Pandemic Mode, episode 2

This is the second of what I anticipate will be a weekly update on life during the greatest pandemic in over a century. Because it's clear that's what we'll be living through for the next several months, at least.

The overall story of the last week has been the exponential rise in cases in the US, accompanied by a growing knowledge about the virus and consensus regarding the severity of the pandemic. "Social distancing" is now a universal phrase, and the resultant anxiety has palpably seeped deeper into the collective consciousness.

According to reports, many in Britain are in a state of shock as prime minister Boris Johnson, Prince Charles, and several high-ranking ministers have contracted the virus. Elsewhere, Italy and Spain are continuing to struggle with what is hoped is the peak of the pandemic's first wave. India has completely shut everyone inside for 21 days in hopes of avoiding additional stress on its fragile healthcare system. China, on the other hand, has relaxed some of its restrictions as new cases have plummeted, at least initially.

The sober, wartime mentality was punctured earlier in the week by Donald Trump's relapse into denialism, claiming that he thought the country would be back to work by Easter. Which is less than three weeks away. And which would clearly be catastrophic. His insatiable lust for a return of the bull market of his first three years in office has served to only derange his already-catastrophically-impaired decision-making capacity.

This is mainly mentioned to highlight the utter lack of leadership at the federal level. We are all starting to pay an incalculably steep cost for raising such an incompetent, narcissistic, and irresponsible human being to the office of president. We don't need a great leader. We just need someone who has the basic level of competence to set the right tone for the nation, consult with experts to make some big important decisions, and delegate serious policy-making to competent people. 

A correlate with Nazi Germany comes to mind. Not Trump to Hitler (necessarily), but rather how loyalty was elevated above competence in placing people in power, resulting in a cast of fools trying to making decisions and utterly failing every step of the way. Unfortunately, that's all we've seen the past 2 months from this administration, and all we can expect to see until a new administration hopefully takes power next January.

A silver lining is that half of the states have taken bold steps to stem the pandemic. Though this may be slowing the progress in more rural areas and in a few cities like San Francisco, it clearly has been insufficient in most cities. A week ago, Italy was shocking the world with its  25,000 cases. Today, the US has over 120,000-- 52,000 in New York alone, with skyrocketing numbers in New Jersey, New Orleans, Chicago, Detroit, and elsewhere.

As expected, reports out of New York in the last couple days have started to mirror those coming out of Italy from the previous week. Because of New York's size, the situation has not yet gotten as dire as Italy, but I am certain I will be stating a different case a week from now, when the US will be closer to a million cases and New York in the hundreds of thousands.

Locally, North Carolina just topped 1,000 cases, over half of which are in Charlotte and Raleigh-Durham. Those areas are on shelter-at-home, while the rest of the state will be starting that on Monday at 5pm. Watauga County sits at just 5 cases, and we have yet to see any inpatient cases or local transmission outside of a single household. Watauga Medical Center has barred all visitors except for spouses of delivering mothers and family members of dying patients. All staff are being temperature screened on our way into the hospital each shift. Policies are in place and the COVID ICU and intermediate units are up and running. I am personally caring for the COVID rule-out patients this week, and have been encouraged at the rapid pace of change. After weeks of preparation, we are nearly as ready as we can be, excepting the continued lack of rapid COVID-19 testing capability-- which is by far our greatest limitation in terms of caring for possible COVID patients and conserving PPE (personal protective equipment). If reports are to be believed, responsibility for this lack rests squarely at the feet of the FDA, which delayed all testing development for the entire month of February. But no matter who is responsible, heads should roll. My job and the job of thousands of healthcare providers is markedly more difficult without rapid testing capability. And most importantly, patient care is suffering, even before we have any actual COVID patients in the hospital. 

The dark clouds continue to gather, and the rain has started to fall. But the silver linings remain. Distributed work (ie working from home), a beautiful concept, is starting to see its day in the sun. Service industries are being painfully disrupted, but much will rise from the ashes. People are having to be more intentional about staying connected.  And the world is starting to see the value of competent leadership... and the steep price that must be paid where it is lacking in trying times.

Stay calm and self-isolate on.

Pandemic Mode

Like everyone else, I've been amazed at the pace of change over the past few weeks. Though I've been receiving a flood of COVID-19 emails for the past month, it has not struck home until much more recently. The first in-person impact I recall occurred thirteen days ago, when I found out that a friend's son's highly-anticipated college spring break trip to Ireland had been cancelled. Around that time, I started hearing about universities' plans to extend spring break and possibly go to e-learning for the rest of the semester. The next day, on March 9, my small group met at my house, and though there was some minor conversation about Coronavirus, there was little to no thought that that would be the last time we would meet for months. North Carolina had hardly seen any COVID-19 cases, and Watauga County certainly hadn't. I did start taking action as the medical director of the Community Care Clinic to implement reasonable and recommended precautions, which started changing on a near-daily basis that week. On Tuesday, Mindy and I visited my grandfather at his assisted living facility in Charlotte, not supposing that the facility would be put on lockdown just 2 days later. On Thursday, March 12, I still felt little risk to teaching my 1-day obstetrics course to 11 missionaries at EQUIP Ministries in Marion. I tried to remember to not shake anyone's hands, but that was about it.

That evening, however, I found out that all professional and collegiate sports had been indefinitely cancelled after an NBA player tested positive. I also got an email from my church that all services were being cancelled, and a text from a friend letting me know that the Banff Mountain Film Festival (which would have been today) had been cancelled. On my way back from Marion, I listened to a Sam Harris podcast that raised my concern that the supply chain might be disrupted. After discussing that with Mindy, she started stocking up on supplies. I also started considering the need to cancel my yearly college friends' get-together and other upcoming trips. The following day, I started hearing about schools shutting down, and court was shut down halfway through the day before Isabella's case was heard (earning Mindy's ire after she had sat around court for 1.5 days)

Though I still ran a relay race on March 14, everyone was careful to not shake any hands, and plans for a post-race hangout were scuttled. But even then, Mindy and I decided to go out to eat at a restaurant by ourselves-- where I made sure to wash my hands, of course. Much like my small group a few days earlier, I scarcely imagined it would be the last time I would eat at a restaurant for months. Though that may seem foolish just a week later, a complete restaurant ban still wasn't within my imagined realm of possibility at that moment.

But that was to change extremely quickly. I found out that night or the next morning that all NC public schools had been shut down, that gatherings of more than 100 people had been banned, and that someone in Watauga County had tested positive for COVID-19. When I drove to the hospital on the morning of March 16 after nine days off, I hardly recognized the place. There were traffic cones everywhere and a checkpoint on my way in where I had to show my ID, like a military base. That day, I had to test a patient in whom I could not reliably rule out COVID-19, and more patients like that would come over the course of the week. Preparations for dedicated COVID units swung into high gear, and emergency staffing and other plans were drawn up. The next day, March 17, the restaurant and bar ban dropped, and community life ground to a standstill.

Yesterday, I had planned to meet with a friend here at my house to hang out, but his family had already started to "hunker down." Now that we're both off work for a few days, Mindy and I are starting to "hunker down," too, though there is of course no chance that I will be called off of work. I've realized that I have a duty to avoid having to self-quarantine, since my services may be urgently needed at the hospital in a matter of weeks-- so I should therefore avoid any unnecessary contact with other people.

There are a few things I'd like to say about all this. Obviously, all of these developments are bad for the economy, and it's easy to become anxious about finances. To minimize that, I'm trying to meditate and journal more. And will try to time my entry into the market appropriately.

Secondly, things might get pretty lonely, especially for people who are out of work or who have to work from home. Since I'll still be working, that's less of a personal concern, but I still feel it on my current days off when Mindy is working. But the good news is that Mindy and I have had a lot more time to hang out and work as a team around the house. We've already noticed the relational dividends from the increased quality time.

Furthermore, now that we see cases in Charlotte and the Triangle starting to exponentially rise, it's obvious that all the measures put in place over the past week have been the correct calls. And the naysayers one would come across just days ago have all changed their tune. So kudos to Governor Cooper. I can only imagine that the controls are going to get stricter over the coming days and weeks.

On a larger scale, there's no question that the federal government in general and the Trump Administration and FDA in particular have horribly bungled their response to this emerging crisis. If they had taken the right steps at the right time, we would not have to be waiting for 3-5 days for a COVID-19 test result, and places like New York, Seattle, and San Francisco would not be experiencing the beginnings of a true crisis. I have no doubt that we will experience a catastrophic reckoning from the current administration's incompetence.

Everyone is rightly worried about following the path of China and Italy. With the measures that North Carolina has put in place over the last week, I think it's unlikely we will see that kind of crisis locally, though it's still possible, especially in the Triangle and Charlotte. I'm optimistic that we will be able to flatten the curve, at least moderately. Though the exponential growth in cases over the last week may seem to be telling another story, there is a lag time of several weeks to the effects of our current efforts. Only time will tell if what we are doing is enough.

The best comparison for the past few weeks and the coming months from my lifetime is 9-11. As we all know, the world has never been the same since then. And the same will be able to be said for the current crisis. In the meantime, don't take any unnecessary chances. Stay well, stay calm, and isolate on.