America: No-Fly Hot Zone

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.

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