Hi my dearest dears I’m back as Robin-the-Boston-cancer-doctor-writing-about-Covid.
{Incidentally: Thank you for reading such a long post! And yes you can absolutely share this with my name attached}
Here are the mind-numbing COVID-19 numbers from Massachusetts:
A thousand more deaths since last week (now 3700)
Ten thousand more cases (now 64,000)
Sixty thousand more tests (now 290,000)
BUT: One hundred FEWER people in the ICU (was 1050, now 950).
Are we past “ICU peak”? Yes! Yay! This is a cause for celebration! We did “flatten the curve” and we really are not going to have to use a scoring system to decide who gets a chance at a ventilator. Small but tender mercies.
But are we “past peak”? No, unfortunately. We’re not past peak for the number of cases (going up by 1700/day) or hospitalized (consistently around 3800 patients).
This means we can’t abandon social distancing yet. This means there’s still hundreds of people who are just incredibly critically ill, with the virus attacking lungs and hearts and kidneys and even the brains of these so-so-sick people. And the loneliness! All these patients who maybe if they’re lucky get to “talk” with family via FaceTime on an IPad looped onto an IV pole. And the loneliness of the helpless medical and nursing staff standing outside their door with few tools, no treatments, no drugs that look like cures or even close.
Yes, there were lots of press releases and a journal article about the anti-viral medication Remdesivir. Yes, it maybe shortens the illness, and that is certainly a helpful thing but it certainly isn’t a cure.
We have to be very careful about news reports on drugs. We are “building the plane while we’re flying it.” We want to believe in something — we want to believe in anything! (Vitamin C! Aspirin! Zinc! Malaria pills! We’ll try anything!).
But the fact is, viruses are devilishly difficult to cure — we haven’t even cured the common cold! Not to mention HIV. We’ll need multiple clinical trials (and fewer press releases) to have a prayer of finding a cure.
Bless all the doctors and nurses who “hear somebody coughing and walk towards them” and run clinical trials at the same time. These heroes and their science will be our salvation.
But ERs and ICUs were already super hard places to work and now they are the stuff of end-of-the-world novels. It is terrible to know people in your care are going to die alone and there is not a thing you can do about it but bear witness. It is devastating to stand by helplessly, shift after shift. It is awful to be constantly afraid — every night when you come home — that you will infect your own family.
The toll is huge. You probably heard about Dr Lorna Breen, the New York ER doc who reportedly died by suicide, or the EMT John Mondello who did the same in Queens. My bet is that we’ll hear more of these stories because things are going to stay emotionally and physically dreadful in hospitals for weeks and months.
And now the financial part is hitting medical workers just like every other industry. The cost of taking care of a thousand ICU patients and retraining and PPE and stopping all the elective surgeries and office visits and all that is HUGE. MGH estimates they’re losing $5 million dollars a day.
Many Boston docs and health care workers started getting notifications a month ago about 20% pay cuts or mandatory days off without pay. This was when PPE/masks was a major issue, so can you imagine: “Here, go into that ER with 25 coughing patients who may have Covid; here’s your flimsy mask, and oh by the way your paycheck next week will be smaller.”
Ugghh.
And for all of us: we can already feel our own “physical distancing fatigue,” especially in this May weather, especially if we are frantic about money or if we’re home with at-home monsters, inner and outer; especially with such profound uncertainty about what next month or next fall is going to look like.
There’s so much we have to take on faith. Faith that all events are finite, faith that the tsunami will recede, faith that much that has been taken away will someday be restored.
My faith lies with the science and the numbers. Science is my co-pilot.
Science told us we had to flatten the curve and that we had to say home, and it worked: we didn’t overwhelm the hospital system. We have an economy in tatters and some shaky health care workers but we didn’t have Katrina-like nightmares of people lying on gurneys in hallways while we had to choose who lived and who died. So that part worked.
Science is now telling us we need to reopen only when the numbers make sense: when the cases decline over 14 days, when there’s plenty of rapid-fire testing kits for patients and heath care workers alike and enough tracers to find the positive patients and tell their contacts to quarantine, when enough hospitals have enough empty beds for non-COVID patients and have enough staff with enough PPE to handle another surge.
So we need to wait for these numbers and that is going to take a while.
How long, everybody wants to know. Simple answer: longer than we want.
All day long I talk to cancer patients, almost all of whom have been fiercely self-isolating since date of diagnosis: cancer and other serious illnesses have a way of making things black and white.
They mostly all seem to have moved from the “acute” crisis where we were at the tip-top-top point of the anxiety scale, following every tweet and CNN ticker tape and rumor and press conference. They’ve learned they just can’t do that anymore (especially right before bed!). And they’ve gone through the disbelief, the numbness, the take-me-away-Cabernet stage but they mostly don’t do that anymore either (at least not just after breakfast). They actually are mostly quite settled in their homes: nobody out except for chemo, nobody in except for visiting nurses; chemo and radiation and coping and groceries and child-time and that’s it.
I asked one lovely woman last week how she managed to be such a beacon of peace amongst all this craziness. She said, “I just don’t get my heart set on too much.”
That has stayed with me ever since.
Science and numbers and heart-set are what are going to get us through this next phase.
That and YouTube videos like this one with its reminder of the global interconnectedness of our actions and our goals and the total awesomeness of our front-line workers: https://www.youtube.com/watch?v=7LcLqIHzNkY&feature=youtu.be