There are many reasons to love my city, Toronto. As I’ve gotten older (and a lot wiser) one reason stands out over and over again - Toronto is as diverse a city as there is on the earth, and maybe the most diverse. Over half of us were born outside of Canada. Over the years I learned that people are good and people get even better when they know other good people who don’t look like them.
But now I fear Toronto is about to pay the piper. It is only a matter of time before the new Coronavirus is introduced into the wild here. There are simply too many people coming from too many countries and too many routes of entry to catch the one carrying the virus. It’s coming. Just as it is about to come everywhere. We are witnessing the beginning of a pandemic.
When SARS struck Toronto in 2003, six of my hospital colleagues contracted the disease. All were younger than 50 and one almost died.
I am now 17 years older (and far more decrepit). Several of the docs in China who died from Coronavirus in the last days were young men. So, frankly, I am . . . reflecting.
During SARS, it jolted me to realize that my generation of doctors (at least in developed nations) had been given pretty much a free pass in not being exposed to deadly communicable diseases. I remember thinking that it was now our turn to consciously accept risk. To place ourselves at real risk (and possibly even our families, too). Other generations of physicians had cared for people with smallpox and TB, cholera and polio. How could I complain about caring for people with SARS?
And now, again, I am not complaining. No, just preparing to ante up.
Fight the good fight, my old friend. I’ve not had to face SARS or MERS or this new threat like you, but I always lived in dread of bringing influenza, parainfluenza, etc. home to my daughter with CF. Now I’ll avoid seeing her for weeks at a time, because influenza B is in my workplace, I’m seeing patients with it, and she can’t really afford to get it, as it could well kill her.
Otherwise I’m an old sled dog; I will undoubtedly soldier on, even if/when my patient population is hit with Corvid, or the next plague. I’ll be afraid at times, I’m sure. But if I don’t take care of them, who will?
I was working emergency in the GTA during SARS. No one initially knew anything — not what it was, where it came from, how it was spread. We had to wear space suit thingees before they came out with mask fitting and N95s. They’d take your temperature at the door when you came to work. Half the doctors were scared, half blew it off completely.
Toronto Chinatown became a ghost village. Businesses didn’t open. Mayor Lastman refused to go there to set a positive example. For some reason, gas stations reduced the price of gas to 25 cents a litre as a show of solidarity. From maybe 60 cents a litre? I guess business was way down.
Our small emergency gained a proper negative pressure room and decontamination areas. Patient transfer by ambulance was much delayed since hospitals were initially too scared to accept new patients. One of my patients turned sour mostly due to the unusual delays. Eventually, though, it became more of a formality. Lessons were learned. I did not fear working, but it is not fun to work in a spacesuit. Our Chinese radiologist quit, I think perhaps tensions were exposed when no one quite knew what to do. Or the commute was too long.
I see coronavirus as different. It was quickly tracked down. People knew to wear masks. Most folks did fine. Yes, it is scary and mistakes like cruise ships will happen. But this isn’t the bug that will stop the show. That one is coming later.
Here’s a question for you, though: Covid-19 has appeared in at least one prison in China - and with everyone in relatively close quarters, I would imagine it would spread quite easily.
How would a US prison deal with something like this making the rounds? I know a lot of the issues with the Diamond Princess had to do with the fact that the crew was not trained or equipped to deal with true isolation conditions, and even with passengers on lockdown the crew was passing the virus around.
We’d do what we do for influenza when it hits: masks for the victims, basic respiratory precautions, lots of handwashing, close nursing followup, treat secondary bacterial pneumonias, get them the hell out of the institution and to the local ER if they’re getting unstable.
The American case of community exposure with no travel or contacts is interesting and scary. I suspect the test is imperfect and it is already around. Perhaps many cases are mild and sub clinical. I suspect it will pass, and the markets will recover. Part of the reason these things are scary is because of media saturation to a degree which has never existed. Part of the reason is unknown things are scary. There is no need for panic, though I will be delaying my trip to China.
I read a recent article by Drs. Randy Wax and Michael Christian on critical care and anesthesiology protocols for 2019-nCoV patients—mainly to see what PPE they were using—and thought of you, describing your experiences here with the SARS crisis. Absolutely fascinating.
Thank you very much for your hard work and service. You help keep people like the rest of us safe.
I trust and hope your administration cares more about you—even if it is only so you’ll provide the best possible patient care—than some of those poor doctors and other health care workers in Hubei Province.
It’s amazing to me to think of who is getting sick and who isn’t. It almost seems random, and hopeless to completely protect yourself. Somehow I’m not sick. Yet. But EVERYONE else in my family is. Amazing.
It’s times like this that must really make medical professionals take stock of how important yet risky their work is (as you are doing). Godspeed.