What can I say that hasnât already been said about COVID-19? Perhaps not much. Iâve never experienced an event that has captured the worldâs attention and imagination as intensely as this. Across medical literature to opinion editorials, from family and friends to my own thoughts early in the morning and late at night, COVID was everywhere. And now I come to this; what have we learned thus far? What is the underlying theme that I now attach to this period of my life that so changed the way I viewed the world, medicine, and the way we live?
Letâs go back to the start.
I first read about the news from Wuhan on social media. My memory of it all was that there was an event where a few hundred people were thought to have become sick after being exposed to an unspecified (but heavily speculated) substance. I did not think much about it. After all, bouts of flu-like illnesses are not necessarily considered a strange event, in any case, I thought the whole thing would blow over, and the reports I had read seemed mostly unconfirmed. However, things quickly started to change. The reports changed. Suddenly, the number of infected individuals rose to the thousands. There was a novel coronavirus affecting humans. It wasnât just a regular viral outbreak, it was a severe pneumonia causing Acute Respiratory Distress Syndrome and many people were dying. A young doctor was being censored by authorities for calling for international attention to what he was certain was a new health crisis.
The novel SARS-CoV-2 virus and the syndrome it created; COVID-19 felt to me like an interesting but singular occurrence, not something tangible that I would probably ever see up close. After all, when had I ever seen a case of SARS? At the time, every person affected seemed to have a direct connection to Wuhan or the main event. As scientists were rushing to make sense of it all, I saw reassuring posts about how there were no cases of âcommunity transmissionâ and put the whole thing on the back of my mind. All of this information was fragmented in bits and pieces of what I could gather while still being fully preoccupied with my day to day duties as a medical intern. Â Itâs hard to worry about something that’s happening 7000 miles away when there are sick patients in front of you and youâre scurrying to do everything that needs to be done in a day. My parents were more concerned than I was. But gradually the news started to become far more worrisome. The city of Wuhan was in an absolute lockdown, and the images and news were nothing short of horrifying. Community transmission was widespread. In what now feels like an instant, coronavirus exploded into our collective consciousness as the eyes of the world tracked its every move. Then came the wave of international surges. South Korea, Japan, Iran, Italy, Spain. On March 1st, New York State had its first case right here in New York City, by March 11th, the World Health Organization declared Coronavirus a pandemic.
I never thought it would hit us that hard or that fast. Itâs difficult to overstate how scary those first few days felt. Guidelines appeared to be changing shift by shift, treatments were recommended, then avoided, or avoided then recommended, and we got mask upgrades. We didnât have enough time to watch the news, and sometimes we found out, we were the news. The flow of patients was torrential. The information flow quickly overwhelmed even the fastest readers and yet, many times we felt that there was nothing we could do, we just didnât know enough. This disease had broken through the barriers of age, race, and background. We feared for ourselves and our families wherever they were, and for each other.
Slowly, the first few of us started becoming sick, and there was little left to do other than to support each other and cover whatever shifts lay before us. It should not be overlooked that it took a certain amount of courage to rise to the challenge of filling someone elseâs shoes, knowing we were possibly exposing ourselves to the same culprit. âTake your time. Get well soon. Donât worry.â During those earlier days, it wasnât uncommon to hear comments, sometimes jokingly, other times sincere, about whether or not all of us would make it through this crisis. We talked about advanced directives, some already making their wills. I heard a resident ask an attending if they would save some ventilators for staff (just in case). It all seemed somewhat exaggerated to me, except it wasn’t exaggerated at all and I knew it.
Yet even in such circumstances, nothing could distract us from the task at hand. We had patients to take care of, some of which were critically ill in non-monitored settings and all our efforts and vigilance had to be on them. We soldiered on. Adapting quickly to a new normal; social distancing, WebEx meetings, daily PPE. Our goal was clear, minimize exposure, but provide the best care we possibly can.
New York became the worldwide epicenter of the pandemic, with an exponential growth and disproportionate amount of cases that still baffles experts and the public alike. Despite shutdowns and social distancing, it seemed that the number of cases was just going to continue to rise. Painfully, many lives were lost. Our morgues quickly backed up. On a particularly bad night, after two consecutive unsuccessful codes, I went to the bathroom and cried. Was this going to be the same for the rest of the year? The rest of residency? The cases just kept rising, it would not have been sustainable had it not been for the enormous amount of support we received from every corner of the hospital and beyond.
Battling coronavirus is the new definition of a âteam effortâ. It simply is not possible unless people come together, and in more ways than not, we did. I am still in awe of all that we were able to accomplish and eternally grateful for everyone that stepped up to do their part during this crisis. I would never be able to say thank you to everyone who helped and encouraged us during this time, but I will make an effort now to name but a few; Iâm thankful for the international medical community, and the way we shared medical information so quickly, I think back to when I had my first COVID patient, and already had a helpful one-page summary from an Intensive care doctor in Seattle. For all the donations we received, such as from our colleagues in South Korea and China who sent over N95 masks, to our friends and allies in the neighborhood who sent us encouraging posters, letters and food, not to mention the World Central Kitchen who provided 3 warm meals each day for every single worker in the hospital. Iâm grateful to the nurses and doctors who came from all over the country to help with the pandemic. Including the critical care attendings who rounded with us remotely from North Carolina and Maryland, or the critical care fellow I met who came from Philadelphia to help during the surge. More help also arrived on our doorstep when the U.S Army physicians and nurses were redeployed to Jacobi and helped carry the heavy workload alongside us.
I am thankful to the Einstein students who reached out to many of us and offered their time and help, and for the outpouring of love we received from different residency programs. I am especially thankful to our colleagues in other specialties who worked side by side with Internal Medicine residents so we could overcome this challenge together. I thank the chiefs and our attendings for their continued teaching and support, and our leadership for listening to our concerns and adjusting quickly to the changing landscape so that we felt heard, appreciated, and protected. I am most grateful to my fellow residents. Now more than ever I am blown away by their hard work, determination, and humanity. It is remarkable how during these difficult times we still managed to learn from and help each other, even more than before. I am proud to be part of your ranks.
One day, without even realizing it, we passed a turning point. Each day brought less cases than the day before. We could feel ourselves breathing easier. The overhead announcers started playing happy music instead of code alarms. Gradually we realized, we had passed the peak. At this moment in time, we can look back at where we were 2 months ago and cautiously say that things are slowly drifting back towards normal. In New York City the cases have been trending down for several weeks, and we are seeing âregularâ patients again. The city is slowly easing restrictions, and we are looking forward to a reopening. So what have I learned? That extraordinary circumstances bring extraordinary people together. Our ability to change, adapt and learn are greater than we could have imagined. Itâs also to OK to cry. We are better and stronger today than we were three months ago. And while the world thanks healthcare workers, we should also thank each other and the world because there is not one person who could have faced this crisis alone. I do not know what the future holds, whether or not we will have a second, third or fourth wave, or if this is a one time fluke that will not happen again until 100 years from now. The only thing I know is that united we can overcome the challenge.
Melissa Elaine Berges Morales, MD From my early experience during the 2020 COVID-19 pandemic at Jacobi Medical Center and Jack D. Weiler Hospital.