Kate Rassie, a New Zealand doctor living in Melbourne – but writing in her personal capacity – reflects on an unfathomable week.
This piece was first published on March 20.
Highly specific items do remain on supermarket shelves. Even in a pandemic; no-one wants canned tater tots, canned mushrooms, large-sized squeezy bottles of pizza sauce or mung-bean pasta.
There are some extraordinarily gifted statistical modellers among us, and I am grateful to them. (This is ten days old, but has had more than 30 million views and is still by far the best explanation I’ve seen of all of this. It’s utterly worth the 26 minute read).
Something about all this feels awfully medieval, doesn’t it?
We should absolutely be social-distancing.
But I liked shaking hands. I liked farmers markets. I liked coins. I liked strictly unessential meetings. I liked keep-cups. I liked shared lunches. I liked communion wine. I liked dancefloors. I liked gatherings of more than a hundred people.
Busy public places filled with slightly-panicked people are awful.
Eerily quiet public places are safer, but feel much worse.
Radio, as a medium, is perfect for a time like this. When one is anxious, clicking-and-scrolling becomes feverish and fragmented. You’re an untrustworthy pilot of the narrative. Radio allows you to relinquish control, to be taken by the hand and guided through the facts.
Virologist Chris Smith from Cambridge University, who talks regularly to Kim Hill on RNZ, is an international treasure and a gifted science communicator.
One of the most difficult things about this issue is its invisibility: unless we’re on the front line, our day-to-day worlds in Australasia currently look much the same as they always have (supermarkets aside).
That’s because, unlike bushfires and volcanoes and shootings, this thing happening is on a macro level (population transmission, growth curves, mathematical projections, travel networks, economic systems) and a micro level (viral capsules, proteins, receptors, vaccines). These both require an enormous amount of abstract thought, and a whole new vocabulary. I think that’s part of why we finish each day feeling so intellectually exhausted.
We are all bitterly disappointed about something. There’s a pathetic little child in all of us wheedling, but I was so looking forward to that.
There’s a bizarre irony (and a significant practical challenge) in the fact that a situation requiring unprecedented teamwork and extraordinary coordination of human response also requires physical separation.
We still have babies, and fresh bread, and wine, and smiles, and birdsong.
While this feels like it’s hitting us all hard, it’s also accentuating the disparities in our society. It’s a top-slice luxury to work from home, to avoid crowded subways, to have an internet connection and a pantry. A patient came to my diabetes clinic to get a prescription today (she’s terrified her insulin supplies might be exhausted, and I don’t blame her). The bus services are stripped back, so she’d been up since 4am making the cross-town commute. By the time she arrived her blood sugar was dangerously low. We gave her jellybeans and a cheese sandwich and she left, alone, to find a pharmacy that wasn’t out of stock.
Which brings me to important and urgent. Covid-19 is currently both of those things, and is – quite rightly – our sole current focus.
As well as the urgent, though, I’m worried about all my equally important patients with probable cancers and high-risk pregnancies and new diagnoses of diabetes. We’re already indefinitely cancelling all elective surgeries and outpatient clinics for the foreseeable future (these already had year-long waitlists). There simply is no contingency plan for the other side. All of this will, left untreated, also become urgent (perhaps not tomorrow, but in days or weeks or months); and I honestly don’t know what the health system will look like then.
New Zealand is an excellent place to live.
I’ve been thinking about pangolins a lot. They’re a possible scapegoat, an unwitting viral vector, a potential intermediary between horseshoe bat and human in the origins of all this. Look at a picture and try to feel sympathetic, I’m not sure I can. They are repulsive, with lean conical snouts and damp brown noses and scalloped armour.
As the world’s most-trafficked mammal, they are apparently best served braised or steamed, with ginger or citronella.
Surely, this is a lesson that universal healthcare is a necessity.
Doctors are intrinsically careful people. We like evidence and guidelines. Our training teaches us to do things with extreme caution, and to avoid rash decisions. We do not use drugs until we are sure they are absolutely safe. An article in a reputable academic journal ordinarily requires multiple rounds of peer review over several months, careful referencing and micro-analysis of statistical accuracy. This situation challenges all of that. But we’re stepping up. We’re being quick, flexible, dedicated.
Less than two weeks after the first reported cases (December 31), the entire genetic sequence of the virus was mapped. We’ve created and mass-produced diagnostic tests. We’ve identified the cell surface receptors the virus uses to access human cells. We’re feverishly trialling antiviral agents (existing ones ones repurposed, and investigational ones). We are researching the effects of Covid-19 on the liver, in pregnancy, on heart muscle, in smokers, in the immunocompromised. The first trial dose of a vaccine was administered in to a patient in Seattle on Monday. There are already more than 1,000 rigorous, peer-reviewed articles in the medical literature on Covid-19.
We’re going laterally, too. We’re researching the psychological implications of quarantine. We’re creating telehealth hubs so we can see diabetic and cancer patients outside of hospitals. We’re devising new statistical modelling techniques. We’re trying to work out why children seem relatively unaffected, and whether they may be capable of asymptomatic transmission. We’re preparing for a burgeoning mental health crisis. We’re cancelling all our conferences, and organising big online international conferences on Covid-19 instead. We’re on the internet late into the night talking about this thing, because none of us can sleep.
Lost money has taken on an arbitrary feeling. No, you won’t get a refund, but nor will anyone else. The business may fold anyway. Money suddenly seems conceptual, a highly-contrived social construct; far less real and less important than lungs and respiratory droplets.
I saw a mouse today, on our suburban street in Melbourne, licking an empty Nutella sachet. He looked absorbed and blissful. I stood and watched him for three minutes and felt jealous.
All of us, regardless of social standing or financial status or positions of power; are dependent every minute on the gas exchange that occurs across damp tissue-paper membranes in our alveoli. We are only as good as our immune systems. Each day, we all take our improbably precarious knife-edge physiology for granted.
You might, in extremis, spend $4.50 on a canned of tinned tomatoes at a specialty grocery store, because no supermarket in the city has them. They taste like privilege and guilt.
Dr Ashley Bloomfield is doing an excellent job at fronting for public health in New Zealand. He also looks like he is rapidly losing weight and has not slept for days.
I am enjoying the sun and my morning cups of coffee with a sort of desperate, potent, pre-apocalyptic gratitude.
No-one panic-buys Easter eggs. The displays are untouched, and it’s the only aisle in the supermarket fully stocked.
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