America: The No-Fly Hot Zone

By

Leonard Zwelling

         MD Anderson has cancelled all business travel—period. No international travel or domestic travel will be sponsored by MD Anderson for the foreseeable future. This, of course, keeps all the faculty away from the AACR and ASCO meetings in the spring, although I suspect these meetings will be cancelled any day now, as will many sporting and other public events. There were quite a few empty seats at the Rockets game last night. The NCAA Men’s Basketball Tournament—March Madness—may well be played in front of crowd less arenas. Such is the national response to the coronavirus and it is a wise response, indeed.

         There are simply too many unknowns about this virus that will remain unknown until widespread testing becomes available and the true prevalence of the virus is learned and the incidence of the covid-19 disease along with its rate of fatality is clarified.

         We simply do not know the incubation period. We do not know how many people harbor the virus, or are contagious, yet are asymptomatic. Without knowing the degree of the virus’ penetrance into the population, the number of cases resulting in true illness is unknown as is the true lethality of the illness which may be far less than the 2% estimated at present. If large numbers of people have the virus, are not sick, but are contagious, that puts a whole different spin on things.

         So was MD Anderson (and Columbia and Mass General) wise to cancel all travel? You bet. Putting the faculty, especially the clinical faculty, at risk for contracting the illness and returning with it to Houston would be foolish. It would endanger the patients of Anderson in two ways. It could knock out the caregivers so needed by so many and also set up immunosuppressed patients for infection just by exposure to carriers of coronavirus. Discretion was the better part of valor here and the leadership of Anderson should be lauded for making a tough decision ahead of the likely decisions from AACR and ASCO. Meetings have been cancelled before (SARS) and may be again, but getting as far out front as possible was a judicious step for the Anderson leadership and the faculty ought to consider limiting their own personal travel as well. Anderson has also cancelled all local meetings of greater than 25 people. Not a bad idea either.

         We simply do not yet know enough about this apparently new virus. Given our lack of knowledge, caution is advised.

         That being said, MD Anderson is also positioned to help patients who can be cared for nearer to their own homes at sites outside of Texas and, of course, telemedicine was made for outbreaks such as this.

         We live in strange times. The globalization of commerce and science makes every meeting an international one. It also means the world is more interconnected, but that also means an infectious disease can spread more readily, especially one that seems to be contagious in the asymptomatic host. In such a situation, the need to interact face-to-face may have to take a back seat to the use of Skype and other electronic means of communication.

         This will also mean that cruise ships may have to stay in port and vacations at sea must be cancelled. You have to be crazy to get on a boat that is the USS Petri Dish. One positive test and everyone will be quarantined because it is still unclear what a negative test means in a person who was exposed to another person who tests positive. How long does it take to seroconvert?

         Major gatherings will undoubtedly be cancelled soon and the Tokyo Olympics may be only available for view on TV. The political conventions may have to be held on Facebook, a move in the right direction, but a devastating blow to the makers of red, white and blue boater hats and balloons.

         My guess is that this will all sort out soon enough. The incidence of the disease itself may drop in the summer. It is anyone’s guess if it will re-emerge in the fall. For the near term, we will all have to stay close to home and six feet apart. It’s not for ever, but it is for now.

         How we respond will be a measure of who we are. If we collectively address the threat of a new infectious disease, care for the ill, and take precautions ourselves, I think we will be OK. If we carelessly get on cruise ships, take unnecessary airplane rides, or crowd into 50,000 seat arenas, then we will not be judged as having handled this prudently. Wisdom must prevail. We will see if the Trump Administration has that wisdom. The Pisters Administration clearly does.

Leonard Zwelling