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 talking about taking the long view on vaccines and coping with the long view.

Our situation in Massachusetts has been less stable.  Any uptick in our numbers gets us incredibly concerned, and sure enough, after our positive testing rates ticked up to 2.2%, Governor Baker responded by rolling back some of our reopening rules. This has worked in other parts of the country so hopefully will work here, too.

In the meantime the big colleges have huge testing and quarantining programs planned for the kids they let in (most small schools remote only, only seniors on campus at MIT, only freshman at Harvard; at Northeastern the campus kids will be tested Days 1, 3, and 5 after arrival with quarantines until two negative tests) with twice-weekly testing at most places. 

These are good moves and it is encouraging to live in a place where the decisions are data-driven.  Our positive testing rate today is 1.8% — compared to NYC of 0.9% (yay!) and Texas close to 20% (ugggh).

A while back I wrote, “My feeds have been full of itchiness to know when this is going to be over … the agonized waiting that comes from being in the middle…” 

I wrote that on April 11!  Oh, the INNOCENCE!

Right now the waiting seems to be driving many people bonkers.

I think one of the things happening right now is that we are slowly coming to realize everything Covid is good news/bad news.  The good news is the science.  The bad news is the dawning realization that This Is Not Going Away Overnight. 

At this point, no matter how much we wish this over with, I would say most scientists don’t think it will be controlled in 2020.  They aren’t even sure about 2021.

Tons of science will take place between now and then — just like tons of science happened between January and now.  The virus’ genetic code was cracked in under two weeks, and six days later they started working on a vaccine.  Three promising vaccines are already recruiting volunteers (https://www.coronaviruspreventionnetwork.org) and two more will probably follow and then more after that. Science has done amazing things with Covid, faster than ever in history.

So the good news is there are vaccine trials in the offing. The bad news is that getting ourselves protected by a vaccine is still a long ways off, during which the Covid suffering amongst patients and health care workers will continue and all our self-protections (masks, physical distancing, hand washing) will remain part of our lives.

Why is it a long ways off? Because there’s a whole bunch of steps between finding an apparently effective vaccine and running down to your doctor’s office to get the shot. 

First and foremost, you have to prove it’s safe and the side effects are acceptable, not just in the hundreds of people who were the first brave guinea pigs during the Phase 1 trials (general safety) and Phase 2 trials (dosage and effectiveness), but then in the thousands of people who will take part in the Phase 3 vaccine trials —  and not just in young healthy people but in older people and people with various medical conditions.

Then you have to mass produce it (and that means getting access to chemicals, and glass tubes, and the gazillion little things involved in manufacturing a complicated product) and test and distribute and set up vaccine centers and create a bunch of reporting and administering systems. 

And then the country has to decide who gets the vaccine first. Older people?  Health care workers?  Poor people? The immunosuppressed?  And then see how it works. Is it like a tetanus shot, where once you get the shot you will never get tetanus?  Or will it work like a flu shot — where you diminish the number of cases, yes, but mostly you lessen the severity and death rate of a caught-anyway flu?

And then scientists need to find out if we need a “booster” shot like we need with most vaccines. 

And then see if vaccine-skeptical people will take it.

So vaccines are going to help us, no doubt. But. 

  • Will vaccines be ready in 2020?  Hard to imagine.
  • Will vaccines be ready by the winter semester?  Maybe yes but maybe not in a broad way.
  • Will vaccines change our lives in 2021?  Quite possibly.
  • Will vaccines improve our lives in 2022? Most probably.

Whenever it happens, it remains clear that although This Is Not Going Away Overnight, eventually science, with its blistering pace and falters and good news and setbacks, will get us through this.

For so many months people have been told or have been thinking, “I’ll do so-and-so (have my wedding/see my mom/go back to the gym) when there’s a vaccine,” or “The schools won’t be a worry when there’s a vaccine” or “We’ll get our lives back when there’s a vaccine.”  How do we live with the reality that This Is Not Going to Happen Overnight?

When we have a short-term crisis we use short-term coping mechanisms, often whatever is at hand.  For some people that’s red wine, or Ben and Jerry’s, or becoming a Sourdough King, or watching Tiger King, or burying one’s head in the sand.

But how do we cope with this long term?

Everything I know about coping I’ve learned from my cancer patients. One of the things they’ve taught me is there’s all kinds of ways to carry on through calamity. 

The 45-year-old woman with her second breast cancer who says, “It’s not a sprint, it’s a marathon.”  The grizzled old guy with his lung cancer who says, “It’s like my tours of Vietnam.  I’ve done it once; I can do it again.”  The elderly woman who tells me the lessons she learned watching her mother go through her own cancer: “I always have something to do with my hands and I get through one day at a time.”  The Buddhist monk who said, “Life is suffering.  Just enough.” 

This is what I have learned in the cancer clinic: that everybody invariably finds their ways to cope with catastrophe. It’s what we are designed to do. 

For me the coping varies on how I see this.  Sometimes I feel like we’re in a post-Katrina landscape and it is crazy to expect anything to be close to normal.  Sometimes it feels like a war so of course the losses are legion.  And sometimes I liken it to a cancer diagnosis and I remember the wisdom of my patients.

The bad news is we’re in this war/hurricane/cancer we never signed up for and it is Not Going Away Overnight.  The good news is we will all find ways to adapt — just like the war veterans and Katrina survivors and cancer patients before us — and that science in the end will see us home.