COVID-19 Update from Dr. Smith: 5/10/20

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,

I have already thanked my mother today. She and my father will be 95 years old at the end of this month, and are doing as well as can be expected under lockdown in an excellent assisted living facility in Virginia.

Yesterday on its front page The New York Times celebrated the recently-discovered Covid-positivity of two aides in the White House entourage. “The virus is in the White House,” gloated an Obama appointee, who concluded that this event “…has the potential of undermining confidence in any capacity to defeat it.” I wonder if the commentator applies the same standard to hospitals.  NYP and other hospitals are testing their workforces, and are finding a measurable number of asymptomatic infections (rapidly evolving data, unpublished, probably around 5%). Testing for antibody by NY State found 12.2% positive healthcare workers, compared to 19.9% in the general population. Does that undermine your confidence? We know coronavirus is everywhere, a fact that makes the adjective “Covid-free” ludicrous. All hospitals are Covid hospitals, and all houses are potentially or actually Covid houses. Finding virus in the White House does undermine outrage against fortress elitism that keeps the evildoers above the flames while Rome burns.

My point is not left-right politics. My point is how we project “confidence in any capacity to defeat it.” Our hospital and our offices represent the White House in the NY Times story. In my view, our ability to build confidence depends much more on the tangibles than the intangibles. Tangibles are the things our patients can test with their senses. From parking garage to front entrance to reception desk, do surfaces look and smell clean? Are masks being worn? Are they greeted with a combination of courtesy, competence, and calm? Is social distancing provided for, and politely reinforced, rather than sternly imposed? Do healthcare workers appear comfortable in the presence of patients, rather than wary? Is hand hygiene readily available, and are healthcare workers using it? If confidence is a pyramid, tangibles occupy the lower two-thirds.

Among intangibles, testing is the most complicated and controversial. Why is testing intangible? Because there is no way to determine someone’s testing status by sight, touch, taste, or smell, and there is no practical way to verify a status claim in most encounters. We will surely be telling our patients and co-workers what kind of testing we’re doing to minimize risk of transmission for all parties, but any reassurance added by “testing” will rest on the confidence we’ve built through our tangibles. Even if test status could magically be made visible, with an immune-mediated variably-colored spot on the forehead, the limitations of testing are increasingly well understood, and were not ignored in the New York Times article cited above, to their credit. If all we tell patients is that 5% of healthcare workers have asymptomatic infection, they will still engage with us when necessary, and their confidence in our mitigation of that risk will be derived from the tangibles—masks, hand hygiene, and all the rest. 

Returning for the final time to “confidence in any capacity to defeat it,” I will suggest replacing “defeat” with “manage.” That goes against the war metaphors widely exploited by me and countless others…or maybe not—did we “defeat” Germany at the end of WWI? I wouldn’t say we’ve “defeated” SARS or Polio, but we have managed them. Managing is also a more comforting concept to apply to the world’s rampant fear of a resurgence. Based on everything I’ve read and heard, including at least four serious epidemiologic modeling attempts by credible scientists, I’ve concluded that we may or may not have one or more resurgences, and they will either be large, small, or in between. Whatever the future holds, we will manage it through some combination of responses that have been refined by experience gained in our first surge. The arc of science bends toward progress.

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

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