The Mixed Messages of the Pandemic
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In my early career as a writer on Medium (i.e. about a week and a half ago), I wrote an idealistic story on how this whole pandemic could best play out. Now, as a seasoned veteran wordsmith (who just used thesaurus.com to look up another word for ‘writer’), I want to talk about what happens when we spot incongruences in the response to COVID-19, and what to expect in the future.
First, a quick review of what we know. We have lost the containment of SARS-CoV-2. The virus is on an inevitable path to becoming endemic worldwide as was the fate of four of the other coronaviruses (HCoV-229E, -NL63, -OC43, and -HKU1) whose names no one remembers.
Will vaccines and therapeutics help alleviate morbidity and mortality? Possibly. Hopefully. I’m sure glad we’re trying.
Will they swoop in and eradicate the pandemic? Snowball’s chance in hell. The path forward to defeat SARS-CoV-2 is to protect those at the highest risk for complications and death (people over age 65 and those with severe or uncontrolled chronic disease) while the remaining population uses their robust immune systems to gain herd immunity.
Are we in tracking so far? If not, please read this post or ask a question below.
Can’t touch this
Last week, I was on rounds in the hospital examining a patient. I listened to her heart, lungs, and bowel sounds with my stethoscope. I palpated her abdomen to check for pain or masses. I pressed on her lower legs to check for swelling. After reviewing her plan of care and fielding questions, I started to exit. As we were saying goodbye she extended her hand towards me. She abruptly stopped and said, “Oh, we’re not supposed to do that.” I reassured her that I wash my hands going in and out of the rooms and that it was ok for us to share a handshake.
As I closed the door to her room, alarms and airhorns sounded off in my type-A, left-brain consciousness. What just happened?!? That doesn’t make any sense. I can palpate a patient’s abdomen, but I can’t shake her hand? This wasn’t an isolated occurrence either. I’ve had multiple patients in the past few weeks do almost the exact same thing.
Just to clarify, even before COVID-19, I didn’t always shake a patient’s hand. Sometimes patients are too sick, too upset, or too shy. And that’s perfectly ok. Research, at least prior to the pandemic, demonstrates most patients prefer a handshake. I try to read the room and make my best guess if that’s a good idea or not (if my wife is reading this she’s probably trying not to pee her pants from laughing so hard because she knows how inept I am at reading body language).
The point is if you’re like me, and even if you’re not, you may be wondering at times where the logic is in this new world of a pandemic. And the best answer I have right now is, ‘For crying out loud, we’re in a pandemic! Many of us are in stress, contemplation, panic, protection, or anxiety mode, just to name a few. We should expect the illogical.’
Shake it off
When can we shake hands again? Well, if it were up to Dr. Fauci (who, at this point, needs no introduction) the answer would be ‘never.’ This is the part of the story where I lose my audience (or what’s left of you) because I’m about to touch the third rail of coronavirus discussion and criticize Dr. Fauci.
A recent fictional study I just made up concluded 98.46 % of Americans love Dr. Fauci, and to make this abundantly clear, I do too. What’s not to love? He has been published in scientific journals 236 times more than I have. He has been a stabilizing and easily-recognizable voice for the nation and compared to, ahem, some of the nation’s other voices, Dr. Fauci sounds absolutely brilliant…which may or may not be much of a compliment. Here’s what he said on April 7th,
“I don’t think we should ever shake hands ever again, to be honest with you. Not only would it be good to prevent coronavirus disease; it probably would decrease instances of influenza dramatically in this country.”
Look, this wasn’t one of Dr. Fauci’s best moments. I happen to disagree and don’t think stopping the handshake would dramatically decrease flu in the US. There is no dramatic decrease in flu incidence when comparing western nations who use the handshake with others, such as Japan, where bowing is a traditional greeting. More importantly, if stopping the handshake actually would dramatically decrease the flu and its 43,000 associated deaths in the US, why in the world can’t I find any mention of this recommendation from Dr. Fauci in his previous 36 years as director of the National Institute of Allergy and Infectious Diseases?
This dearth of logic makes my head want to explode! Before it does, I’ll admit that if my words were under the same constant scrutiny as those of leaders like Dr. Fauci, I’m sure there would be just as many, if not more, foot-in-mouth moments for me. However, shaking hands won’t be any more dangerous in 2022 (and hopefully earlier) than it was in 2019. I don’t think this tradition that dates back millennia is permanently going away, but if it does we will surely find another means of connecting and showing goodwill towards one another. Amiright? Elbow bump?
Masquerade
What about facemasks? Weren’t we told not to wear them at first? Yes, we were told not to wear masks at first but once it became clear that asymptomatic spread was occurring and once supply improved, the CDC and surgeon general reversed this decision. So, how long are we going to keep this up?
I’m originally from Atlanta, went to med school in Augusta, GA, residency in Cincinnati, and have been practicing in Billings, Montana for the past 5 years. I can assure you that sporting a summertime facemask and matching cowboy hat in Montana is a walk in the park compared to constantly readjusting a sweat-drenched, half-dissolved, glob of suffocation that a mask would become in Georgia’s summer. This is just one more item on the long list of reasons to direct our thoughts and prayers towards the citizens of Georgia.
Right now there are two clear indications for a facemask. The first is if you are going to be within 6 feet of someone in the high-risk group assuming that person isn’t in your household and assuming you haven’t already demonstrated immunity to COVID-19 by either recovering from it or having a validated antibody test (which as far as I know isn’t available just yet). This is a common-sense rule.
The second indication for a facemask is if you are in a setting where it is recommended by your local, state, or the federal government. The reopening plans of many states include wearing facemasks in public settings depending on what reopening phase for your state. In addition, the CDC currently recommends, “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain especially in areas of significant community-based transmission.” Even though the endpoint for facemasks may seem nowhere in sight, this too will pass.
I would espouse that the first indication shouldn’t end until herd immunity is reached — hopefully in 6–18 months, but I could envision the second happening by late summer or early fall. For practical purposes, like many aspects of this pandemic, I anticipate an anticlimactic ending. Will we all remember the day we stopped wearing face masks? If you lived in the 80s or 90s, do you remember the day you stopped wearing a fanny pack (if you never stopped then consider yourself exceedingly cool since they are now more popular than ever)?
What now?
So why the inconsistencies? Let’s first note that by investigating handshaking and masks we’ve only scratched the surface. To continue this discussion as it applies to the virus’s seasonality, contact tracing, and a vaccine, please check this out. But for now, let’s remember this is actually how science works. In science, there’s a lot of trial and error (sometimes emphasis on the error) while getting to the truth.
Have you ever watched someone else try to put together a puzzle? It can be maddening, right? In this age of infodemic, we are watching live every flip, twist, and turn of every little piece of the COVID-19 puzzle as it is put together. In a recent article Ed Yong, a science writer at The Atlantic, stated,
“The staccato pulse of reports merely amplifies the wobbliness of the scientific process, turns incremental bits of evidence into game-changers, and intensifies the already-palpable sense of uncertainty…”
Yong astutely recognizes the reason for the madness. Even though these mixed messages are likely to persist for some time, talking about them and understanding why they exist is therapeutic and reassuring to me and hopefully has been to you too. And if you want a good laugh take a look at Adley Stump’s coronavirus speech. Thanks for reading. Take care, stay positive, and stay safe!
