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  9. An Editor’s Invitation: Contagion

An Editor’s Invitation: Contagion

We have entered a period of uncertainty and fear as a new coronavirus infects more people and makes its way around the globe and into our midst.
As an undergraduate, I read The Plague by Albert Camus and wondered what it would have been like to have lived in the time of the Black Death.

As a medical student in New York in the 1980s, I began my clinical rotations at a time when the AIDS epidemic was decimating communities of gay men, of intravenous drug users and of the women who’d been their partners.

Many of the individuals we treated were young and terribly ill. We might be able to temporarily beat back the organisms that were infecting their lungs, their brains, their eyes, their skin, their blood or their intestinal tracts, but we had no real treatment for the thing itself–for the HIV virus–and every diagnosis was a death sentence.

The fear of AIDS was such that some healthcare workers resorted to extreme measures. I recall an ambulance driver who arrived wearing what appeared to be a Hazmat suit because she was picking up an HIV-infected four-year-old. “I’ve got children at home,” she explained to me.
Others of us, offended by this approach, went to another extreme–drawing blood and placing intravenous lines without any protections at all. Universal precautions hadn’t yet come into common practice–and we were left to figure things out for ourselves.
As I recall my inept barehanded attempts at placing IVs, I feel shame and remorse at my ignorance, and exceedingly lucky that the HIV virus is not more contagious than it is–that the blood that splattered my fingers did me no harm.
Over a month ago, in response to CDC warnings of a new virus causing illness and death in China, the staff at my family health center began questioning all patients with a fever as to whether they’d traveled to China in the previous 14 days. (A few days ago, the CDC expanded the list of affected geographic areas to include Iran, Italy, Japan and South Korea.)
For coronavirus updates,
visit this CDC website
If the answer was yes, a staff member was supposed to offer them a mask, and a nurse was to lead the patient to an isolation room, where a gowned, gloved and masked provider–myself or one of my colleagues–would see them and ask if they’d also had a cough or trouble breathing.
If the answer was yes, we were supposed to call a hospital number and get further directives. Presumably we’d take a swab from the patient’s nose and throat–and that swab would somehow make its way to the CDC for coronavirus testing.*
And what then?
I’m not fond of situations like this. It’s easy to say “Everything is under control,” and yet, in the moment, our flawed humanity reveals itself. Where are those special masks we’re supposed to wear? Where’s the number we’re supposed to call? And what about all the other people the patient encountered here today? We’re wearing masks, but the patient rode up in a crowded elevator and sat in our waiting room. What about those folks? And what, exactly, to we tell this patient now?
The devil is in the details.

This month’s More Voices theme is Contagion. We’d like to hear from you if you’re making special preparations to ward off the coronavirus, or if your life has already been impacted by it in some way.

Have you ever lived in the midst of a previous contagious disease outbreak? What was that like?
We’d also be interested in your experiences with contagious illnesses in general. Are you a frequent hand sanitizer? What do you do when your significant other comes down with a cold?

Tell us about it in this month’s More Voices.

Paul Gross
New Rochelle, NY

* Actually not. When we received further clarification, it turned out that our capacity for coronavirus testing was so limited that the only patients to receive testing were those sick enough to be hospitalized. So even if we saw someone with a cough, a fever and a good story for coronavirus exposure, we were told to send them home (but not via public transporation) and have them self-quarantine.



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