The following is the opinion and analysis of the writer.
The patient I treated on Feb. 5 may have been infected with the novel coronavirus.
On one hand, it seems impossible: The first confirmed case in the United States was in Washington state, only two weeks before. On Jan. 21, a man in his 30s came down with symptoms there after a trip to Wuhan, China. It wasn’t until Feb. 11, about a week after my patient’s hospitalization, that the disease caused by the virus got its name: COVID-19.
On the other hand, it is entirely possible there were undiagnosed cases of COVID-19 in Tucson in February (though probably not that early). We have an airport. The patient had traveled in China. But we didn’t have sufficient testing then to know, and we still don’t. Though it is getting better.
As I spent hours helping a colleague care for the patient, four thoughts formed in the back of my brain while we tried in vain to order a test from the Centers for Disease Control and Prevention (CDC).
First, we were headed toward a pandemic. On March 11, the World Health Organization made it official.
Second, everyone in our hospital would need to take extra precautions – to protect ourselves and our patients.
Third, politics would be a factor in who gets access to a test and who doesn’t. I don’t mean “Big P” politics, like partisan politics. But “little p” politics: what are the rules for access to a test, who wrote them, and how loosely or strictly are they interpreted.
Fourth, there would be many, many long nights ahead. Many, many anxious patients. Many, many tough questions, unanswered questions, and sometimes tough-to-swallow answers.
As I sit here to write 12 weeks later, it occurs to me I didn’t know what those questions or answers were back then, just that there would be a lot to grapple with.
I have personally seen dozens of COVID patients since then, and the grappling hasn’t stopped. In fact, our earliest questions — What is it? What are the symptoms? — are giving way to tougher ones.
I’ll start by saying the toughest question I get — that any doctor gets — is from a spouse or a child who wants to know if their loved one will make it. I have practiced for 17 years, and I have learned that the right mix of honesty, hope and hard work is what I have to offer. But a mask that covers most of your face doesn’t let your bedside manner shine through.
Here are some other tough questions.
For me and the doctors and nurses I work with, we have had the amazing fortune to have the personal protective equipment – so-called PPE – to safely do our work. But what about adequate PPE for the nursing home staff in our community, the home health aides, and the family caregivers? I worry a lot for them, and more than a few have turned into patients themselves.
What do you do when you still don’t have adequate testing, and what are the implications for reopening schools, workplaces, and houses of worship? Not to mention stadiums, wedding venues, graduation events and polling places.
I don’t mean only testing for the disease itself, but also “antibody testing” — ideally, an accurate and reliable test that would let us know who has built up some immunity. The studies so far suggest that most of us haven’t been exposed to coronavirus yet, so we cannot have immunity.
Then there’s the question that stumps us all: How do you guess the next move of an opponent you’ve never fought before and have very little information about?
Many people talk of a “second wave” and a virus that’s “here to stay.” The top public health officials on the planet don’t know the answer to this question, and unfortunately, I can’t improve on the advice my mom used to give me: “Do the right thing: it isn’t always easy, but it sure beats the alternative.”
True, it isn’t easy to wear masks, wash up often, limit gatherings, practice physical distancing and the like. But until we have a vaccine, putting up those defenses sure beats the alternative.
Research shows that nearly 80% of those who catch the virus get it from someone without symptoms. That fact, paired with our desire to return to normal, could leave us vulnerable to a false sense of security. It’s not just a physical chore to keep complying with all the guidelines and rules, but a mental chore, too.
There’s a likelihood the patient I saw on Feb. 5 wasn’t a COVID patient. But he helped me start to think about all the COVID patients to come that now arrive at the hospital with gloomy regularity.
I am learning every day about this virus, how my patients experience this disease, and my health-care colleagues’ tenacity. But I am also learning about our community through the care and concern we’re showing each other.
It’s a two-front war against coronavirus and its mental toll on us, but I am more hopeful than ever that we have the grit and ingenuity to see our way to better days.
Matthew G. Heinz, MD, is a hospitalist at Tucson Medical Center. He’s also the former Director of Provider Outreach at the U.S. Department of Health and Human Services during the Obama administration. Dr. Heinz assisted in the domestic response to the Ebola crisis. He is running for the Pima County Board of Supervisors in District 2.
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