What it looks and feels like out in the street - USA - July 7, 2020

Several videos follow.


They capture a situation that no one living today has ever experienced.


A difficult time. In the USA, in the United Kingdom, in Italy or Spain ... take your pick.

Some countries seem to be passing into less turbulent waters. Not the USA. Or not just yet.


In all cases, human resourcefulness is being stretched to the maximum.


In all cases of success, people placed as much distance as possible, between themselves and the SARS-CoV-2 virus. Masks, distancing, sterilizing surfaces, waiting appropriate amounts of time before recontacting items brought into the house. Nothing else works as well. 


In surgical practice, when results were not those desired, it was often due to errors in technique or errors in judgement, but most often, errors in diagnosis. When one applies a good treatment to the wrong disease, the result is often poor. Here, the diagnosis is known: COVID-19. 

So not wearing masks on purpose = an error in judgement. Laws of probability for something this transmissible, mean that eventually such a faulty judgement leads to loss. A bad result.

Errors in technique are unfortunately common if people haben't been messing with masks aand gloves and disinfectants and hand washing for 5 to 20 or so years. Most of the time, you sneak by, and the patient does too. But if errors in technique happen too often, you're up against the laws of probability once again. Oops! and you have a bad result. 


In surgery, bad results, though frowned upon, were privately a source of sadness, and often took years to excuse, and ofte never were. Forty years later, some are never forgotten. All that represents a willingness to bite the bullet, learn from one's mistakes, share openly what one has learned, and get on with a better result the next time. We laughes at ourselves often. But the dedication to "potential patient benefit" as we gave our all (at least many who's company I shared, did just that, each and every time) to select what just might help the paient get better ... that was never taken as a joke.


I'm not sure that I see that level of dedication in much of what follows. It's now time for the jokes to end.

There is only one side to take in all of this. That of humanity as it currently exists worldwide. We have to all get on the side of our fellow humans and give them our best. Tired or not. It starts with ourselves. Each one getting her or his technique down perfectly. Teaching it to others. Sharing. And getting enough rest to be able to stay in the trenches. It has come down to that.


When one listens to the experts at NEJM, JAMA, Lancet and others, present what they are learning, understand that the experts are still learning a lot. Think of terms like asymptomatic transmission, droplet transmission for hours in closed spaces, the special role of children in all of this, Blood-Type differences in outcomes, more transmission of virus in homes than at the hospital, antibody responses that are hard to make use of,  to name a few. They are learning, they get surprised each day, they still try to keep that "expert look." Don't get angry when they seem to fall flat on their faces. This is noy appendicitis or a duodenal ulcer. We've studied and treated those for years. And still make mistakes because the unknown never drops to zero. 


But for SARS-CoV-2 or COVID-19, the unknown may still be a majority of what we have to learn.

That has nothing at all to do with saying the right thing to garner more votes.


But we are learning. And the people in the street are learning. Too often the hard way, after a 3 to 6 week delay. Saying goodbye to family members from a distance, through a window. 


Just as we wrote back in late February, the right aproach comes from Uncle Remus (no matter how those stories are now taken in the new racial context): "An Br'er Fox, He Lay Low." Continue to be like Br'er Fox. An Br'er Bear too. Lay low.  


For all of those at the bedside of sick patients today, from my comfortable seat across the Atlantic, I honestly wish I could be with you at the bedside, doing together all that we can. Sharing what I learned as an ICU Director, and learning more together. Caring for each other while caring for others. I also fear that such dedication to a vocation, might quite likely end as a fatal error if I got on the plane and just showed up where needed. So my prayers for you and yours are constantly in my heart, and often on my lips. Rest assured.


As one watches below, nothing else need be said. Nothing else can be said.


















"An Br'er Fox, He Lay Low."


This is a much bigger, stickier, and nastier Tar Baby, than Uncle Remus ever imagined and wrote about.

It doesn't have a brain. It just has it's RNA, and a helluv' an effective way to distribute it and assure its Darwinian success.


Who will be "the fittest"?


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