How much has 9/11 been on your mind the last month or so, and what is it like to have this long lead-up to what we assume will be the worst of it?
Tough question. I think many doctors are frustrated at the failure of testing that happened in this country. We were flying blind for too long and still feel quite hampered by it. It is frustrating when the country’s leadership, and the medical establishment over all, fail to deliver the resources—the bullets for your guns, so to speak—and you are flying blind, or flying with clinical criteria that are not clear. You are trying to do your best, but know you could do better if you had better data. That’s frustrating, and it’s scary, because you don’t know the invisible risk versus the measurable risk, and that makes a big difference. And I think that initially was very disconcerting to a lot of us.
That has become more defined and more manageable now, as we get our hands around it and see more patients. It sounds paradoxical, but you get more of a comfort level with it, and of saying, “O.K., this is what I need to do, and this is what the risk seems to be.” I find, personally, that I was more nervous before shifts than actually dealing with it. I have certainly seen a large number of patients with it now. I am sixty-three years old. I am in a risk group, something I try not to think about too much. I know the odds, and I know the data in other countries, but you make a rational choice, and you need to be there. When you are at close quarters, you start getting less scared and more focussed on the task. I know that sounds a little general, but I have been more scared by this than I was by 9/11.
Medical professionals seem like they have seen how bad this was going to get for weeks, so, I suppose, along with preparation time comes time for fear to build. On 9/11, it just happened.
Right. And I think on 9/11, again, we downplayed the risk subsequently. We survived 9/11 and we thought, “Oh, what’s a little smoke?” And that just shows you how badly you can miscalculate and how careful you have to be with all the factors as something this unprecedented unfolds.
Another difference here is that the patients you were treating on 9/11 weren’t at risk of giving you a disease. What is that difference like, and how much of your preparation is based around trying to prepare yourselves as well as your patients?
I think the key is to try to communicate to patients. Specifically, when people come and they look well and they want testing, and we tell them they don’t meet the criteria, and that everyone has a responsibility to protect the resources we have and the providers we have. So, in other words, me evaluating a twenty-three-year-old with normal vital signs who has a cough is actually potentially detrimental. It exposes me to COVID-19, and it does not do him any good if he is stable. And, so, trying to have patients help us deliver the interventions that are most needed to the people who need them most, while everybody else sort of stands aside and helps us not overload the system and select the patients who do truly need help, is critical.
And the contrast with 9/11 is that there was so much solidarity throughout the city and the country on 9/11. We were so together. And the disconcerting thing about this is that we have to be so apart, and I don’t know where that will take us. And it even applies to doctors and nurses and other providers—we have to be careful to not infect each other. It is a bizarre universe we are entering now.
Even if somewhat socially distanced, do you feel a sense of solidarity with other doctors and nurses?
You know, I think a week ago I would have been dubious. I wouldn’t have known how to answer that. For us, this is week two and a half, going on the third week, of seeing patients with this. And I think seeing other people be brave makes you brave. I have been taken out of my own head and my own fears as I watch colleagues, and especially nurses—God bless them, they spend more time with patients and more time at the bedside physically than we do—just showing unflinching bravery. You tell yourself, “Listen, buddy, if they can do it, you can do it,” and stop worrying. That solidarity is building. Obviously, if you really overwhelm the system, you could see it starting to crack, but we are not at that point yet. Right now, I think there is an amazing amount of mutual support and camaraderie.
And in terms of patients?
Some people do have severe anxiety, and it is very hard to talk them down without a test. They are just in a loop where they just think they are going to die, and they are imagining every symptom possible, and you are really trying to prove to them that they are okay. And I have had people very grateful for that. I think, for the patients who are sick, the good news is that the treatments and the way that treatments have been protocolized—so we know what they need given what stage of the illness they are at—means that there is a very high survival rate. With optimal care, and learning as fast as we are learning from both China and Italy, the mortality rate is quite low. Again, it is not zero, and it is tragic to lose anybody, but with excellent care and adequate resources the odds are very good.
Have you talked to doctors or medical professionals in other countries?
We were getting a lot of information from Italy. The Italians were fantastic in sending us personal communications or summaries of their experiences, even videos, and protocols they have adopted, and experiences and pitfalls and tips and very useful medical information. “Learn from our mistakes and learn from our victories” was really their message, so I give them a lot of credit.
Who are you looking to for advice and guidance right now?
I think, for me personally and my colleagues, the direction we are getting from our own hospital is excellent. It is updated twice a day. We are learning from our own experiences as we go. They synthesize different sources and combine it into something they can use.
And, on a personal note, and I hate to get political here, but I think the way that the messages have been politicized, and the way Trump deals with it, to be blunt—not letting the scientists simply have the platform and not have to worry about annoying him or contradicting him—is still very disturbing.
Are you still staying at home when you aren’t at work?
When I get off work, I change my clothes and shower carefully. I am here with my wife. We try to keep our distance, because I don’t want to infect her, obviously. It has been shown that health-care workers are vectors for their families. I am not self-quarantining. I am doing fine. I feel okay. I don’t have any social contact with friends. I go out jogging with a buddy and we are six feet away. You are trying to weigh the benefits of isolation versus loneliness. You need to keep your sanity.
