On COVID-19 (Coronavirus Disease 2019), caused by the SARS-CoV-2 virus.
For up to date information: https://www.cdc.gov/coronavirus/2019-ncov/summary.html
My friends, it’s been such a strange and surreal week.
I’m feeling so much more tense and agitated than I ever would have expected.
What keeps me really hopeful, though, is connection.
My colleagues and I have dug deep, cancelled our own spring break plans, and stood up in solidarity, ready to do what is needed to help one another take care of all of our patients.
Patients express empathy and patience for us their docs, which is so heartwarming.
They listen to my explanations for decisions to cancel gatherings and close schools. They understand when I describe what’s happening in Italy, and the difference between St. Louis and Philly during the 1918 Spanish flu pandemic.
Many are living the economic consequences of these decisions much more concretely and acutely than I, and their perspectives moderate my own.
I think the best thing we can all remember in the next several weeks is that we are all doing the best we can. We are all in it together.
It’s stressful and scary for everybody, and sometimes we will lose our cool.
Now is the perfect time to call forth our best efforts at calm, compassion, empathy, and forgiveness.
And then wash our hands.
I share below a compilation of the media pieces that have helped me most in my communication with patients, with the most salient quotes below each respective link. Maybe they will help you, too.
Onward.
“Some of the best epidemiologists in the world are estimating that between 40 and 70% of adults will end up getting an infection. Even if we begin with that low end of 40% of adults in Massachusetts, that’s 2 million people getting infected. If we take data from China that says 20% of people needed hospitalizations, that’s 400,000 hospitalizations. Even if we said ‘No, that’s too many, we can cut that in half,’ that’s 200,000 hospitalizations. At any given time in Massachusetts, we think there are [3,000 to] 4,000 hospital beds open at most … And so, if you start doing the numbers, you very quickly realize we do not have anywhere near capacity to take care of tens of thousands of people with [COVID-19] who might need hospitalization … But if we can spread that out over many, many, many months — ideally a year — then I think we have a shot of being able to take care of everybody who will need the care.”
How how does that happen, that it becomes spread out?
“So, what we know is that this idea that people talk about social distancing — this is why Harvard University today just canceled classes. In-person classes; we’re going online. In our offices, were now encouraging everybody to work remotely … Certainly all large gatherings should close.”
https://www.theatlantic.com/ideas/archive/2020/03/coronavirus-cancel-everything/607675/
When the influenza epidemic of 1918 infected a quarter of the U.S. population, killing hundreds of thousands nationally and millions across the globe, seemingly small choices made the difference between life and death.
As the disease was spreading, Wilmer Krusen, Philadelphia’s health commissioner, allowed a huge parade to take place on September 28; some 200,000 people marched. In the following days and weeks, the bodies piled up in the city’s morgues. By the end of the season, 12,000 residents had died.
In St. Louis, a public-health commissioner named Max Starkloff decided to shut the city down. Ignoring the objections of influential businessmen, he closed the city’s schools, bars, cinemas, and sporting events. Thanks to his bold and unpopular actions, the per capita fatality rate in St. Louis was half that of Philadelphia. (In total, roughly 1,700 people died from influenza in St Louis.)
In the coming days, thousands of people across the country will face the choice between becoming a Wilmer Krusen or a Max Starkloff.
In the moment, it will seem easier to follow Krusen’s example. For a few days, while none of your peers are taking the same steps, moving classes online or canceling campaign events will seem profoundly odd. People are going to get angry. You will be ridiculed as an extremist or an alarmist. But it is still the right thing to do.
When we engage in social distancing, it’s not so much that you don’t get infected yourself. The real advantage is that by removing yourself from circulation, you stop all the paths of this virus through you. You are doing a social service, you are helping the community. Employees who want to work from home [and are able to] can work from home.
Italy’s experience:
https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/
Two weeks ago, Italy had 322 confirmed cases of the coronavirus. At that point, doctors in the country’s hospitals could lavish significant attention on each stricken patient.
One week ago, Italy had 2,502 cases of the virus, which causes the disease known as COVID-19. At that point, doctors in the country’s hospitals could still perform the most lifesaving functions by artificially ventilating patients who experienced acute breathing difficulties.
Today, Italy has 10,149 cases of the coronavirus. There are now simply too many patients for each one of them to receive adequate care. Doctors and nurses are unable to tend to everybody. They lack machines to ventilate all those gasping for air.
Now the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines for the criteria that doctors and nurses should follow in these extraordinary circumstances. The document begins by likening the moral choices facing Italian doctors to the forms of wartime triage that are required in the field of “catastrophe medicine.” Instead of providing intensive care to all patients who need it, its authors suggest, it may become necessary to follow “the most widely shared criteria regarding distributive justice and the appropriate allocation of limited health resources.”
The principle they settle upon is utilitarian. “Informed by the principle of maximizing benefits for the largest number,” they suggest that “the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.”
On taking the larger, community-centered view:
Your losses are real. Your disappointments are real. Your hardships are real. I don’t mean to make light or to minimize the difficulty ahead for you, your family or community.
But this isn’t like other illnesses and we don’t get to act like it is. It’s more contagious, it’s more fatal—and most importantly, even if it can be managed. It can’t be managed at a massive scale—anywhere. We need this thing to move slowly enough for our collective national and worldwide medical systems to hold the very ill so that all of the very ill can get taken care of.
So what is our work? Yes, you need to wash your hands and stay home if you are sick. But the biggest work you can do is expand your heart and your mind to see yourself and see your family as part of a much bigger community that can have a massive—hugely massive—impact on the lives of other people.
You can help by canceling anything that requires a group gathering. You can help by not using the medical system unless it is urgent. You can help by staying home if you are sick. You can help by cooking or shopping or doing errands for a friend who needs to stay home. You can help by watching someone’s kid if they need to cover for someone else at work. You can help by ordering take-out from your local restaurants. Eat the food yourself or find someone who needs it. You can help by offering to help bring someone’s college student home or house out-of-town students if you have extra rooms. You can help by asking yourself, “What can I and my family do to help?” “What can we offer?” You can help by seeing yourself as part of something bigger than yourself.
Dr. Anthony Fauci on how to counsel patients, 13 min New England Journal of Medicine podcast with transcript:
Healing Through Connection 