers to determine how they could best serve.

The poet, John Milton famously wrote in a 1650s poem, “They also serve who only stand and wait.” This might be a time when art and life have a potential for mutual enhancement. A nurse or physician who maintains the greatest PPE of all, social distance, may sustain much longer, serve much longer, and ultimately avoid becoming one in need for these limited medical resources.

There is much truth in the grim adage, “A dead responder doesn’t save anybody.” In the age of COVID-19, ill-planned utilization of retirees could doubly rob the response by depleting an intellectual resource and creating another in-patient requirement. It is critical to consider all the potential risks and consequences of such decisions before making or responding to these calls for action.