More than a year into the Coronavirus pandemic, a Fenwick alumnus, whose class is celebrating its 50th reunion this fall, reflects on the pandemic from the perspective of a front-line health care professional.
By Dr. James Tita ‘71
The COVID-19 pandemic has been the greatest public health crisis of our lifetime. Most physicians go through their entire career and never experience an event of this magnitude. As a physician who specializes in pulmonary and critical-care medicine, I found myself confronting an illness that had never afflicted humans.
The SARS-Cov-2 virus, identified only in bats previously, was reported in late 2019 from Wuhan, China, as the cause of an outbreak of a severe viral pneumonia. The illness appeared to be very contagious and frequently deadly. There had been limited outbreaks of two other similar coronavirus illnesses within the last 15 to 20 years, but SARS-Cov-2 virus appeared to be much more contagious. Our fascination with the medical reports coming out China soon turned to dread as the virus spread to Europe and beyond.
I recall our public health authorities estimating that, based on a handful of positive tests in Ohio, the virus had infected 6,000 people across the state by mid-March 2020. By the end of that month, our hospitals went into crisis mode as they were overwhelmed by the number of patients with COVID pneumonia. Elective surgeries were canceled, and most of the hospital was filled with critically ill COVID patients on ventilators. Many were elderly and frail. Supplies such as N-95 masks, gloves and gowns were in short supply and had to be re-used.
Since there were no effective treatments, we offered largely supportive care. Because of the need for strict isolation, families were not allowed to visit, even at end of life. The isolation this caused only added to the anguish and despair. We tried to facilitate video visits, but most times the patients were too sedated to communicate.
Watch the heart-wrenching video from a Toledo, local TV news station.
Caring for patients became difficult because of the constant need for personal protective equipment. The fear that any of us could become infected, and potentially spread the disease to our families, was always present. And yet, despite the long hours and difficult and stressful conditions, our nurses, respiratory therapists and staff demonstrated a level of professionalism, teamwork and compassion that was inspirational. Acts of kindness were easy to find.
Ebb and flow
By summer, the number of new cases had fallen dramatically, and our COVID caseloads dropped. The hospitals started to open for elective surgeries. People grew tired of masking and social distancing and began to let their guard down. It was not uncommon to see large gatherings of people at a party or other event. Unfortunately, the virus was not gone and, by late fall and winter, our case numbers began to skyrocket. Hospital beds again filled with COVID patients.
This second surge was different, however. The average age was about 10 years younger than in the spring. We don’t know why exactly but believe it was related to the fact that the nursing homes, through strictly limiting visitation, were able to keep their residents safe. I think we got better at managing the illness as well. We used more alternatives to invasive ventilation, such as high-flow oxygen. We also had a drug (dexamethasone), which was modestly effective at treating those who had severe pneumonia. (Dexamethasone is a corticosteroid used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects.)
But despite these small improvements, the United States recorded its highest daily COVID death numbers in January this year at more than 4,000 deaths. We are closing in on nearly 600,000 deaths in the U.S. since the beginning of the pandemic.
From my perspective, a turning point came in late November when the FDA gave Emergency Use Authorization to the Pfizer vaccine and, shortly thereafter, to the Moderna vaccine. Last summer we could only dream about an effective vaccine for this illness. While some worry that these vaccines were “rushed into production,” the technology for mRNA vaccines was developed nearly 10 years ago. The Chinese, early in the pandemic, were able to map out the entire viral genome. From there, we were able to find the sequence that coded for the spike protein on the surface of the virus; insert this sequence using nanotechnology into a lipid coat, and the vaccine was complete. These mRNA vaccines have been extraordinarily safe and effective. I was among the first to receive the vaccine in December and strongly recommend the same to all members of the community. The more people we get vaccinated, the less the virus can replicate and the less chance for variants to occur. (Fenwick faculty and staff received first shots in late February.)
For those who recover from COVID, approximately 10% to 30% develop post-acute syndrome. These “long-haulers,” as they are referred to, can suffer lingering symptoms for weeks to months after the infection. Symptoms include fatigue, shortness of breath, racing heart, cough and headache. Many other symptoms have been described including prolonged loss of taste and smell, sleep disturbances and GI [gastrointestinal] problems. Most people with this syndrome were not hospitalized and reported relatively mild COVID symptoms.
We cannot know how and when the pandemic will end. It has been said “the virus will do what the virus will do.” However, given the outbreaks occurring in India and South America, it is likely that COVID will become endemic. [An endemic is a disease that belongs to a particular people or country.] Vaccine hesitancy has stalled vaccination rates in our communities and does not bode well for the U.S. to reach herd immunity. Local outbreaks, such as the one occurring in Michigan currently, are likely to continue until more of the population becomes vaccinated.
Pandemics change history, and it is likely our lives and world will be changed as well. Only in retrospect will we understand the significance of this pandemic.
About the Author
A native of Berwyn, IL, Fenwick alumnus James Tita is a Doctor of Osteopathic Medicine and Fellow of the American College of Chest Physicians. A specialist in pulmonary and critical-care medicine, Dr. Tita is the Chief Medical Officer at Mercy Health St. Vincent Medical Center in Toledo, Ohio.