Hi, I’m back as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about-Covid.

(And it’s okay with me if you want to share.)

Today I’m going to talk about living with uncertainty and the slow lumbering pace of science.

Massachusetts continues to test a lot with low positivity rates — still just a bit over 1%. All the other metrics have been fine this month — very good news.

The college testing is also going well. 

  • BC has had 10 positive tests out of 15K (eight undergrads). 
  • Northeastern has 7 positive individuals out of almost 17,000 tests. 
  • Tufts has 4 out of nearly 10,000. 
  • And BU has 39 positives and they did over 28,000 tests

(These all have public dashboards if you love data.)

Plus, the latter three colleges have told their students they’ll suspend them if they go to any parties per state regulations. And Northeastern even created expedited disciplinary boards that will toss the kids out quickly.  With no tuition refunds!  I’m thrilled these schools are being so plain-spoken.  Smart schools, smart town. 

But let’s not have false expectations.  We need to remember there will absolutely be cases in all these places. 

We need to expect this and not see cases as a “failure” or a “sin” or an immediate reason to slam the gate shut. As long we test often and quarantine well and keep up the masking maybe we can prevent another forest fire of spread.  A number of summer camps in the Northeast did this — super strict and lots of testing — and they did fine.

Recently, parents in my area have made school decisions for their younger kids and some parents have started going back to the workplace.  We need to remember there will be cases among the schools and our offices, too, because wherever you have people together you will have cases.   

I haven’t said this in a while but I think it’s worth mentioning again: most not-at-risk people who get Covid don’t get super sick.  Around 40% have NO symptoms, another large chunk (25%) have very mild or short illness.  And less than 5% end up hospitalized. 

I am in no way trying to minimize (heaven forbid) but I think it’s important to remember that if you or your non-elderly, not-chronically-ill loved ones get Covid this fall, chances are it will not be life-altering. 

But at the schools and the colleges and the workplaces, the questions of who should stay home when feeling unwell, who gets tested, who get quarantined, for how long — the devil is in the details and the details, many of them, are still surrounded by uncertainty.

And we hate uncertainty. We want to be able to confidently predict the future and we want to be able to confidently talk to our kids as well. Kids need certainty, right?

Well, one mom I know has given up on the certainty paradigm.  She told her kids that living in uncertainty is now their “super power.”  She calls her kids (who love Doctor Who) “Doctor DWU” which stands for “Dealing With Uncertainty.” 

Whenever she encounters something uncertain — like if school is going to be in session —  she says,  “Let’s show our super power. We have no idea if you’re going to school next week so it’s time to be Doctor DWU!”  And she and the kids fly around the room in mini trench coats pretending to be Dr DWUs. I think we should build them a blue phone booth.

Why all the uncertainty?  Because we are watching science in action, laboriously making its way to the truth.  It’s full of two-steps-forward-one-step-back. 

It’s lousy declarations (hydroxychloroquine) getting disproven and then tossed aside to make room for good studies (steroids).  It’s a reasonable hypothesis (convalescent plasma might help) being hampered by inadequate study set-up (no randomization or controlling for conditions). It’s mis-statements in headlines (little kids are huge spreaders) getting seared into public consciousness (actually, they don’t seem to be as involved in transmission as teens and young adults).

It can be sooooooooo painful (and confusing!) watching this sausage get made.

But this has always been so. If you look back at the early days of every disease ever studied, it is never a straight shot; there are always zigs and zags up unproductive alleys and down false paths. I have a very clear memory of my very smart UCLA professor standing at a podium saying with all the confidence in the world, “I’m convinced AIDS is caused by poppers” (a form of amyl nitrate). It was the early 80s and soon we learned he was completely wrong. 

Scientists and doctors live in a world of uncertainty, of grey, and the smart ones admit it straight up. Things are unknown, undiscovered, unclear, and then facts gradually emerge out of the mist. 

And we’ve done a lot! Here’s where we stand in Our Disease Knowledge Checklist:

  • Physicians see a sick person and then one more and then a bunch more and then an illness is identified.  (Check!)
  • Gradually, you find the bug that caused the illness.  (Check, and very fast work!)
  • Gradually, you learn the bug’s anatomy, how it functions, its genes. (Check!)
  • You learn who it hits first, or worst, or not at all.  (Check!)
  • You learn how to test for it (Check, check, but rapid testing needs more work)
  • You learn how it spreads (Partial credit; need more work on aerosols)
  • You learn how to prevent it from spreading eg masks & hygiene (Check)
  • You learn what medicines work and what aren’t safe (Partial credit)
  • You learn what medicines work when, and on whom (Some progress, needs more work)
  • You learn what aftermaths may happen (Needs more time)
  • You learn how to prevent it at all, eg vaccine (Needs more work)

All of this has emerged from that first sick person. Every sick person after that became a teacher. Every lab test, every lab experiment, every medical journal article, every person enrolled in a vaccine trial, we learn. And slowly the grey uncertainty recedes. 

The other thing science needs is the passage of time.

For instance, these people who apparently got re-infected. We can’t know a lot about them because we haven’t watched them for very long. It’s certainly very reassuring that the numbers of reinfections so far are tiny.  It’s certainly very reassuring that it’s looking like their immune systems are doing a good job at keeping them from getting super sick the second time and the immune response is working like with some other viruses.  It’s certainly very reassuring that so far the issue of reinfection isn’t a huge one (25 million cases and just these few documented cases of reinfection) so these cases aren’t a game-changer as of yet.   

But all the big-ticket questions — are people contagious the second time, what do antibodies tell us or not tell us, do we have to change our behavior — all those questions are going to take some time to figure out.

Meanwhile we use the long list of knowledge we have already accumulated (check/check/check) to protect ourselves and our loved ones the best we can: physically distancing, masking, hand-washing.  We adjust our behavior based on the facts as we know them today, reminding the kids and ourselves it may well change next week because, hey, that’s science. 

And if all else fails, we throw on a trench coat and pretend we’re Doctor DWU.