Dealing with COVID-19

One of the underlying principles of our magazine is that medical experiences affect people and their loved ones in ways that a simple “factual’ medical history doesn’t capture. We try to share this part of the people’s stories, because we feel we are presenting something that is both real and true for the people involved, and that giving people the opportunity to know more about what others are feeling and going through can help them feel less alone, or educate them about what other’s stories are truly like.

And this viewpoint certainly has relevance today as people in America struggle to come to grips with two main problems; a respiratory virus outbreak, and the flow of feelings, chiefly fear and anxiety that have come along with it.

Now much of this fear is not “rational” but when did that ever help anyone to hear that? Was there ever a conversation that went:

Person One: “I’m deathly afraid of spiders.”

Person Two: “That’s silly. Most spiders are harmless and even the poisonous ones only bother you if you bother them.”

Person One: “Thanks for letting me know. Now I’m not afraid of spiders anymore!”

Not happening. And just because a fear isn’t “logical,” doesn’t mean it’s not “real.” In fact, irrational, illogical fears are often the most troubling, aren’t they?

Of course, just like spiders, coronaviruses are a real thing. This particular coronavirus spreads readily, and although it causes few or no symptoms in most younger people, it does possess the power to make older or chronically ill people quite sick, and might even kill up to ten percent of people over 75 who get infected, which is quite concerning. Nobody could object to paying attention to this situation, or taking measures to “flatten the curve” to avoid overwhelming a healthcare system.

But it is extremely unfortunate that this already unpleasant situation has been accompanied by unnecessary suffering on the part of the general public, as many of us have been overwhelmed with excessive horror and dread. Any why is this so?

Quite frankly, it’s because our political leadership and media have failed us.

Go to  one of those celebrity video and listical websites to sample what online entertainment is doing. Scare stories: “This totally healthy we swear 37-year-old died!” “This 50-year-old guy died!” That anyone, ever, has died is sad for them and their loved ones. But stories like this, without context, are just hysteria driving clickbait.

But Buzzfeed is low hanging fruit. Surely, a respected news source like the New York Times would be reporting if rates of hospitalizations and cases are dropping or stablizing in the New York area? Surely, they will have informed and reasonable “op eds” providing education on the relative risks of say dying in an automobile accident versus this virus, or that contagious diseases are a part of life, like it or not, and that this one is not actually the most virulent threat we have faced, although that doesn’t mean we shouldn’t mitigate risks, or just ignore it. Surely, they are providing context for statistics so people have a reasonable idea of how common or rare the rates really are in their neighborhoods to reduce unnecessary fear. Hah! Guess again. Turns out the “grey lady” is as much a clickbait whore as any ad-ridden news aggregation site.

And our leadership, be it quango, bureaucratic or elected? Double hah! We mean this in a totally nonpartisan way, but what we have ended up with is frightened politicians reacting on the fly and instituting economy-wrecking measures that may or may not be effective, and career bureaucrats who work in healthcare related areas of the government doing what they always do when they see an opportunity to get more money and power. That is, they take of their shoe, pound it on the table, and declare this (SARS, H1N1, Ebola, influenza, obesity, crack, communists, juvenile delinquency, opioid) epidemic to be the worst thing in the history of forever, and they need more money and power, stat, to fight it.

These latter are probably doing more damage than the politicians. Love or loathe President Trump, no one expected him to be a medical expert, or not to have a political agenda. But the general public is not aware of the common machinations of the bureaucratic existence, or how politicized government healthcare entities actually are. They see only that someone is the director or a task force or a surgeon general and has an actual degree and think these are disinterested parties that are only providing factual analysis without any agenda at all, political or otherwise.

Now it’s unlikely that these professionals would flat out lie. They most likely do sincerely believe there is an important problem. But they have no crystal ball, but they do have long practice publicizing worst case scenarios to advance the needs of their particular agency or bureau. It’s what you do. You fight for the best piece of the pie, and you do that by playing up urgency and bad consequences of whatever threat you have been designed to address.

And to be fair, if you work in public health, your job probably often feels like shouting into a blizzard. “Stop smoking, you idiots!” “Don’t drink and drive!”

But these people should rethink this in our current fear climate. The “Hippocratic Oath” which is still a thing with most doctors, states “first do no harm.” When people are getting so upset they are committing suicide, you need to scale back the drama. Surgeons always inform people of the risks of surgery before they operate, but they don’t walk up to the patient’s bedside just before surgery going “You know how many times the anesthesiologist puts the breathing tube in the patient’s stomach so you suffocate to death? Hoo boy! And then we’re always leaving stuff inside you? Go figure!”

Again, many of these professionals are undoubtedly well-meaning. But they are also forgetting their audience. As a physician, a person deals every day with risk stratification and the existence of infectious diseases. Every prescribed course of treatment comes with risks. As a physician, it’s your job to decide whether or not the benefits from the proposed treatment outweigh the risks and inform the patient of your recommendations. Similarly, every day, every physician, even ones that work in fields that are not directly connected with infectious disease has to consider whether or not a patient presenting for evaluation has an infection causing their symptoms. It’s always part of what doctors call “the differential,” that is the list of possible things that could be causing the patient’s symptoms. In addition, if you work in the healthcare field you are always aware of the existence of infections. You hear it from the infection control nurse, you attend educational activities on infections, and you are briefed and rebriefed on precautions to take against infections.

This is not the experience of the average person. Many people until now had been going through life blissfully unaware of infectious concerns. That’s why some people cheerfully cough snot all over their hands and then touch every available surface, never wash said hands, and cheerfully visit their 89-year-old grandmother at the nursing home after having just gotten off a plane or attended a giant concert.

So, for them, the average person, it’s not like hearing that something that’s always been a background concern has now developed one of its periodic exacerbations. It’s more like they just learned that vampires are actually real and loose in their neighborhood and there’s nothing you can do about them. Vampires that are invisible and can strike anytime, day or night.

Therefore, people are afraid. Not reasonably afraid, or concerned so they take precautions to flatten the curve of infection so we don’t face an overwhelming demand on our healthcare system in the future (again, despite what you may have seen online (see media above) this has not happened yet,) but irrationally afraid.

People have all these factors adding to their concerns in a way that isn’t helpful. If you feel that sometimes you are starting to get into this state, here are some things you can do to when you look at virus related information, that may help reduce anxiety.

Practical Steps to take in this climate of hyperbole and uncertainty.

You can’t fix the government or the media, but you can take steps to limit your exposure to these pathogens or mitigate the symptoms they produce.

Remember, everyone has an agenda, besides the obvious.

Public figures may be indeed very well-intentioned, but politicians want to be reelected, bureaucrats want their departments to be as important and well-funded as possible, and governors and mayors want to make sure that their particular area has all the resources and federal money they can get. So, when you see these public figures waving their hands in the air, predicting doom and apocalypse, remember that they can’t predict the future, and they have reasons for painting a dark a picture as possible.

Anecdotes are just that, anecdotes.

We all know, just from living life, that people are not always factual in what they say. People have agendas as we mentioned above; they want to sell you something, or persuade you to something, they prevaricate, they exaggerate, and they give their own interpretation to events they experience. So, when you read a news article that consists of one individual expressing their experience or opinion about their situation, even if they identify themselves as a medical professional, that’s all it is—one person’s anecdote, which might be factual, but also might be an exaggeration, prevarication, or filtered so much by their agenda, fears or issues so as to be of limited connection with reality.

Even assuming someone’s story is completely “true,” whatever that means, it is still one person’s experience.  A nurse that says she’s overworked? That is always happening, but don’t be influenced by the media to extrapolate that an entire health system is overworked.

Be Alert for the Sob Story

“Sob stories” are an old journalistic standby. For a news outlet, there’s nothing better than a cute little kid dying of cancer, unless of course they also fell down a well. But all kidding aside, it is tragic for anyone and their family when someone passes away, regardless of the cause. We aren’t trivializing that. But be aware that it’s the kid in town with cancer that gets the news article—not the fifty old men who are passing away with prostate cancer within a five-mile radius. The media figures, correctly, that you don’t want to hear about them. Similarly, with the Covid-19 virus, news outlets are pushing stories about younger people who died, or people who died with some other ironic or notable factor. Somehow there aren’t a bunch of stories about the people over 75 who make up 80-95% of the deaths. Remember, when you see a story about someone young who died, that’s sad, but it’s also rare, and it’s featured because the publishers feel that they can get more of a rise (and thus more engagement) out of you. Your risk of dying is extremely, extremely low if you are under 40, even though there are a handful of unfortunate people who have passed away.

Ignore the opinions of the rich and famous.

A recent headline: “Bill Gates says we should shut down the country.” Would that be some noted physician who happens to be share the same name as the Microsoft founder? Nope, it’s noted rich person Bill Gates, AKA a guy who dropped out of college after his freshman year to sell other people’s software, and as far as can be determined hasn’t spent a minute in medical school. But if your rich enough, apparently, your uninformed opinions are news. Don’t waste your time reading and responding to this kind of filler.

Figure out what a story isn’t saying.

Governor Cuomo was in the news again the other day, talking about how he was going to try and order hospitals with excess ventilators to send them to other hospitals, because New York city could run out of ventilators in the near future. Naturally this got the usual apocalyptic spin in the media, who are, again, all about engaging you and your clicks through emotions, but let’s stop and use this as an example of how to figure out what’s really being said.

1.New York City could run out of ventilators in the future. They could be invaded by aliens as well, although that admittedly is less likely. So right now, they have enough ventilators which is actually good news. And isn’t still nice that some politician is finally thinking ahead, and considering some things that might be done proactively?

2.There are plenty of extra ventilators close by, which, if needed could be moved to New York City. Again, good news!

This is actually a story that is both about a non-event (no one has run out of ventilators and there are plenty nearby anyway) and about some decent proactivity by a governor. It’s all positive! But if you weren’t careful to parse that out, the tone could again add to your fear, to no good purpose.

Don’t put too much attention on things that don’t pertain to you.

Spain and Italy are lovely places to go on a vacation, but their economies have been in shambles for years. This means that they have limited funds to invest in their medical infrastructure.  Americans tend to romanticize government-controlled healthcare systems. However, just like the American commercial system, these systems have their pluses and minuses, depending on what your particular needs are. These systems are also very utilitarian in outlook. By design, they do not plan to spend hundreds of thousands of dollars to put an eighty-five-year old person with acute respiratory disease in an ICU when they would only have a ten percent chance of survival even with optimal care. They would prefer to spend that money on prenatal care, or vaccinations, or blood pressure medications- i.e. on what they think is the greatest good for the greatest number of people. You could certainly argue a long time about whether or not they are right to do so, of course, but it is what it is.  With an upsurge of older people getting acute respiratory illnesses in these countries, it highlights this existing aspect of their system’s design, and you see a relatively high mortality rate in their oldest citizens with coronaviruses.

However, if you live in America, this doesn’t pertain to you. America’s medical-industrial complex has plenty of flaws, but it is second to no other country in its ability to provide copious amounts of tertiary care. Unfortunately, very old people don’t do well with serious respiratory illnesses. But they will have access to and be offered as much care as they can stand if they get sick.

What happened in Italy and Spain is tragic but except for teaching us in America some lessons about how to better respond to viral illnesses, their experience is not relevant to what is happening or will happen in the US.

Similarly, if you don’t live in a particular area of the United States, what is going on there is not, with today’s travel restrictions, going to be very relevant to what is happening where you live. Check your own city or state health department websites, read the graphs carefully to avoid being tricked into getting overexcited, and do your math to get an idea of how prevalent the problem is in your area.