Getting Back

By

Leonard Zwelling

         I just got an email message from my new concierge doctor. He writes that the likelihood of me contracting covid-19 is small and that none of his patients have thus far come down with the viral illness. He urges those of us in his practice to continue to wear masks, practice social distancing, and wash our hands frequently. In other words, he is urging good sense and care as we try to come to grips with a world that has changed dramatically over the last few months, but is trying to get back to business in some fashion.

         What his note reflects is two realities. First, the novel coronavirus that emerged from Wuhan, China will be with us for the foreseeable future. This will be true even if a miracle treatment is found and surely until a deployable, effective vaccine is developed. Second, the world needs to get back to business again. It will not be business as usual. I personally do not see going to a concert, sporting event, or convention any time soon. I am still reticent to get on an airplane and I am not rushing to dine in a restaurant, even though many are now open and serving clientele. This is reality. I am in the high-risk age group. I choose not to tempt fate for a high-priced plate of pasta.

         What is the reality of academic medicine?

         At centers like MD Anderson, so dependent on patient flow from places outside of Houston, it is likely that patient volumes will remain low until people feel comfortable getting back on planes. Hopefully, the restrictions on in-patient numbers will be relieved and at least necessary local admissions and “elective” cancer surgery can resume, even if that too is mostly for local patients.

         I have recently learned that most of the staff of Anderson currently working from home is expected to stay there for the next two months. This would include much of the administrative and research staff of the cancer center. It will be difficult to ramp up vital research from kitchen tables.

         Note was taken in the Wall Street Journal today (May 5) of this precise issue.

https://www.wsj.com/articles/medical-research-is-locked-down-too-11588629492?mod=searchresults&page=1&pos=1

         This piece by Dr. Kevin Sheth of Yale notes the need to get research back up again, especially clinical trials, many of which have been halted as support staffs have been sent home and the interpersonal proximity needed for good clinical research was deemed too risky. For patients with serious ailments whose only hope may be clinical trials, the risk is not doing the research. And by the way cancer cannot wait for a coronavirus vaccine, nor can cancer surgery and out-patient visits let alone cell therapy and radiation.

         I am pretty sure that we have a sufficient bead on the coronavirus to know several key things.

         Yes, it is highly contagious and is transferred from person-to-person.

         Yes, masks can help minimize this risk and it may well be that more disease is being transmitted within households than outside of them.

         Yes, biomedical research is a key component of the academic mission of most medical centers and it cannot be done from home. We are giving up a great deal keeping large swaths of investigators and technical personnel at home. How wise is that?

         Yes, there are ways to work shifts, sanitize work spaces, and even meet in person to advance the cause of science. After all, the solution to the coronavirus problem may rest in a discovery from a lab that does cancer research so shutting all those labs down makes no sense.

         There must be a way to continue the educational missions of academic centers as well. Much learning cannot take place at a distance. Surely this is true of learning clinical medicine, but is also true of performing research.

         Getting back will take some innovation. We will not be going back to the pre-corona world. Our behaviors must change and the way we do business will as well. However, that does not make the academic missions of clinical care, research, and education less important than they were two months ago. Their pursuit may require the very creativity in which academics take pride. Let’s put that to work and figure out a way to open the labs and continue educating students, post-docs and residents while maintaining safety. It can be done. Many places are doing it. All should.

         There are those proposing a normalization of working from home, something that has happened in many industries already. I do not believe that patient care, biomedical research, or post-graduate education are industries in which working from home advances progress. The suggestion that a more permanent move to working at home is a good idea and part of the future of an academic center is, quite frankly, absurd. Anyone who has had his or her fill of Zoom meetings longs for face-to-face (even if it is mask-to-mask) contact with collaborators, students and colleagues. Before we adapt ourselves into oblivion, let’s consider becoming more creative with our work, but let’s agree that that work is in the hospital, clinic, labs, and classrooms of American biomedical research.

         We need to find a way to get back even if it is a new normal. Sixty days more of this is not a good idea.

Leonard Zwelling