On the COVID Front Lines, The New Dystopian Era of our World

**Published first on Dr. Wood’s prior blog, Mod Med on May 12, 2020.

———

This virus, for its impact on our health as well as our livelihood, is not one that is forgiving. For most—a mild cough. For those whom the virus has fully taken hold of — sedation, intubation, and death.

We don’t know how to prevent it. We don’t know how to cure it. We can only hope to manage its complications until our patients can recover on their own or until death wins.

In a crisis, the good and the bad of human nature is intensified. There are those that come together to help a neighbor out. And there are also those that take advantage of the rapidly changing societal norms—to get a paper published whether its conclusions are sound or not. To achieve the glory of having your name in print. To push political agendas on a global scale.

And with this— the constantly shifting data is reporting a virus only slightly deadlier than the flu. In New York City and its surrounding areas, those of us on the front lines are seeing a slightly different narrative. Our average of 3 intubated patients with the flu has turned into 60 intubated with COVID—requiring operating rooms, dialysis units, and other floors to be turned into make-shift ICUs. Individual rooms are foregone and patients are lined up, sedated and hooked up to machines that will be breathing for them from now on. When new patients arrive, they are shuttled down the line of humans hooked up to machines and their cries are piercing as they see what their bodies will look like for the next few weeks— or potentially until death.

The Data

Our medical management changes daily as we agonize over which papers have clinically significant data. We haven’t run out of ventilators, but we are short on dialysis machines and other critical medical equipment. Those that aren’t dying of respiratory failure start to die of renal failure. What is ethical and what is not is constantly put into question as we designate a single person, usually me (the resident at the bottom of the totem pole, the “most expendable,” as I was told) to perform CPR on these intubated patients, with plastic bags over their heads as if they were already preparing to be put in a body bag. It’s morbid. It’s scary. But we are doing our best to maintain our physician’s oath to first, do no harm.

We are trudging through the trenches trying to navigate this newfound era of limited medical supplies and knowledge. We question everything and constantly keep an open mind, changing our management daily to try to prevent the virus from taking someone’s last breath away.

What are the consequences?

While we are fighting for our patient’s lives in the hospital, the world is rapidly changing around us—but per usual the hours we spend in the hospital leave us no time to fight what is appearing to be even scarier than the virus itself.  We see how quickly the virus can take someone’s life and spread—there is no denying that. As public and global health advocates, we need to find a better way to prevent this. For the time being, social isolation is the solution, but it cannot be a permanent one. We can’t create a world that lives in constant fear of going outside or speaking with another fellow human. This panic that has risen out of government mandated lock down has turned the public into what the DSM would classify as social anxiety disorder, a disease that we are taught to treat, not perpetuate.

We’ve seen the seemingly good side effects of social isolation: decreased carbon emissions secondary to less overall commutes. Less chances for unwanted touches by strangers in this era of ‘Me Too.’ Universities have admitted they can provide just as effective education without the need of a physical classroom (whether this proves to be true or not is still unclear).

But is this sustainable? And if so, at what cost?

We have cheapened the need to find real sustainable solutions to those problems that social distancing has seemingly resolved. We have fast forwarded into a dystopian endgame— and as these days in social isolation pass, it seems less and less likely that we will turn things in a different direction.

We’ve allowed the government to dictate who can go to work and who cannot. We’ve allowed big brother like surveillance, arresting people for merely going on a walk outside. As a physician my clinical judgment is stripped from me as I stand in a long line waiting to be screened for symptoms of COVID before entering the hospital to keep those alive that COVID has taken away their ability to breath.

We’ve certainly entered a new era of medicine and a new era of how we interact with people and keep society afloat. Will we come out of this on top?