Working in the Virus’ Shadow: SARS-CoV-2 26 March, 2020, 0204 Hrs

We all know something is happening. Something that we’ve not seen before. Of course we see it in the news reports, the closings, the empty streets. We are not used to this. We see it in the gallows humor: If we don’t know who has the Plague, then everyone has it.

If everyone has it, how are we to be safe? How are we to care for the ill when almost any symptom – headache, cough, fever, shortness of breath, diarrhea – suggests that the sick human might be capable of transmitting the Plague to one of us. How to keep from allowing fear to burn away the shield of compassion? How?

As one of the more senior of the physicians, I have seen this before. Not the SARS-CoV-2 – the viral agent causing CoViD19 – no, this is new, but the behavior.

Years ago, a lifetime ago, on a sunny morning in Chicago, I walked into the office of Doctor Quentin Young Office, the Chairman of Internal Medicine at Cook County Hospital. As I walked, I was reading the abstracts in the most recent number of the New England Journal of Medicine, and I came across two articles describing – for the first time ever – an odd and destructive syndrome seen in gay men. Whatever this syndrome was caused by, it was killing these men in the prime of their youth. Why?

“Why” and “How” are questions that drive science, that drive scientific discovery. These are two of the most important words in any language. Soon after that morning, however, those were not the words I heard. Too many of my senior colleagues – at the time I was a second year resident in Internal Medicine – were so frightened that they wanted nothing to do with any sick human who appeared to mirror those reported in the Journal. They were absent, leaving the work of figuring out what to do primarily to those young residents and Chief Residents. It wasn’t that all of the senior medical staff did this, but enough did. Physicians and nurses became, very shortly, frightened. And being frightened humans, didn’t always behave well.

Many others, nursing, laboratory, and medical colleagues whom I cherish to this day, did not leave their post, did not desert the ramparts. Of course they – we – were frightened, always. But we said “This is our job, our calling.” Full stop.

While all of this was developing, the US Government, led by Ronald Reagan, slept. Worse than simply being asleep, they denied there was a problem and subtly suggested that, even if there was one, it was the fault of the sick. Lifestyle and all, you know.

Thousands died while our “Leader” looked on.

Why, you might ask, do I bring up this ancient history?

Why indeed.

Today, we face a Pandemic caused by a viral agent infinitely easier to transmit than is the human immunodeficiency virus (HIV), the causative agent of the acquired immunodeficiency syndrome (AIDS). SARS-CoV-2, is the virus causing COVID19. This agent has brought the world to a near standstill; it threatens the world economy as has nothing since the start of the Great Depression of 1929. The World’s response to this challenge has been mixed, to say the least. But nowhere has it been more dysfunctional, more inept, more vicious, than in my country, the United States of America.

Donald J. Trump has denied there was a disease; he called it a hoax, perhaps like our Climate Crisis “hoax”, one that was perpetrated by the Chinese. From the moment he could no longer deny reality, he has continuously lied: About the virus, about our ability to test for the virus, about our ability to respond, about vaccine availability, about treatment. Effectively, Donald J. Trump, a vicious and incompetent “leader”, has lied about everything related to this Pandemic. While Trump’s specific handling of the COVID19 Pandemic is different than was Reagan’s of HIV/AIDS, his callousness, cruelty, and incompetence are a match for that of the Great Communicator.

And that, my dear brothers and sisters, is why I remind you of this history. While the virus causing this Pandemic is new, the response to it by a Republican administration is not. The same cruelty, callousness and indifference is seen now as then. But as bad as was Reagan, Trump is even worse. Apparently demanding fealty from Governors before he will send federal aid. Demanding to be treated by his subordinates – who seem very happy to oblige – as is Kim Jong Un of North Korea.

We all know, those of us in this hospital, this ICU, this ED, that something is wrong. While the virus challenges us, it is our Government’s response – or lack of response – that is frightening.

There are many of us on the front lines writing about this Pandemic. I have taken a bit of time, after Patient Rounds and Teaching Rounds, after ensuring we have beds available of the coming onslaught, to document what is happening here. For later. Because none of us knows if we have a tomorrow, Pandemic or no Pandemic. Yet toiling in the shadow of this virus, we can be sure that some of us will be taken.

For the time when this is over, when we try to determine how this could have happened, these words, and more that will come in the days that follow, are written.

We are your front line. We are your first line of defense. If we fall, do not allow it to be forgotten that, while the emergence of the virus – SARS-CoV-2 – was not Trump’s fault, he and his Administration are responsible for the inadequate, inept and incompetent response that is ongoing.


About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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