by Mark Wallace, MD, MPH, Executive Director of the Weld County Department of Public Health and Environment
Featured in the May-June 2020 Colorado Medicine Colorado Medicine.
For me, as with nearly every one of us, life has changed very dramatically. While many of us in this profession work long hours, I think for many of us – especially for people my age who are mid-career – this is recalling for us the days back when we were interns and residents working 110 hours a week and struggling to find that time to rest and regroup. It’s a good thing that a kind of muscle memory remains, that you can put yourself into a place where you are working hours that are out of your control and that are often filled with uncertainty, and be able to adapt, maneuver, innovate and respond in ways that are very similar to our training years. I don’t do hospital medicine anymore but it is a good thing that I was trained that way so I could be prepared for this.
Well before this crisis, we were a profession in an extreme state of burnout. But for me personally this is one of the situations where you see what physicians and our colleagues can bring to an unprecedented challenge: The unceasing giving of themselves to care for others – taking personal risks that leave them with decisions about whether they can go home to their families and questioning whether they have the right equipment that they need to protect themselves while they’re at work – but they show up every day and they are at the top of their game. They tell you that this is what they prepared for, this is who we are, and it’s our time to step up and do it over and over and over again.
For me there’s an energy behind that. As difficult as it is some days to hear the stories and see what my colleagues in the hospital are facing, it also highlights this critical connection between community and hospital. This response that we’re trying to do, this war we’re waging, won’t be successful if it isn’t connected all the way from public preventive health through this emergency response into the hospital and then back out into the community.
I frequently start my day with connections to my Weld and Larimer county colleagues who are on the front lines in the hospitals, the chief medical officers and chief executive officers of Banner Health and UCHealth, as well as Sunrise Community Health Center. Where are we, how are we doing, how many vents do you have, how many people are that critically injured, how many people came in last night, where are you with your personal protective equipment (PPE), what do you need? I am fortunate to be in a community that, while we are a hot spot, has partnerships that we have built over years of caring about our mission, of being disciplined in how we built our trusted relationships, so in moments of stress like this we don’t have to worry if we can rely on each other. It’s always a yes.
We’re really fortunate to have strong health care systems up here, and we’re really fortunate to have incredible clinical people – the doctors who are part of the Northern Colorado Medical Society – but also the nurses and first responders. I sit on calls every day with the city managers and with those leading first response. We built the right foundation for us and that has made it possible to keep going at this pace.
One of these examples of a little place where you can take control is PPE. It is such a critical part of this fight to save the people who are out there on the front lines. When you’re in the environment where all of these resources are scarce, it’s easy to get discouraged and start to wonder whether you’ll need to change the calculus about how many people are going to get infected and potentially die. Then people come together. Our health department organized a PPE drive and had all sorts of people bring in supplies, from painters to construction companies to those in other science-based fields, and they gave generously in recognition that we have to protect the people on the front line. Again, it gives you a boost. We realize we can make it for a little longer.
Even when it comes down to some of the more controversial things, where we finally got to the stage where cloth masks were being recommended, even though at the beginning we were not recommending them, again we saw a tremendous outpouring from the community; folks who I don’t think had sewn in 25 years pulled sewing machines out of their basement and got to work. I walked into my office one day and there were three gorgeous masks on my desk that had been given to me. There are lots of those bright points where we see what communities will do.
The hardest part of this is the ongoing uncertainty, and it’s the area where I spend most of my day: how do we look at the prevention of the spread of this disease when we can’t pursue our normal way of aggressively managing something like this. We have to constantly innovate and work without evidence, which is a difficult place for evidence-driven physicians! I urge caution. We could end up doing harm and that’s the last thing we want to do in our need to innovate quickly.
Rising above the current situation to the 30,000-foot view, there are some things we’re going to have to wrestle with. One is that we are in a cycle of these unknown emerging infectious diseases. We’ve had them in different ways, some of them easier than others: H1N1, SARS, MERS and now coronavirus. My hope is that we exit this pandemic with a sense that it will happen again – not to depress us but to say we are going to be better when the next one comes around. There’s a resilience in human beings. This has been dramatic enough that we’re going to figure this out. We are going to have a long-term view of the world that says we can’t ever let ourselves get in the position in which we don’t have PPE, in which we are not prepared to immediately respond. How does community engage again so that we also have muscle memory on social distancing? How do we get back to all those things we love but be prepared so that if we have to come back around to it quickly we can do it? We’ll be able to acknowledge all the things we did before and be ready to do them again. I’m hopeful we’ll learn some things out of this and not have a short memory.