At large academic medical centers—like UCLA Health, where we work—infection preventionists, or IPs for short, keep patients and healthcare workers from catching and spreading communicable diseases. We come from a variety of backgrounds. Some of us are nurses, some are lab technicians, others have training in public health. We understand how infections spread, and how different infections spread, and how health care workers can keep patients (and themselves) safe when there is no easy cure for a contagious and dangerous illness.

Our role is often hidden. We don’t treat patients, but we touch many aspects of hospital life.

In normal times, our days involve preventing infections patients could get from external devices such as urinary catheters or central lines. We enforce protocols for dealing with viruses like the flu, or stomach bugs. We function as the “hand hygiene police,” constantly reminding our colleagues on the medical units to wash their hands, to wash their hands more, and to remember, later on, to wash their hands again. We inspect patient rooms for hazards, and conduct trainings for staff. We answer questions, and prioritize concerns.

No two days are the same, but the goal never changes: make the healthcare system safer for all. It is the driving force behind the work we do every day—especially now, in the era of COVID-19. This virus has consumed our daily lives at work and at home, focusing our attention on a single, vexing subject.

Before this year, none of us had ever experienced a major pandemic, and while we had prepared for various exotic contagions like SARS or Ebola, we’d never confronted patients with those illnesses. We always realized it might happen one day, and the idea of it was kind of exciting, since we had trained for so long in preparation. But we had no idea how big this outbreak was going to become, and never really anticipated its devastating outcome.

In February 2020, we began receiving many pages, late at night, concerning patients with travel history and respiratory symptoms. Historically, many of these people would have been thought to have the flu, but now there was an added potential diagnosis: Could they have the novel coronavirus? The pages triggered a frenzy of activity. First, a multidisciplinary team, comprised of experts in emergency preparedness, infection prevention, nursing, physicians, hospital leadership, and operations, would hop onto a conference call to determine if the patient met the criteria for COVID-19 testing. Were they displaying symptoms of respiratory disease due to unknown cause, such as cough, fever, difficulty breathing, and shortness of breath? Had they traveled to an area with known transmission—at that time, China, Iran, Italy, South Korea, or Japan?

More and more patients qualified for testing as we reached the middle of March. And as soon as we deemed someone a person under investigation for COVID-19, the on-call team would head into the hospital. For IPs, this meant consulting a fat binder, prepared by the emerging infectious diseases team, that contained all the official COVID precautions and protocols: what protective clothing to wear, what disinfectants to use, and so on.

We conducted on-the-spot trainings to prepare the staff on the most recent guidance, collecting personal protective equipment (PPE)—N95 masks, gowns, gloves, and face shields—and showing doctors, nurses, and respiratory therapists how to take these items on and off, step by meticulous step. If a nurse was going to take a nasopharyngeal specimen, we advised them to double bag the sample and wipe the outer bag with a bleach wipe. As we helped a doctor put on the appropriate PPE, we reminded them of crucial precautions such as sanitizing their gloves before removing them.

As the care team got to work, we stood watch outside patient rooms, peeking through interior windows, ready to answer questions or provide tips. No one really understood much about COVID then, so IPs had to exercise extreme caution. We did not know how COVID spread, so the PPE we gave health workers was extensive (including extended-cuff, doubled gloves) and completely disposable (today we wear reusable gowns that we wash between uses). We instructed nurses to wipe outer biohazard bags with bleach (now that we know this refuse isn’t dangerous, we follow standard disposal processes). When staff rolled a patient in a gurney down a hallway, environmental services workers followed alongside with a Swiffer-style mop, decontaminating the path the bed traveled over the floor.

Treatment teams started utilizing cell phones or white boards to speak to one another, flashing written messages instead of entering and leaving a patient’s room and wasting precious, disposable PPE. Stationed outside of a room in one of these moments, we were dying to know what a nurse was scribbling on her white board. Often the message was something like, “Do I wipe the specimen bag with a bleach wipe or alcohol wipe?” We’d write, “Bleach wipe.” The nurse would give a thumbs up, and continue with her work.

To minimize risk and PPE use, we did a lot to try to prevent people from walking in and out of patient rooms if they didn’t absolutely have to. Visitors, of course, were not allowed at all, but we tried to keep staff away as well when it was feasible. This meant teaching doctors, nurses, and others new ways to do their work. IPs coordinated with hospital supply workers to make sure rooms remained stocked with ample supplies: receptables for removing PPE, wipes for cleaning surfaces, gloves for patient care, hand sanitizer, biohazard bags for specimens. Usually such items would have been kept in a central supply room, with care workers going in and out to grab what they needed whenever they needed it.

We worked with the facilities team to minimize potential maintenance issues and repairs. We made sure they aggressively monitored sinks, doors, patient care equipment, and ventilation systems. Normally, nutrition staff delivered meals directly to patients. Early on in our pandemic response, we instructed them to hand trays of food to nurses, who would then take the meal into the room. We also worked to remind nurses to help disinfect highly used surfaces when they were in a patient room, since the environmental services team couldn’t enter until discharge.

Anyone who did need to enter a potential COVID-19 patient’s room had to add their name to the Patient Room Log, which listed employee ID numbers, names, times in/out of the room, any safety concerns, and their preferred contact information. If this patient’s test results came back positive, every person who had been in the room would be monitored for 14 days.

In March and April, as we realized that COVID-19 was not going away, we expanded our education efforts to the entire hospital, creating new policies, conducting large trainings on PPE guidance, and walking through units to answer any questions that staff may have had.

We hit a stride that never really slowed. Every day, you would come to work with a blank slate approach. Things changed so often that guidelines provided one day might be radically modified the next, based on new information. Every month, you would think things were going to get better—but they never did.

The worst-case scenario we had planned for in April finally hit us over the holidays—cases in the Los Angeles area exploded. We went back to our binders to remember all of the systemwide protocols that the hospital had laid out—adjustments like setting up intensive care units in surgical areas, housing adults on pediatric floors, and “cohorting” more than one COVID patient in a room.

Inside and outside the healthcare setting, COVID-19 became all anyone talked about. We are all fortunate to have received the first dose of the vaccine. There is light at the end of the tunnel.

This work is exhausting, but we’re thrilled to be doing it. It’s what we trained for, and it’s helping keep people safe.

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Our friend, a physician, had just witnessed the death of a 27-year-old man with no chronic conditions. In his hospital, doctors were already making decisions about who to put on ventilators. “It’s a mess and there’s no help,” he told us. The young residents—doctors in training—were completely disillusioned; one of them told him, “When this is over, I don’t want to do this anymore, if this is what our health care system has come to.”

We should all be afraid about that reaction to COVID-19. If this pandemic can be compared to a war, we have sent our soldiers—our medical professionals—to the front lines without the protection and protocols they need to survive. Physicians, nurses, and other hospital workers are overwhelmed by endless streams of patients, the extra-long hours, and the deaths they see all around them. Scared and confused, they fight on. We should expect that when their duty is done, some of our best and brightest will decide never to return to the battlefield again.

In this respect, this pandemic is an extension of the ordinary. The United States routinely neglects the needs of one of its most vital workforces. If COVID-19 has any silver linings, the most important one will be its exposure of the fault lines in American healthcare, including the fact that even before the epidemic hit, healthcare professionals were suffering from toxic levels of burnout that hampers their ability to care about their patients.

More broadly, this epidemic shows that many aspects of the way we speak and think about healthcare, and the way we provide it, need to be reconceived and redesigned. To do that, we need to listen to doctors, nurses, and other healthcare professionals.

Despite the health risks of treating COVID-19 patients and the lack of masks and basic protection in many hospitals, healthcare professionals are not running from the challenge. Instead, they are building their own masks out of office supplies, coming out of retirement to offer aid, and isolating themselves in garages and trailers to protect their families.

Such commitment is particularly impressive when you consider that even before COVID-19, a significant proportion of them were unhappy in their jobs. According to research from the National Academy of Medicine, between 35 percent and 54 percent of U.S. nurses and physicians feel substantial symptoms of burnout, including exhaustion, depression, and emotional numbness. For medical students and residents, the prevalence of burnout ranges from 45 to 60 percent.

Our caregivers are not just tired or stressed—they are experiencing “moral injury.” The term moral injury was coined in 2009 to describe how soldiers’ mental health suffered from having to act against their own moral compass in times of war. Dr. Simon G. Talbot and Dr. Wendy Dean applied this term to the healthcare setting to describe the “suffering, anguish, and loss” clinicians feel when they cannot deliver the care patients need in our profit-based healthcare system.

In our profit-based healthcare industry, billing is king, and clinicians bear the brunt of the busy work that’s required. According to an annual survey conducted by Medscape, an online medical news outlet, the most common contributor to moral injury is the absurd number of bureaucratic tasks healthcare workers now do. For example, a 2016 study found that physicians in four specialties spend about half of their work day filling out electronic medical records and paperwork. Family physicians spend another 1 to 2 hours at home after work doing coding and billing in the electronic medical record.

Another casualty of profit-driven healthcare is the time doctors get to spend with patients. More patients per day means more billing opportunities, and many clinicians are pressured to fit as many patients in their schedule as possible. The “15-minute visit” in primary care has become routine. Many physicians barely have time to listen to patients’ concerns before sending them for one test or another. This diminished time with patients gives doctors and nurses the feeling that they are mere cogs in a computerized system that cares little about people and their health problems.

This is not what most practitioners signed up for, and the mismatch between the ideals of medicine and the reality takes a high toll. Physicians in the U.S. have the highest suicide rate of any profession. That statistic may reflect the fact that physicians are stigmatized and sometimes punished for seeking mental healthcare.

Of course, the COVID-19 pandemic has reinforced the sense of purpose driving many medical professionals. But as they’re putting themselves in danger, and their mental health is suffering as they watch patients and even colleagues die. For many, including our friend in Queens and his colleagues, the crisis has already inflicted a devastating emotional impact.

In order to retain health professionals after this epidemic, we must do more than recognize their sacrifices, or address their current anger. We must answer their long-held concerns—and involve them in charting new policies and ways of keeping them healthy enough to tend the sick. Call it the GI Bill for Healthcare Professionals, if you will.

Some of these new policies should be financial. Nursing and medical students often leave school with thousands of dollars in debt, and the mental stress that accompanies it. Educational debt also adds pressure for doctors to choose a high-paying specialty rather than primary care and geriatrics, where the need for a larger workforce is most urgent. Steps can be taken to address that: Erase all health professionals’ school debt to help those already in the field. In addition, medical, nursing, and physician’s assistant training should be free for all low-income students, to encourage more people from disadvantaged neighborhoods and regions to pursue these necessary careers.

We also need to ease some of the burdens of daily work life. Electronic health records, as currently configured, are primarily tools for maximizing billing. Beyond the time required to fill them out, they create all kinds of headaches for doctors and nurses, who find them incredibly frustrating to use. These record systems need to be redesigned into one single, easy-to-use platform, with the primary purpose of improving care. A committee of healthcare workers should be the principal advisors in this endeavor.

We also need to adjust regulations to make it easier to deliver care to patients. In this state of emergency, the federal government has eased regulatory requirements to allow increased flexibility in where and how patients are treated. For example, Medicare is now paying clinicians for a wide range of telehealth services. We have heard from frontline clinicians that the reprieve from many regulatory and administrative burdens has reminded them of how much better it feels to devote time to caring for patients, rather than navigating paperwork and rules.

One primary care doctor told us that before COVID, she would have to see patients in person to determine that they did not need to see her for in-person visits. Now, she is encouraged to care for patients virtually whenever possible, without an unnecessary in-person visit beforehand. Common-sense policy changes like these should be made permanent if possible, with recommendations from healthcare workers helping to drive decisions.

Unfortunately, it isn’t enough to make health jobs easier and more patient-focused. After this pandemic, doctors, nurses, and other healthcare workers will need to recover from what they’ve recently experienced. Hospitals should expand access to counselors and other mental health services we need, and teaching hospitals must do the same for trainees. Health professional schools should follow the example of Weill Cornell Medicine in offering free mental health counseling for all students. Mental health services should be accompanied by safe and confidential screening services for depression, PTSD, and other mental health issues, to reduce barriers to access.

Finally, in the wake of COVID-19, the U.S. public health response to pandemics will have to be re-evaluated and overhauled. One priority must be to make sure healthcare workers are never forced to beg for masks and other basic protections again. To that end, we should establish a Clinician’s Affairs agency within the Department of Health and Human Services with representation from nurses and doctors. By putting clinician representation at HHS, and also at the Department of Homeland Security, it would position healthcare professionals to give direct input on national health and security policies.

For years, Americans have stood by as the healthcare system pushes our doctors and nurses to the breaking point. Now, our need for them is as great as it’s ever been, and we are pushing them further. World War II veterans got the GI Bill. Clinicians today deserve the same assurances. We need a Healthcare Professionals Bill that eases their educational debt and also includes them in redesigning multiple aspects of our broken system.

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