Life in the Time of Coronavirus (The First 10 Days)

Sheltering in place in a local park 

My, how the world has changed in the past 10 days. As I am writing this, we are in the midst of the biggest modern public health crisis in recent history--the coronavirus that originated in Wuhan, China at the end of 2019 has finally reached American shores and is spreading exponentially. Most of America is under quarantine, and it feels like the world is ending around us.

I remember reading about the novel coronavirus (now CoVid-19 or SARS-CoV-2) in January, right around Chinese New Year. Coronavirus is a group of common viruses that cause the common cold, so I didn't think it was a big deal. Influenza kills thousands a year, and most people don't even get their flu shot. However, the main difference was that it was a novel coronavirus, never before seen in humans (they believe it originated from bats) and we do not have a vaccine or innate immunity to it. I--we--didn't know how virulent it was at the time (about 5-10x more virulent than flu) and how contagious it was, even as news was traveling fast throughout China that cities were being shut down. For the next few weeks, I treated it like an afterthought, like much of the country. At the end of every day's news would be a footnote about the coronavirus, while the rest of the news focused on the upcoming primary and presidential elections. As news of the virus spread, I still did not worry. I would continue on with my travel plans, which included a big vacation planned to Vietnam and Los Angeles in April, and the coronavirus would not derail my plans. Even when friends and family told me to reconsider, I did not want to listen. In all honestly, I was uninformed, didn't realize how serious the threat was and dismissed it until recently.

It wasn't until the news starting getting out about Italy, the epicenter of the European epidemic, where doctors had to make hard decisions about which patients to intubate because there were not enough intubators, that I started paying attention. Friends also told me they were seeing personal tweets by doctors in Italy sounding the alarm. That was March 11. This was not just like the flu--young, previously healthy adults were succumbing to the coronavirus rapidly, ending up in respiratory failure, intubated in the ICU. The flu does not do this. Then, the World Health Organization officially announced on Mar 11 that the coronavirus was officially a pandemic. It was at that point that the dominoes began to fall.

Visiting a local Japanese garden instead of traveling anywhere

My boyfriend texted me that morning, March 11, that his company was recommending that everyone work from home indefinitely for the rest of 2020. Indefinitely? Crazy, I thought. Then the news started rolling in that day that many companies were doing the same, recommending that all work be done from home for the foreseeable future. That night, the news continued to roll in that all schools would be cancelled for the next few weeks, VCU moving to all online classes for the rest of the school year. It seemed like all gatherings, events, and life were being cancelled to reduce the spread of the coronavirus. On Thursday, my clinic was uncannily light as multiple patients cancelled their appointments. We began having to personally wipe down surfaces with clorox wipes after each patient. As this was going on, my phone was blowing up around the clock with group chats and texts from friends and colleagues around the country talking about their own experiences with this rapidly evolving scenario.

Here is a timeline of the events that have happened in the past 10 days, from my perspective. This is by no way an official timeline, just an account of key events that have stuck with me.

Wed, March 11 -- WHO declares Covid-19 a pandemic. Employers start mandating people WFH. Richmond County public schools are cancelled, leaving thousands of kids at home. VCU undergrad extends spring break and moves to online classes indefinitely.
Thurs, March 12 -- Trump announces travel ban from Europe for 30 days. I start wiping down surfaces in clinic. All upcoming weekend activities cancelled, including St. Patrick's Day celebrations.
Fri, March 13 -- Trump declares national State of Emergency. Doctors start recommending that social distancing is the only way to prevent the virus from spreading, to "flatten the curve" to avoid overburdening the health care system. We spend most of the weekend indoors.
Monday, March 16 -- The Bay Area enacts sweeping regulation to "shelter-in-place" until April 7 to flatten the curve, the most conservative measure taken by a region to combat the coronavirus. Frontline medical staff start warning of the dangerous shortage of personal protective equipment (PPE) including masks, gowns, and faceshields for medical providers taking care of covid patients. There is no milk in the supermarket. American Airlines calls us directly, cancelling our flight to Vietnam.
Tues, March 17 -- Trumps recommend no more gatherings of groups >10 people. My apartment building closes, sending its staff to WFH. Apartment amenities close. All educational conferences cancelled for the week. The request for PPE continues.
Thurs, March 19 -- I start wearing a mask in clinic. Only 3 patients in my clinic for the day.
Fri, March 20 -- my attending and I both wear masks in clinic. We conduct our first phone clinic visits. So few patients, we have a short day. Los Angeles joins the Bay Area in "sheltering-in-place," which makes trips to non-essential businesses a misdemeanor. California, New York, Illinois, Connecticut, and Washington all basically order shelter-in-place directives, with varying exceptions. No national quarantine, though there is a huge societal pressure and online movement to quarantine at home to flatten the curve.
Monday, March 23 -- Virginia schools are cancelled for the rest of the school year. The Virginia governor officially recommends non-essential business close, though he falls short of issuing a mandate. And that is where we are now.

A happier moment

As a doctor, patients, staff, and the public look to you for guidance and leadership. While it was hard for everyone this week to deal with the uncertainty of the situation and fear of the future, it was even harder to be a doctor and tell everyone that we simply do not answers right now. I have asked experienced attendings and wisened patients in the 80s, all have said this is uncharted territory. I tried to do my best to stay informed, reading every news article that was published and looking at professional medical societies for guidance, but this only added to my anxiety as here was no new information, and there was no guidance. I was getting the same news as everyone else, no more.

It was the same at my hospital. In the beginning, news was evolving so quickly that the hospital administration provided us with no guidance on how or when to reschedule patients and no plan for dealing with the incoming influx of coronavirus patients (which has since improved in the past 2-3 days). Most of us began taking the initiative by doing what made sense, rescheduling patients for 2-3 months out in hopes that the epidemic would die down but being honest in saying we do not know how long this will last.

Over the past 10 days, I've been on a roller coaster of emotions (well, mostly on the low side). On Monday, as I listened to the Daily NYT podcast episode about the struggle of Italian doctors making decisions about which patients to save and taking care of their colleagues and friends, I cried on my way home from work. Even though as a specialist, I am not on the front lines, I am a young, healthy board certified internal medicine doctor and will certainly be asked to provide backup when the front lines fall. Hearing about the horrors in Italy, I felt like I was preparing myself for battle and was catching the first glimpse of the enemy. On Tuesday, I watched a 30-minute chronicle of the struggle of Chinese doctors to initially contain the outbreak in Wuhan, and sobbed at their heroism and bravery, sacrificing their own lives to take care of their patients. I know as a doctor, I am prepared to answer the call as well. On Wednesday, a colleague reported that a sick leukemia patient presented with high fevers and cough after attending a family BBQ over the weekend, and coughed all over him and another colleague in the hospital, a presentation very suspicious for Covid-19. He reported that there were no more masks in the clinic to protect himself. After work, I panicked and went to Home Depot to see if there were any more N95 masks, but they were all out. I learned that 2 other colleagues did the same thing that day, all with no success. 

A week later, I have a better control of my emotions. I've seen drastic shifts in the way my hospital is running to prepare for the incoming peak of coronavirus patients. The state is stockpiling PPE for health care workers, and it should be adequate. We have seen a drastic decrease in the number of patients in the hospital, keeping vulnerable patients out of the hospital where they could catch the virus, and lightening our workloads. However we all need to double down on the long, uncertain road ahead. This is the calm before the storm.

The economy is in tatters. Hundreds of thousands of people are out of jobs. Kids are out of school, placing a toll on working parents across the country. Infections are still spreading, most notably in New York City. However there is hope. Social distancing is taking root and the message is getting through. This poignant article from one of my personal heroes Atul Gawande, on how to protect health care workers, soothed some of my worries that the coronavirus is not anthrax or tuberculosis. Taking examples from Hong Kong and Singapore, he writes that regular surgical masks (not N95's, which the country has a critical shortage of), proper hand hygiene and regularly wiping down surfaces, seem to go a long way in protecting against healthcare acquired infections. Gawande writes "Those of us who must go into the world and have contact with people don't have to panic if we find out that someone with the coronavirus has been in the same room or stood closer than what we wanted for a moment. Transmission seems to occur primary through sustained exposure in the absence of basic protection or through the lack of hand hygiene after contact with secretions." This is good news for us all.

I do not know how the world will look in a few weeks or months. I do not know how long the epidemic will last, though experts forecast at least 45 days until we reach the peak of infections in America and months before business open up and we are allowed free reign in society again. The Virginia governor just announced this afternoon that non-essential business will close for the next 30 days at least, so we know we will be inside for at least a month. However the silver lining is that we are all in this together. I know that many have lost their jobs, but stringent social distancing, at the expense of businesses and the economy, is required to protect human life. And as long as we survive, we will recover.

A few things I am grateful for right now:
- being quarantined with my boyfriend....I think I would go crazy if I were alone
- job security
- actually going to work every day to get out of the house
- extra downtime to rest at home
- frequent calls/video chats with family and friends-- I feel like this has brought us all closer as a society while we are physically distancing
- time to prioritize exercise (running outside, BBG)
- time to cook

Here are some lighter scenes from this past weekend, where we drove to Maymont, a huge local park to stretch our legs. It was super empty and we had plenty of space to avoid other groups and families. With everything going on this week, we almost forgot it was spring! It was a great time to see the beautiful cherry blossoms that were blooming all around Richmond. 

Pretending we're in Vietnam (which has obviously been cancelled) =(

Pretending like I'm in a Korean drama instead of living in a dystopian fantasy 

A few lighter daily snaps from the week: 

Improvising during a BBG workout 

Chicken milanese with salad 

Can't take credit for this one, lobster ravioli from Costco

Since we didn't have anywhere to go this weekend, I made pancakes! I don't even like pancakes, but wanted something to pass the time. They were ugly but tasted delish! Recipe from the NYT (Perfect Buttermilk Pancakes) and I subbed milk + lemon juice for buttermilk. 

Kogi style beef tacos 

My boyfriend sadly ordered a new camera for our cancelled trip to Vietnam so one of my goals will be to document our quarantine meals with his new camera going forward. Be on the lookout for more updates and better food photos in the next post.