COVID-19 Update from Dr. Smith: 4/17/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

Today is Friday.  As many have observed, that used to mean more than it does at the moment.  Our Department’s surgeons, me among them, would be finishing a tiring but rewarding week of operations.  There might be rounds to make in the ICU, academic work to catch up on, but the weekend ahead would be clearly distinguishable from today.  Now, not so much.  But enough self-pity!  The curve is flat.  The intrepid marines working at all levels in the ORICUs have improved care delivery in the past few days.  Planning for the journey through COVID to new-normal is exploding, and energizing.

Two days ago, a zoo in northern Germany startled the world by announcing a plan to slaughter some of its animals to feed others, because the coronavirus shutdown has eliminated the admission revenue required to buy food.  For extra sting, they added that Vitus, Germany’s largest polar bear, would be the last man standing (at 12 feet on his hind legs), if the crisis goes on long enough.  I wonder how Vitus will feel about watching his fellow citizens walk the plank, while he becomes Robinson Crusoe.  It’s easy for many people to accept sacrifice of animal lives as a food source in the world at large.  Perceptions of that value proposition appear to change when animals become the food source in their own zoo.  Which animals go first, and who decides?  Is it based on nutritional value (large mammals first), or on popularity (snakes, rodents, hyenas first)?  Uncomfortable parables abound.

It’s perhaps obvious that this German zoo announcement (called “eye-popping” by the New York Times) was designed to draw attention to the economic strains imposed by lock-down.  In the same vein, I’m beginning to feel a bit like Vitus, standing tall on my hind legs as part of our health care delivery system, while the rest of our economy is slaughtered to feed me.  In the vastness and complexity of the world’s economy, how do we weigh the relative value of living things?  How much of our economy, or which elements of it, do we sacrifice to make treatment of COVID-19 our highest health care priority, and for how long?  To simply say “all lives matter” overlooks the complex trade-offs involved, such as patients with COVID-19 displacing patients with other treatable and potentially lethal conditions.  Someday we will have more quantitative guidance derived from epidemiologic calculation of mortalities from all competing causes.  Sadly, our current understanding of COVID disease, and the related immaturity of our predictive models, make this little better than guesswork.  I don’t pretend to have the answers, but my instinct tells me it’s as sad to be Vitus as it is to be fed to Vitus.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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