The virus takes and it takes. Physicians give and they give.

A lifetime ago, when we first heard of a novel virus making the rounds in China, I was added to several physician groups on Facebook. The discussion surrounding the virus was academic; the distance made it easy to be objective, speculation on how severe it was, and how widely it would spread was casual and detached. Terrible what was happening in China. Those lockdown measures were so draconian. If only they closed their wet markets.

As the list of countries affected by the virus grew, the discourse slowly became more concerned. We read the personal accounts from doctors in the hardest-hit cities, most notably from Lombardy, Italy, where the virus had taken the city in its grasp. We started to talk about what this could mean for us, for the rest of the world. There were some who predicted tragedy and widespread death and despair early on. One post that keeps coming back to me stated, “People you know will die from this.” At the time, the OP was largely vilified as being alarmist. Yes, things did not look good there, but why would you say that? Surely it wouldn’t be that bad here.

Today, 140,000 deaths later, we are in a different world.  We have learned that COVID “does not discriminate between the sinners and the saints, it takes, and it takes, and it takes.” In Texas, where I live, cases are surging, and hospitals are overwhelmed. My newsfeed has been littered with posts from physicians describing the state of their hospitals. One notes they were forced to manage COVID patients in the ER because ICU beds were full. In other hospitals, known COVID patients were being turned away from the ER if they “didn’t look sick enough.” Another physician put out a desperate plea for a family member who was critically ill with COVID. She was admitted to a hospital that did not have enough supplies to even get the appropriate IV access. The physician had reached out to see if anyone, anywhere in Texas could find an ICU bed that could take her.

These physician groups are a window into the realities of the pandemic. In the absence of evidence-based guidelines, physicians have taken to crowdsourcing the latest data, treatment protocols, and fact-checking news articles with each other. It is the only way to have the most accurate and current information without the noise and hype of the media. Perhaps most valuable, physicians are sharing personal experiences in the day-to-day care of this new and challenging disease. The names are different, the places have changed, but the stories have a haunting familiarity. Arizona has traded places with Italy. The Rio Grande Valley is the new NYC.

Also evident in these posts now is a new level of frustration. How can we protect our communities from the danger that is clearly in front of us when we are met with resistance and distrust at every turn? Front line workers feel as if they are trying to catch a tsunami in a butterfly net. And they turn to the public for help with the rising waves. Wear a mask. Wash your hands. Physically distance. That’s all we ask. We promise we will handle the rest.

To physicians who are in the know, the public response does not make sense. If only people would just do what needs to be done. But we must remind ourselves the public does not have access to the same window we do. And over time, the volume of conflicting information has left people wondering who to believe. To most people unfamiliar with the scientific methodology, the frequent change in guidelines equals unreliability. Under normal circumstances, data is collected and analyzed over months and years, multiple studies are done to ensure the findings are reproducible over time and circumstances before any recommendations are made. As new data comes to light, the guidelines are revised. The pandemic has dramatically accelerated this timeline. What we are witnessing, in fact, is scientific research working at warp speed.

Meanwhile, physicians struggle to do their jobs. Five months into the crisis and we are no closer to having adequate PPE for our health care workers. The safety label on our masks that proclaims “not for reuse” now reads as ironic. We are being forced to ration our COVID testing supplies, because we never know when the supply chain will fail. Labs cannot keep up with the sheer numbers of tests, and results that previously took 24 to 48 hours are now taking up to 7 to 10 days to be reported.

While anti-maskers resist even the smallest change to their routine, we have changed our lives dramatically to protect ourselves and our patients. Our protocols have been written and rewritten to make sure we can provide the best care in the safest possible setting. We find ways to work with the shortages, the sick colleagues, the ever-evolving data. We go through elaborate decontamination rituals when we return home from work in an attempt to protect our families from the perils of our profession.

Fortunately, physicians too, do not discriminate between the sinner and saints. We give, and we give, and we give. Our time, our expertise. Our safety. We treat all comers, whether they wear their masks or not, whether they believe us or not. What motivates us to do this? We took an oath, and we accept all that comes with it. But it is difficult to not become disillusioned. To not throw up your hands at the lack of support, the wilful negligence, the inefficiencies. And we do, multiple times a day. And then we grab a mask and carry on.

Nida Zakiullah is a family physician.

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