Blog | Thursday, May 7, 2020

COVID-19 Quarantine: Are we afraid of going back?

Gov. Brad Little of Idaho issued a statewide ”stay at home” order at the end of March and my little town has been staying at home because of an earlier mayor's order. The whole U.S. has been increasingly moving toward self-quarantining. People throughout the world are being asked to avoid sharing space and sharing germs with others. Buying and selling and traveling aren't happening much. There is very little going to school, receiving non-essential services, partying, touching, or breathing on people outside of our immediate biological or chosen families.

Some people are getting bored. Many are feeling challenged by having to do things that aren't normal for them, things like cooking, cleaning, childcare. Many of the things that filled our days are just not happening. There is a whole lot of quiet.

The creativity that is happening in the absence of whatever it was we used to do is pretty stupendous. People are writing for each other and making music. They are doing crafts and sharing the how-to's online. Very rich people have nothing much to do with their money and are donating it to causes or initiating projects aimed at improving the situation, but also improving the world in general.

There are also new and familiar terrible things going on such as the poor getting poorer and relationships strained to breaking because of too much togetherness. Some people are drinking too much alcohol or doing too many drugs or gaming until their eyes cross and they develop bedsores on their nether parts. We all react to stresses in different ways.

Skies are going from dirty brown to brighter shades of blue as air pollution from factories and cars recedes. Pandas are mating in a spectator-free zoo for the first time in I'm not sure how long. Wildlife is coming back to cities. We are producing much less carbon dioxide and much less waste in general.

In medicine, my field, all kinds of changes are happening. In places where people brought the novel coronavirus from distant parts and then mixed with other people in close quarters, places like New Orleans, New York, and Detroit, hospitals are hopping and people are dying partly due to having overwhelmed the medical system. But in these busy places, doctors and nurses and aides and administrators are using ingenuity to solve problems that have been around forever but are now critical. In smaller towns we are slower to experience the epidemics and are still in a state of quiet waiting. Few people are seeing doctors for problems that don't seem to need immediate care. My days are slow and I am able to concentrate fully on each patient I see (or talk to, as the case may be.) It's a little eerie.

We have all made changes. My colleagues and I are talking to patients on the phone or seeing them on a video monitor rather than bringing them in to the clinic where they can infect us and we can infect them. It is not ideal, but it is not terrible. In fact, some of these “virtual visits” are more appropriate for a patient than coming in. In hospitals physicians and staff need to conserve personal protective gear like masks and gowns and so they are batching care, one person will bring in a meal tray, check a blood sugar, hook up an IV bag, pass a medicine, draw a blood test, change a dressing, all in one fell swoop. One person, one exposure, one set of protective gear. Also this is great for a patient who usually gets disturbed and woken many times in a day, interrupting the rest that would be healing. This means that we do need to adjust our dosing of medication so it corresponds to mealtimes, but it turns out that works just fine.

Some hospitalists who are at higher risk of infection or who need to self-quarantine work from home to provide night coverage. They can take calls from the hospital about routine questions, allowing the doctor in the hospital to sleep or concentrate on work at the bedside.

Good stuff, but also balanced by alarming economic devastation, with huge numbers of people suddenly unemployed with no obvious way to pay for necessities. Despots are grabbing power and painting human rights as optional. Leaders are undoubtedly getting away with all sorts of hanky-panky while citizens are otherwise distracted. There is the ongoing tragedy of disability, pain and death from the disease itself.

And also the very real strangeness for all of us, as social and tribal animals, now unable to casually touch and mingle.

We are all ready for this to be over. But maybe not …

Besides wanting some of what we had before being told to stay at home, many people voice that they don't want to return to the way things were. I think people are a little worried that we won't have learned anything. That we will return to wasteful excesses of travel and spending and expensive oversized sparkliness. That we will forget that we are all so very connected when there is no deadly virus to connect us. No worries. We will not be going back. It is not at all clear what the configuration of the world will be when this is all over, but COVID-19 has become part of who we are.

These are a few of the things that can't be undone:
1. We have found out that at least some of us can get a lot of things done from home, without going in to work. This saves resources of many kinds: fuel for commuting, office space at which to confine us, childcare … We can be more flexible with work hours which would allow us to serve working people better and coordinate with colleagues in different time zones. Businesses would have to be crazy not to take advantage of this.
2. We have noticed that we don't need to spend so much money. Many of us have been spending much less money in the last few weeks by not going anywhere. As a world, we are also not doing some of the very costly things that we did do, things like the Olympics or big conventions or professional sports. It will be nice to have some of that back for sure, but we will have survived just fine without it. This will have a durable economic effect. If we spend less money, we need less money and that means that we don't really have to work as hard or as long. It won't be seamless (people in poverty will still need to work just as hard because they had no excess spending) but overall we know we can consume less so we can also produce less.
3. In health care we have proven that leaving a significant number of people without access is neither humane nor practical. That a business model for delivering care, with a workforce just large enough to take care of our usual number of patients, minimizing infrastructure and lacking the ability to expand will leave us in a terrible situation at times like this. We will have to see that it is very expensive as well as tragic when we do this wrong.
4. We have learned that there is an astounding generosity of spirit among regular people: generosity of time, money, and courage. That we can do amazing things when we really want to, and we really want to take care of each other.

Janice Boughton, MD, FACP, practiced in the Seattle area for four years and in rural Idaho for 17 years before deciding to take a few years off to see more places, learn more about medicine and increase her knowledge base and perspective by practicing hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling. Disturbed by various aspects of the practice of medicine that make no sense and concerned about the cost of providing health care to every American, she blogs at Why is American Health Care So Expensive?, where this post originally appeared.