I am a Pakistan- and US-trained, board certified physician with specialty training in infectious diseases, now pursuing a third specialty in New York — the current epicenter of the epidemic in the United States. I contracted Covid-19 a few weeks back, before it had gripped New York. Unaware that I had come into contact with the dreaded disease, its arrival was announced by low-grade fevers, shaking chills, and wrenching muscle aches. Initial denial that this was Covid-19 was replaced by panic, which was swiftly followed by an unsettling acceptance. Why should I be any more immune to the pathogen when star athletes and world leaders are not? We are all human, after all.
I am now in the convalescent phase, after many near run-ins to the emergency department over the last few days, and one hospitalisation. Acutely aware of how the prized hospital beds and scarce resources need to go to our sickest and most vulnerable, I ran a mini-ER of sorts at home, trying to hold off admission to hospital for as long as I could. Round the clock, I self-monitored vital signs, clutched through stabbing, knife-like bouts of chest pain, breathed at more than twice the normal respiratory rate for hours at end, and promised my physician colleagues that I would call 911 if my oxygen level dropped below a critical threshold.
I nebulised, medicated, hydrated myself through a scary, dark, uncertain illness that spares neither young nor old. In our years of training and practice as physicians, we have our share of close experiences with situations involving death. We are not unfamiliar with it. I am ‘only’ thirty years old, but many others younger than me are on mechanical ventilators in hospitals around the globe. I was prepared for all possible medical outcomes.
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As physicians used to a certain level of empirical certainty in decision making, this unfamiliarity with the pathogenesis and the swiftness of Covid-19’s attack has left us all balking. We embrace the fact that we don’t know a whole lot about the virus. And then we fight back. The process for declaring a true cure is slow, long, pain-staking and laborious.
Till then, my colleagues, both here and in Pakistan, armed with their scarce supplies of protective gear, accepting the high likelihood that they could get infected at any moment — and infect their loved ones — step out to help those who depend on us. You salute us and clap for us, but what we really need is for you to stay at home, and to respect the edict of social distancing until we can understand the method behind Covid’s madness.
The cardinal rule of disease epidemiology is knowing your case count. The foundation of effective infection control measures rests on testing, testing again, and re-testing until we are able to identify and isolate every infected case, and break the chain of transmission. Until we have such large-scale testing and quarantining capacity, we have to hunker down and sit this epidemic out at home. That is the only way to save ourselves. Nothing else will hold the virus at bay.
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In Pakistan, the healthcare system cannot handle the additional burden of a Covid-19 outbreak. But surely, we all must know that. If the health system in Italy (one of the most advanced in Europe) and in the US can approach near collapse, requiring hitherto unheard of injections of emergency aid and staff reinforcements to keep it running, what hope do we have? Covid-19 is not like dengue, where as long as we can nurse our patients with intravenous fluids and as-needed transfusions, the body will heal itself. The lungs of many Covid-19 patients will fill up with oedema from all the inflammation, until patients can no longer breathe. Oxygen levels will drop and patients will need to be put on a mechanical ventilator right away if they are to survive. There is no cure for this but time and artificial ventilatory support, and that needs specialised staff, support and supplies.
What does all of this mean? Why are physicians and public health officials all over the world crying out to governments and public alike to take measures that are strict, absolute and immediate? Imagine an avalanche of patients descending upon your already almost-full-to-capacity hospital, all gasping for air, all needing artificial mechanical support within hours of arrival, while the staff, exhausted, barely protected in their meagre equipment, struggle to get every single patient the relief they need. And then another wave hits, and another. It’s a replay of a nightmare, on a loop. This is the apocalyptic reality of Italy, this is the foreseeable future in New York, and this is what Pakistan needs to be ready for. We are collectively being asked to face our own mortality, head-on, right now.
Our lives today are suspended in a surreal, almost dystopian mist as our quarantined selves ask: Is this really happening? In New York, patients are becoming numbers, hospitals are bursting at their seams, people are dying without having a single loved one at their side, portable morgues are being erected overnight. The virus will spread in Pakistan, but we need to slow its spread down to a level at which the healthcare system is able to handle the onslaught of cases.
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As physicians, to serve our patients is in our DNA. As healthcare workers, we consider it our privilege to help our patients through their suffering. Protective equipment shortages are a reality now but they won’t hold us back. We will fight this monster for you even when the ammunition runs out, but you need to stay at home. We do not want any medals. We want you to listen to our call, and stay at home, and tell others to stay at home, for as long as it takes, weeks or months. Let us understand the limits of our knowledge. We can come out of this lockdown a bit late, but we do not want to come out of it too soon.
Right now, I cannot do much more than type away these words to you, but I must because I am scared. For my family, my friends, and for my fellow Pakistanis. I want my words to help shield you from the suffering that is around me today.