Blog | Friday, May 8, 2020

Is COVID-19 the same thing or different things?


I took care of some people with coronavirus in the hospital. There was a person in their 90s who didn't want to go home to their family, because their family had forbade them from coming home with the virus. [I've changed details here and there to preserve confidentiality.] There was a 45-year-old who can probably go home tomorrow and won't even need rehab. A 55-year-old homeless woman, who can only murmur that her knee hurts and she wants to go home. She lies in a darkened room, waiting for some overworked clinician to muster confidence against their fatigue that venturing in to see them is worth their personal risk. That the extra minutes they spend putting the interpreter on the line (in-person interpreters cost too much these days, and hospitals are stingy) is worth the technical hurdles.

All these people have “the coronavirus.” But do they all have the same thing? We classify all of them into the bucket of the same disease, after all, because nosology [classification] groups phenomena in useful ways.

But the difference between the disease in a poor homeless woman who doesn't speak English is night-and-day compared to a 45-year-old with social supports.

I can say that coronavirus isn't even its own separate disease: It's a projection of our inequities onto the canvas of the human body, using the bright light of a particular virus.

Thus a vaccine is only part of the coronavirus story, just like a cure for cancer is only part of the cancer story. It won't change the narrative unless we change the plot, the characters, and the scenery.

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.