I’m Not Sure

I’m Not Sure: Are You?


Leonard Zwelling

When I was young, I was sure about a lot of things. As I grew older, I became less sure about many things. Usually though, as I matured, I would think a problem through, sift through the available evidence, and come to a conclusion. After all, it was how I was taught to be a doctor. Collect as many facts as you reasonably could before making a decision about a patient’s care. This became even more true in the laboratory where I could generate the data with experiments and come to reasonable conclusions. I was sure about the findings in the papers I published, and as far as I know they have stood the test of time. No retractions. No corrections needed.

I cannot say the same worked for the coronavirus and my perceptions of the threat it posed.

In the beginning, I was sure this posed a major threat to humanity. I cancelled a trip to Argentina because I feared I would not have been able to get back into our country. I was right. I cancelled a trip to Hawaii thinking air travel wouldn’t be safe nor would eating in restaurants. I am not quite as sure about that, but in March, it was a reasonable assumption and the restaurants might not have been open on Maui. I spent 23 consecutive weeks in Houston before venturing out on a short flight to Cleveland to visit family. I did that twice now, but I’m through with air travel. Sitting that long in a mask and gloves is a bit much for me. I wasn’t good in the OR for the long surgeries either.

Today, I was thrown into even more confusion. It was my annual physical exam with my concierge doctor who had a long talk with me about covid-19. First, this is a respiratory virus. We don’t usually isolate each other in response to such viruses. Second, its lethality is mostly in the elderly. Not entirely, but we really don’t know what distinguishes the rare young person who gets very sick or dies from covid although the latest news suggests genetics play a big role via genetic markers and blood groups.

Furthermore, it is not at all certain that keeping our kids at home is a good idea unless they come in contact with people over 65 and spread the virus. At school they would probably develop immunity to all kinds of things including covid. At home, not so much. Third, we don’t usually test one another for respiratory viruses. HIV, yes, because there are effective interventions and even before there were, the blood supply had to be protected. In other words, in every way, our response to the coronavirus has been atypical if not aberrant, and aberrant if not bizarre. Why?

Previously, I wrote about my view of the recent history of the pandemic. The one thing that clearly accompanied the virus has been panic and fear. There was a great deal of worry that 2020 would be like 1918, and in Italy and New York City, that may have been the case due to some less than optimal management by authorities (sending the elderly sick back to nursing homes) and unreadiness for a respiratory ailment that had been predicted by many. No excuses there.

I think that the real culprit in the response to the pandemic has been the press and the Internet. The press spread the fear. The Internet spread the confusion.

Here’s what we could have done.

First, President Trump was right to want to shut the borders from China and Europe in particular. He should have done it. Really done it!

Second, the scenario outlined by the Obama Administration for dealing with a pandemic should have been followed. It would have entailed testing, tracing, isolation, some limits to commerce, but presumably not a lockdown and the economic disaster could have been avoided.

Third, once we handled the original shock, we could have gradually opened (e.g., restaurants) in a controlled fashion from what would have been a limited lockdown (if at all). Too many small businesses have gone under and lives have been ruined by a respiratory virus (or our response to it). We did not handle this well.

Fourth, was this all a product of election year shenanigans? There can be no doubt that the pandemic gave the Democrats an issue from heaven and Trump made a mess of it. We needed a cool, analytical approach to what was essentially a problem in medicine and public health. Instead we got widespread panic, economic disaster, and mass depression. Great!

If ever there is an example of why leadership is so important, this is it. We didn’t have leadership anywhere. And, now, here we are. And I am still not sure about anything.

Except this. We could have done better and ought to take the steps now to do better next time, because there will be a next time. I am sure of that.

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