Covid Missive May 30, 2020: Science and Hope

Hi, I’m here as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about Covid.

In the town next to us (Belmont, Massachusetts), a lot of houses have these beautiful maroon printed signs that read “HOPE” in big block capital letters and my heart swells every time I see one.

Things look better in Massachusetts. Yesterday we saw the number of hospitalized Covid-positive patients go below 2000 (half the peak) and the number of ICU patients fell below 500, the lowest since early April.

Thank you, Massachusetts. Your hospitals took care of a jillion Covid patients but because you stayed home it wasn’t two jillion. And because it’s wasn’t two jillion, we didn’t run out of staff or beds or ventilators. Staying at home saved lives.

It’s been a long, long eleven weeks of almost imaginable suffering. And the suffering continues, but at least now it’s with numbers that are more manageable, which gives me hope.

We all have our quarantine stories. Mine started when my department called an emergency faculty meeting for 3 pm Friday March 13 on something called “Zoom.” I have been at MGH for 27 years and I had never heard of an emergency faculty meeting.

But my first thought was not “Why an emergency faculty meeting?” It was instead, “What the heck is Zoom?” How naive I was! How naive we all were — we were such different people then. I keep wondering what we will be like in December.

Our bosses calmly told us MGH and Massachusetts experts had developed Covid prediction models that spelled catastrophe; and even though we only had around a hundred cases in Massachusetts we could not ignore the looming reality. We had to make radical changes in our hospitals and our lives or we would end up with critically ill patients suffocating in the halls of our hospitals with no place to put them, as was happening that very moment in Italy. They told us we were going to create, overnight, ways to protect our patients and our staff.

I remember I went home and dreamt I was sitting on a deck watching a tsunami come rolling in. I’ve had it multiple times since.

I work in a cancer clinic and I’m here to tell you: cancer doesn’t stop for Covid. We stayed fully functional and we never stopped treating, but that afternoon was the last day we had a normal clinic. By Monday March 16, 80% of our doctors were working from home, 90% of the operating rooms were closed, and 95% of our patient contact was via telemedicine. And on March 24, the governor’s stay-at-home advisory shut almost everything else down.

Massachusetts’s first Covid case was on Feb 1, a student returning from abroad. Then nothing. And then a handful of people come home from Europe and then the Biogen meeting Feb 26–28.

Looking at the numbers after that is like looking at a freight train coming straight at you, with every fortnight gathering force:

• March 2 we saw 2 cases
• March 16 there were 197
• March 20 we had the first death
• March 30 there were over 5,500 cases and 59 deaths
• April 14 there were more than 28,000 cases and 957 deaths
• April 28 there were over 58,000 cases and 3153 deaths
• Today, May 30, we’re at 96,000 cases and 6768 deaths.

The peak of ICU and hospitalization need lasted from April 20–30 and then things began, very slowly, to taper. We never surpassed our enhanced capacity. We always had (just barely) enough beds, staff, ventilators. We did this because with most people in Massachusetts staying home, the rate of transmission slowed down.

Now we’re reopening and many of us are going back out into the world. We know this will make the rate of transmission go up, but we’re hoping it won’t go up as terrifyingly fast as it did before. We are hoping the fact that we have more science-based knowledge now will help us.

Now I love science, but it’s critical to realize that science (no matter what your freshman biology teacher told you) is never a one-multiple-choice-answer-is-the-correct-one thing. It’s always evolving and without question some of our current ideas are going to change as the data accumulates in those 4000 Covid medical journal articles per week we are all pouring over.

So while it’s true we don’t know everything perfectly right now — that doesn’t mean we don’t know anything. We actually know a lot; we have learned way more about Covid and way faster than with any virus in history.

You know, when I was driving ambulance in 1980 in Oakland, CA no one knew what HIV/AIDS was — we only knew that gay guys were dying of weird infections. When I started medical school in 1983 scientists had figured out it was something they called AIDS but they still didn’t know what caused it. It took until 1984 to finally discover the actual HIV virus. Then it took until 1987 to do good needle-stick studies with good tests (by that time I was a fourth-year medical student and I experienced this first-hand and it is quite the story).

So it took the length of an entire medical school education to get from mystery disease to virus identification and transmission understanding and a decent test. And truly effective treatment was eight more years in coming.

With the Corona virus, on the other hand, scientists identified the virus in days and the whole entire genome was figured out in three weeks. And we quickly had virus tests and now have much better antibody tests and know a ton more than we did in March.

So even though we don’t know everything right now, we do have pretty good science saying we can reduce the rate of transmission by:

• hand-washing
• masking
• physically distancing
• being near people for short periods rather than prolonged
• being in well-ventilated areas
• trying not to touch our dang face!

What else are we pretty sure about science-wise?

• It’s increasingly clear that respiratory transmission is more important than getting it from inanimate objects. “It’s people, not property.”
• And people’s behavior matters: To paraphrase my fave facebook doc Dr. Jennifer L. Kasten: “Coughing or sneezing > singing > bellowing > normal speaking > breathing.“
• Hanging out with people who have been careful should be safer than hanging out with Uncle Maskless.
• It helps me to think about the fact that most people are not contagious at any given moment (remember last week’s 1/38 in Boston number).

Will any of this keep you or me completely safe? No, absolutely not. With any re-openings, we are going to have more cases, period. Once we leave our houses you and I will never be 100% safe, but we’re pretty sure we can we can lower the risk with the science we know so far.

I keep thinking about the Belmont “hope” signs. They’re so lovely; I keep meaning to get some for my house and my friends. But first I want to order a bunch of similar signs that are the exact same size and typeface and color, but instead of “HOPE” they’re going to have the word “SCIENCE.”

And then I’m going to give both signs to my friends and family to put in their yards or their windows. I already know how mine will be arranged — I can see it in my mind and in my dreams — with science front and center leading hope.