Peter Brindley: Covid-19—and now what?

A single coronavirus weighs less than one attogram (which is 10 to the power minus 18 grams). If 50-70 billion coronaviruses are needed to make a human sick, then we’re talking approximately 0.0000005 viral grams per patient. With six million cases worldwide, we’re still only three global grams, or less than the weight of salt on a teaspoon. However, by the end of May 2020, this tiny enemy has forced doctors to write “covid-19” on over 350,000 death certificates, has had a huge impact on the world economy, and has the public exhausted and fearful. Mercifully, round-one from this RNA wrecking ball appears to be on the wane. For example, my intensive care unit has not admitted a new covid-19 case for a month. So, bring on the “philosophical autopsies:” Did we get it right? More importantly, where do we go from here?

In the hospital we are cautiously transitioning to “no-vid”: touch wood; fingers crossed; rabbit’s foot. Everywhere, green shoots of normal activity are emerging. For example, we have resumed elective surgeries. Visitors are back even though all are gowned, gloved, and generally frogmarched. I expect 2020 to be a “digital year”, namely one where our digits are washed and washed and washed. I also presume smiles will remain “masked” until future notice. In the spirit of “never miss a crisis”, however, I need to sheepishly acknowledge that this been a relative boom for us in healthcare. Compared to those facing financial, physical, or psychological hardship, doctors and nurses are among the fortunate few. 

I have spent years failing to explain what I do for a living. In contrast, the 2020 dictionary now contains entries for “intensivist” (my job) and “PPE” (my costume). Canadian kids have told me they want to be doctors and nurses in the same way they used to say “hockey player, obviously”. With deep gratitude, however, can I ask for the adulation to stop. No more bashing pots and pans or giving me freebies: It is making me uncomfortable. I will know that life is better when the fanfare dies down, and when playful doctor jokes resume. 

Despite uncertainty and fear, so many people have leaned into this problem: medical and non-medical alike. As such, we are right to feel inspired and hopeful. However, let’s also heed covid’s uncomfortable lessons. We have flattened the viral curve, but haven’t really flattened bureaucracy. Documents are still 20 pages too long, and half of all emails are about status-management rather than problem solving. Covid has also meant a dispiriting rise in nonsense (disinfectant to drink, anyone?). Soaring rates of depression highlight how many people were barely hanging on, and rising domestic violence has confirmed the origin of our species. My point is that others need and deserve more support than me. Regardless, it is “patient earth” that I wish to discuss, while acknowledging that 30 years of biomedicine has left me ill-equipped to comment: but, when did that ever stop a doctor? 

I love nature: love it to bits. This has become even clearer during my daily covid commitment to do and see something joyful. I am excited by the prospect of starry skies that were previously blocked by pollution, and the carnival of animals that might return to our towns. With this in mind, Tom Robert’s poem “The Great Realization” is worth your time. A child in the future asks for “the story about the virus”. Roberts opens with: “a world of waste and wonder, poverty and plenty, back before we understood why hindsight’s 2020”. He then lyrically chides lives of lazy consumption, soulless distraction, loss of work-life balance, and environmental disregard. I was guilty on all charges. Halfway through, Roberts pivots into why covid-19 could be a blessing not just a curse: “when we found the cure and were allowed to go outside, we all preferred the world we found to the one we left behind”. The child then asks: “but why did it take a virus to bring the people back together?”. The narrator’s pithy response: “well sometimes, my boy, you’ve got to get sick in order to become better.”

Others will use the viral-lull to resume plans for world domination. Similarly, I fear I will sink back into old ways and selfish conceits. After all, my life before covid-19 was darn good, and its only now that I wonder why I took it for granted. Sure, I want this virus gone and, of course, this yuppie has a dozen post-covid plans. However, truth be told, I hope that covid-19 has irrevocably changed me. As a doctor, I know that viruses insert themselves into our bodies and alter how we function. However, the impact of this tiny virus could be massive if it changes things at the macro societal level as well as the micro cellular. I, for one, don’t mind if covid-19 prevents us going entirely back to “normal.”

Peter Brindley, Professor of Critical Care Medicine, Medical Ethics, Anesthesiology at University of Alberta, Canada.
Twitter: @docpgb

Competing interests: None declared.