Before the age of modern understanding and drug development, HIV sparked fear, anxiety, and panic throughout the country. My eighth-grade science teacher was the first to teach me about HIV, a virus that makes so many mistakes in replicating itself that it confuses the host’s immune system with its mutations. So fascinated by this bizarre product of biology, I knew then that I wanted to study viruses. I read all of the books about Ebola and emerging infections of the time. After college, I worked in multiple microbiology laboratories, eventually culminating in a brief career in hospital labs, at one time managing the majority of T.B. specimens in a major city and handled thousands of MRSA cultures before heading off to medical school.
Some years later, during my internship, I took care of an HIV patient with colon cancer. He was only in his early 30s, but his failing immune system from years of unknown positive HIV status left him predisposed to the malignancy. He was one of my last patients before I moved on to a career in radiology. After he complimented my necktie during rounds one day, I gave it to him. He was flattered and grateful, but given the fact that I still remember this encounter so many years later, I believe that he made a greater impression on me than I on him. Being a radiologist now leaves me largely without these sorts of interpersonal patient relationships, but my memory of him had a clear effect on my understanding of infectious disease from the spectrum of basic science to the bedside.
As the current pandemic continues to evolve, we now turn our attention to antibody testing. Unlike the diagnostic tests that look for the genetic material of the virus in the respiratory tract, antibody tests provide information about whether your body has been exposed to the virus before. We learned in the early days of HIV, when antibody testing was all that we had, it sometimes took six months before someone became “seropositive” for the virus, meaning that a given patient’s serum showed signs of response to an infection. Luckily, technology has advanced, and our hope is that antibody testing will teach us about coronavirus faster than was the case with HIV. Antibody testing will provide much greater insight regarding the incidence of COVID-19. This information can be used to better approximate the number of infections and calculate a more accurate mortality rate.
Interestingly, Major League Baseball decided to pitch in and facilitate antibody testing throughout its member teams, which coincide with the largest U.S. population centers. This is an act that has nothing to do with jump-starting the baseball season; it is merely a public service. This makes me proud to be a baseball fan. Even before public gatherings were banned, I saw the ballplayers in spring training tossing autographed baseballs to fans rather than signing items passed to them.
A few lessons remain particularly salient. What is known about the novel coronavirus hasn’t changed that much since its discovery, and most of our policies have had to center around the rationing of protective equipment, which will become an important talking point in the months to come. Expert opinion in the scientific community has been best distributed electronically or via webinars. Traditional medical journals will be overcome by articles related to the coronavirus for the foreseeable future. If anyone believes that this pandemic has uncovered the fact that the U.S. health care system is flawed, that person hasn’t been doing his or her homework over the past thirty years. Any health system that uses capitalism as its backbone will eventually require a government bailout when an unforeseeable crisis like this emerges. In my specialty, we see that inappropriate utilization of imaging is a correctable problem when an external force is applied.
What is perhaps most striking about our current situation is that despite my lifetime of training (and sizable student loan debt) essentially catered for this moment in time, my hospital ignored me when I offered to help. A doctor with supplemental master’s degrees in molecular biology and public health–what could I possibly have to offer? This is academic medicine at its weakest, wherein the hubris of the academic chain of command clouds intelligent utilization of human resources while my supposed superiors struggle to develop evidence-based policy. The only thing increasing my stress level is people telling me that I am supposed to be stressed out. MLB commissioner, I’m in the bullpen if you need a consultant.
In the meantime, my thoughts remain with the afflicted, both in physical health and economic well-being. Over the breadth of my education, a common theme among pandemics is that they come to an end. This one should be no different. We may not yet be at the beginning of the end, but I believe that we are at the end of the beginning.
Cory Michael is a radiologist.
Image credit: Shutterstock.com
