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Thoughts during a COVID nightmare
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  1. J Mocco
  1. Department of Neurological Surgery, Mount Sinai Health System, New York, New York, USA
  1. Correspondence to Dr J Mocco, Mount Sinai Health System, New York, NY 10029, USA; j.mocco{at}mountsinai.org

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I am happy most of the country has not gone through what we have here. However, without shared experience, how do we understand? I would like to try to convey some of my thoughts, having experienced, first hand, the SARS-CoV-2 pandemic over the past 2 months in New York City. It is not easy, but I think necessary. I am worried that if we don’t communicate, it will lead to misunderstanding, and if there is misunderstanding, then more lives will be lost.

Some friends and I share a text group. These friends live across the country, many are physicians. Its purpose is social. Funny memes, sarcastic comments, and occasional sincere best wishes are the mainstay. While a typical accumulation of texts flew about the other night, one of my friends wrote, “We have 11 hospitals sitting empty for a total of 45 cases treated and two were in the hospital – NYC screwed us all.”

I rarely cry (except the funeral scene in My Girl), but I teared up when I got that text. The force of what I had been experiencing the past few weeks, in contrast to my friend’s profound lack of insight, was enough to tip me over the edge.

He doesn’t know what he avoided.

I know he wasn’t thinking about me specifically, and he was clearly going for some amount of comic effect (in a regional pride sort of way), and I know he is a good person (before anyone guesses, he isn’t a neurointerventionalist and you don’t know him). However, the comment, and the apparent growing sentiment around the country, have me worried. My own sister, who lives in another state, called the other day to ask me if the media was exaggerating and 'over-selling' the extent of the conditions in NYC.

I am elated that social distancing and self-isolation have resulted in powerful protection for most of those outside NYC, but the success of these efforts has created a challenge—a direct threat to our nation’s comprehension of how the world is changed.

There appears to be a chasm. One that scares me. There are those of us who have watched our hospitals fill to four times capacity, seen two vented patients crammed into one ICU room, turned lobbies into makeshift ICUs, lost patients by the dozens, and mourned the loss of multiple friends/mentors/colleagues; and there are those of us who haven’t. There is no value implied in the difference, rather it is an expression of confusion, or maybe sadness. How do we help people understand? Over 16 days of NYC’s coronavirus surge our department lost seven of our staff’s immediate family members. This is just one relatively small department among the many across our health system. My sons’ tiny school (~30 kids per grade) lost multiple parents, fathers who solidly sat in what we would all call 'middle age'. I personally know a neurologist, a neurosurgeon, and a radiologist who were taken by the virus … the virus doesn’t care about your specialty.

I don’t seek sympathy. Truth is, I have had it good. While many close friends have taken ill, none have succumbed. Myself, my wife, and my children are fine. Aside from 3 weeks I spent isolated from them, my family is intact. I am petrified for my parents, but they are healthy so far. I feel a sense of foreboding though, as my wife’s closest friend in NYC just lost her father yesterday, 2 days after he was diagnosed with COVID-19. He is being buried without ceremony, his family watching on Zoom.

We all make jokes. I remember, eight long weeks ago, making an off-hand comment about how the virus must be serious if they canceled football matches in Italy. It wasn’t a joke exactly, but it carried no gravity. Now I am embarrassed I didn’t grasp the gravity. Can anyone gain that perspective unless they’ve had to experience this? I didn’t, but I hope others will. Otherwise, I am worried for the future.

On March 30, 2020, just as NYC was surpassing 1000 people dead from COVID-19 (NYC deaths are 18 069 as I write this, only 1 month later), a co-worker sent me an article from The Atlantic, “What Happens if Healthcare Workers Stop Showing Up?”. Written by a well-meaning ED physician, Dr Thomas Kirsch, it worked through a rational argument why healthcare workers may, rightfully, decide not to put themselves at risk, particularly as PPE was scarce at the time. I answered my co-worker, “I believe the arguments put forth, while holding abstract merit, do not obviate our commitment. We should recognize them and fight for improved protection, but we should lend no credence to a position that forgives our lack of enthusiastically stepping into the fray. I do not hold the other staff, the front desk clerk or transporter, to the same standard. I respect them if they choose to stay but am empathetic if they choose to go. But I cannot condone the physician who benefits from society’s sacred trust for their entire lives, as we all have, and then decides that they do not owe society something back in return, especially at its time of desperate need.” Yes, I recognize it is a pompous and heavy-handed response. I hope the context allows some forgiveness.

However, happily, Dr Kirsch’s concerns were misplaced. Fear did not win. Self-sacrifice did. Sure, there were a few who slouched into corners, stared at the dirt, or just ran away … but they were rare. Rather, individuals shone. Clerks, transporters, janitors, nurses, APPs, therapists, and doctors stood tall and stepped right to the fore. They weathered fear and faced disease. An old classmate from medical school, now a hand surgeon in Minnesota, showed up at our NYC medical school and volunteered to work in a COVID-positive ICU. I called one of my partners who had taken ill (PCR positive), likely catching the virus while intubating crashing COVID-19 patients early in the month. Her 3-month-old and her husband had both developed fevers as well, yet she was confident her family would recover, and she continued to express her desire to rejoin her friends on the front lines.

I’ve not fought in war. I do not hazard that fighting this virus approximates true battle. But, for the first time, as I look at my partners and friends across our hospital, I can feel the visceral pull of those words, “I pray thee, wish not one man more … he which hath no stomach to this fight let him depart … for he today that sheds his blood with me shall be my brother”. I’m proud of that feeling.

But what happens when the rest of the country doesn’t feel it? What happens when good people are annoyed at the inconvenience of the 'Corona-cation'? What happens when jokes morph into interpretations? I don’t know.

I am worried we will find out.

Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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