Doing No Harm as We Reopen: Factual Covid 19 Missive 6/14/20

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The scene of the crime per NEJM

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

I’m going to write about two things today: Health care reopenings and personal reopenings.

Massachusetts’ Covid numbers continue to improve. As we now say in the trade, “All our ‘metrics’ are good.”

At the start of all this we were looking at daily “data points” — how many cases that day, how many deaths — and for all of March and April those numbers went up. Throughout May they were staying the same and then gradually inching down.

Now that the “data points” are steadily decreasing, we have started looking at “metrics” like “three-day-average of deaths” and “seven-day weighted average of positive tests” and “numbers of hospitals at capacity” to get a better idea about trends.

In Massachusetts, we are reopening because the curves for the metrics keep going down. It’s gradual — the curves look like bunny slopes — but day by day, even with Reopening Phase 1, even with the protests, in Massachusetts the metrics are going down.

Not so much for a number of other states — 14 as of today — which opened earlier than we did and now have steadily worsening metrics. Some states, like Arizona, look like they’re heading for our March/April nightmare, maybe getting close to capacity, everybody’s worst fear.

We don’t have the science yet to know if the increases in other states are due to relaxation of social distancing rules or Memorial Day gatherings or what. It takes several weeks to see an increase in cases, and as much as six weeks to start to see more deaths, so we won’t know for a while. But these increases are terribly unsettling, and are a reminder that Covid isn’t over, and how we are still living with all kinds of uncertainty about what is going to happen next.

But in a huge, heart-widening development that shows how much better things are in Massachusetts, this week our hospitals started letting visitors back in — limited, and with strict rules — but in. So that horrendous moment of dropping a loved one off at the ER and not being able to stay, or even, in some cases, never seeing them again — that part is over.

And all over the state, hospitals and offices are reopening to patients as we move back to our regular jobs of taking care of regular people.

But one of the biggest rules they try and teach us in med school is “Do No Harm” (“primum non nocere” if you want to get fancy). We couldn’t reopen to patients until we were sure we’d maximized the chances nobody would get hurt by coming in. So we changed up a lot of things.

It’s probably going to look a lot different the next time you go to a clinic or hospital. Some places will ask you to sit in your car until your appointment (“waiting car” instead of “waiting room”). You will get routinely asked about any Covid exposures or tests or symptoms every time you go in.

{While we’re at it, let’s go over the symptoms:

cough

shortness of breath

fever (sometimes)

loss of smell (amazingly common and if this happens it’s quite likely you have Covid)

fatigue

muscle aches

diarrhea/nausea (we see this a lot more in the US than in China)

funny bruises on toes

occasionally sore throat

(usually not stuffy or runny nose)}

From now on, every time you walk into a clinic you’ll be handed a mask and asked to wash your hands. Some reception desks will have plexiglass or an “X” on the floor showing you how to stay a safe distance away. Everybody will stand far away from you, a good solid six feet, and when a health care worker comes close to you (eg to look in ears, listen to your heart) it will be for as short a time as possible.

So that’s how healthcare is responding to reopening — they’re using the science to try to Do No Harm:

asking people if they could be sick or exposed

hand washing

masking

physical distancing

being near people for a short amount of time

and keeping an eye on the “metrics”

These “Do No Harm” techniques are how we need to handle our own personals reopenings, too.

As soon as Massachusetts breathed a word of “reopenings,” boom, everybody’s out there, and this week, wow! It’s full-on summer after a brutal winter and so: more traffic, more full parking lots, there’s this pent-up demand for TJ Maxx and food-somebody-else-has-cooked and Costco and cook-outs.

But as a friend of mine says, “We are so tired of this virus. But the virus isn’t going to get tired.”

We are in the same danger from the virus as we were four months ago, but at least now we have some science about protection. “Home is safer” but if you decide you really need to go to a store or a restaurant, you should “Do No Harm” and follow the science by concentrating on:

asking your people if they could be sick or exposed

hand washing

masking

physical distancing

being near strangers for a short amount of time

and keeping an eye on the “metrics”

As we reopen, we need to remind ourselves about the “whys.”

Why did we do stay-at-home and severe social distancing? Because we were trying to save the hospitals from being overrun and save our health care workers from PPE-less exposure and having to ration care.


Why are we masking etc as we reopen at work and in public? We wear masks and stay physical distanced to protect ourselves from getting Covid. We also do it to keep our unknowingly infected selves from GIVING Covid to people. We do it because no matter the hassle of mask-wearing or physically distancing, all of us who are fundamentally good people will always want to Do No Harm.

Lately I’ve been keeping a list of Golden Moments of the Pandemic (GMPs) — lovely little things that would have never happened except that we happen to be in the middle of a life-changing global pandemic. High among my GMPs is the unexpected opportunity to take walks with neighbors I might or might not have spent time with without Covid.

Yesterday I walked with an unbelievably smart middle school girl. She told me she had realized something the week before. She said, “Since I don’t have my teachers and coaches around much and don’t spend nearly as much time with friends, pretty much all outside influences on me are gone except my family. So what is happening is that the pandemic is revealing to me who I really truly am, who I am away all those influences, who my deepest true self is.”

Here’s to all our Truest Deepest Selves. And here’s to always trying to Do No Harm.

Radiation Oncologist at Massachusetts General Hospital/Emerson Hospital. Writer. Teller. Mom. Currently Covid-Obsessed. www.DrRobin.org, @robinshome

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