key: cord-0711631-5pm2pj0p
authors: Brooks, Oliver T.
title: What If They Threw A Pandemic And Nobody Came?
date: 2020-05-22
journal: J Natl Med Assoc
DOI: 10.1016/j.jnma.2020.04.005
sha: 6f2db6bd33c721dee94a631e88cf76e616b94789
doc_id: 711631
cord_uid: 5pm2pj0p

nan

Author affiliation: Chief Medical Officer, Watts HealthCare Corporation, Los Angeles, CA, USA W e are at present in the throes of a SARS-CoV-2 pandemic, the coronaviruis that causes the disease process COVID-19, characterized by fever, cough and shortness of breath 1 that may lead to death.

A pandemic is defined as "an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people". 2 The classical definition includes nothing about population immunity, virology or disease severity. By this definition, pandemics can be said to occur annually in each of the temperate southern and northern hemispheres, given that seasonal epidemics cross international boundaries and affect a large number of people. However, seasonal epidemics are not considered pandemics. A true influenza pandemic occurs when almost simultaneous transmission takes place worldwide.

The WHO declared a SARS-CoV-2 pandemic on March 11, 2020. President Trump declared the United States in a SARS-CoV-2 state of emergency on March 13, 2020. So where are we as physicians now and what should we do?

The first response is well-known by now; we are right here and we know it is the same in any outbreak: identify, isolate and quarantine. Treat those that need medical intervention. The CDC recommends social isolation of at least 6 feet/2 m. 3 Simple enough. Now what?

We need the country to not join the "party": this is where I will diverge from referenced information (except two more). Everyone at this point knows that there is a plentitude of credible information being updated daily from the CDC, the WHO, state and local health departments, and so on. Allow me to speak more personally.

I am the second NMA President to serve during a pandemic. The NMA President in 1918 during the Spanish flu epidemic was Dr. George W. Cabaniss. I do not know what the challenges were then, but I but I am sure they were legion. The message I would like to convey is that in times of high stress, in this case a pandemic, management of this, by we physicians, is what we were trained to do. In the end, medical school and any subsequent training was to provide you with the tools to face medical adversity, aka illness. Dr. Lasalle Lefall, my now deceased and world-renowned Professor and Chief of surgery at Howard University College of Medicine taught us "equanimity under duress" (my reference is my colleagues). I see now that this applies not only to the hemorrhaging from a nicked femoral artery in the OR, but to a challenged healthcare system and population during a pandemic. We are on the frontlines, treating COVID-19 cases as we speak. We are also still managing face to face our pregnant women; those needing an appendectomy; those with acute chest pain; the suicidal. Essential care and pathology do not go away during a pandemic. However, as we are learning from COVID-19, chronic disease management before a pandemic is also crucial during a pandemic. Studies are showing that those with certain comorbidities (chronic lung disease, moderate to severe asthma, serious heart conditions, those immunocompromised including cancer treatment, severe obesity (body mass index [BMI] 40) and (particularly if not well controlled) diabetes, renal failure, or liver disease are at higher risk for severe illness. 4 We must reduce these populations of patients with these and other comorbidities. Most of these comorbidities are avoidable; we need to ensure our patients "avoid" them.

Leaving treating illness behind, we have been forced to evolve with our training to understand that there is the next level; that is not just healing the sick and reducing comorbidities, but keeping the healthy well. Wellness as a primary focus is just as important as secondary medicine; we all know this but it gets magnified during a pandemic. The consensus is that those that are healthy are less more likely to have mild disease: proper sleep, diet, and personal behaviors lead to better outcomes. It is unclear which is easier to manage as physicians, getting patients well or keeping patients well; it does not matter because we are ª 2020 Published by Elsevier Inc. on behalf of the National Medical Association.

https://doi.org/10.1016/j.jnma.2020.04.005 charged with managing both. If we treat the sick and keep others healthy, we will succeed, as best we can in mitigating the effects of a pandemic.

We as physicians need to know more about COVID-19 than anyone else, as we pledged an oath (of Hippocrates or Imhotep) to be ready for anything related to health and wellness, e.g. a pandemic. No one else being called upon to act at this took such an oath (except perhaps the police or military). When the whole of society has closed down, shuttered their windows, locked their gates, and gone home to be with their loved ones, we will be the ones that the National Guard will allow to pass onto the highways, with one flash of our MD ID badge. This is our responsibility, to be there when no one else is: to prepare, to have answers, to calm, to treat, to heal, to be responsible. My title was a bit misleading; there will always be pandemics, and those affected by them, but if the popu-lation is healthy, the response is robust, and the knowledge disseminated is accurate, widespread and implemented, we can blunt the effects of pandemics going forward. Let us hope that, just like with a war, it will be poorly attended and over fast.

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

A Dictionary of Epidemiology