War language and metaphors have been used throughout the COVID-19 pandemic to describe the virus and those providing care. Chinese headlines touted "28,600 Nurses Support Battle Against COVID-19 in Hubei" (Xinhuanet, April 2020), while in Canada a 2020 CBC News headline read, "The Nurses on the Front Lines of Canada's COVID Fight," and the previous U.S. president repeatedly asserted that health care workers were fighting a "foreign threat."
Many have pointed out the flaws and limitations of war metaphors when applied to health care. As Adina Wise observed (Scientific American, April 2020), the concept of war implies enlistment and a chance of victory, though, in the war against COVID there are no options for peace negotiations or veteran's benefits for those on the front lines. Addressing the patient perspective, Lawrence Freedman (New Statesman, April 2020) found it "offensive" to infer that a person's recovery from COVID-19 is based on willpower in a fight, when in reality survival depends on "medical, social, and economic factors far beyond their control."
So, is applying the language of war applicable to the COVID pandemic (or any disease or public health threat)? If such language is intended to be more than emotional rhetoric, governments have a responsibility to provide protections for frontline health care workers.
At the onset of the pandemic, U.S. nurses became overnight heroes. There were public displays of support for hospital workers in New York City and banners across the country identified nurses as not just heroes, but superheroes. Yet because of failed prepandemic planning, nurses were left to improvise personal protective equipment (PPE) using trash bags and bandannas or repeatedly use single-use masks and gowns. Despite their hero status, some nurses who publicly advocated for staff safety by calling out PPE or staffing shortages were terminated.
According to a joint project of the Guardian and Kaiser Health News, 3,607 health care workers died from COVID-19 in just the first year of the pandemic, with nearly one-third of these nurses. The number of nurses who have contracted COVID to date is unknown. Unlike other service professionals, few nurses have had their deaths classified as a death in the line of duty. Outside of some state nursing unions, no one is accurately tracking the number of nurses who have died from the virus so far; thus, no one truly knows the cost to the nursing profession.
In federal COVID-relief legislation, provisions for frontline workers were limited to temporary hazard pay and mandated sick leave. Following 9/11, the federal World Trade Center Health Program was established to cover acute and long-term medical and monitoring care for the nearly 100,000 first responders and survivors. A similar program must be developed to treat the initial and long-term physical and mental health issues experienced by health care workers during this pandemic.
Nurses must have a seat at the table when organizational, state, and national discussions take place on how to ensure the shortcomings faced during this pandemic aren't ever repeated. They must actively participate in planning to ensure adequate PPE and safety for those providing care to pandemic patients-and in protecting them from what many observers are now identifying as a "secondary pandemic" of emotional and physical harm to caregivers.
If war language is going to be used to define this pandemic and the nurses caring for patients, then legislation must ensure care for their acute and long-term physical and mental well-being. Health care systems must acknowledge the need to heal the frontline workers who are suffering from moral distress, compassion fatigue, and burnout. No trinket, snack, or massage will fix the care providers who have borne the weight of caring for patients under such challenging circumstances.