On the Front Lines of the Coronavirus Emergency
When he’s not practicing wilderness medicine—caring for climbers with altitude sickness in the Himalayas or victims of the tsunami disaster in Japan—Stuart Harris is a physician in Massachusetts General Hospital’s (MGH) emergency department. That means he will be among those on the front lines as the number of coronavirus cases rises over the coming days and weeks.
On Monday, the same day that The Boston Globe reported that two MGH healthcare workers had tested positive for COVID-19 and the hospital’s president, Peter Slavin, said that confronting the disease would require a “war-like stance,” Harris offered a few thoughts on his concerns and expectations, and his hopes.
Harris spoke to Lydialyle Gibson—who traveled with him in 2017 to report on his work for a Harvard Magazine profile. The interview has been edited and condensed for clarity.
I know MGH has already seen some coronavirus patients. What are things like there now?
Things are changing so quickly. We're kind of in this strange space right now—we definitely are seeing patients return whom we appropriately diagnosed with COVID a week ago, from that initial cohort from the Biogen conference [a late February company gathering that has been linked to a surge of more than 70 coronavirus cases in Massachusetts]. And we had enough tests to prove infection in a few of those patients. Others, we didn't have enough tests to be able to convincingly test them, but every expectation was that they were COVID-positive. They were appropriately sent home and put on quarantine. And we've already had some of them coming back fairly sick—and some younger and healthier people than, frankly, we'd like to see. The initial guidance was that older patients and those with co-morbidities were more at risk from the illness, but we're seeing some sick young [otherwise] healthy people, too.
The initial guidance was that older patients and those with co-morbidities were more at risk from the illness, but we're seeing some sick young [otherwise] healthy people, too.
What do you make of that?
There's just so little information right now. This is a novel infection. We don't have two millennia of experience with it, like we do with tuberculosis or with Staph. aureus, or even the same knowledge we have of infections like influenza or H1N1. We really don't know what the basic characteristics are in the clinical presentation of this new disease. And until the last two or three months, our population was pretty much universally unexposed to it.
The other big thing is, we're now hopefully very rapidly ramping up our capacity to test people. Then we'll have a much better idea of what’s out there. Right now, it's not just that we don't know the disease; we don't know the numbers. We don’t know how many X-thousand patients may have been infected, and so can’t work backwards to estimate that 4 percent of those are going to end up in the ICU, or that 10 percent of them end up in the hospital, or 80 percent might be treated at home. We don’t know those numbers. We are trying to read through a glass darkly. Right now, we don't even know how many people have been exposed. We just have almost no idea of the denominators. So, getting some familiarity with the basic numbers will help us to figure out the characteristics of the disease.
We really don't know what the basic characteristics are in the clinical presentation of this new disease. And until the last two or three months, our population was pretty much universally unexposed to it.
What kinds of preparations has the hospital been able to make amid this kind of uncertainty?
The hospital, I think, has mounted a pretty magnificent response so far, in recognizing the seriousness of this situation. And there are definitely things we can do. We’ve been opening up beds upstairs [in the inpatient hospital, outside the emergency department] and clearing out space for more patients, deferring all non-essential activities. We've closed off the EMS entrance ramp to the hospital, and that's now being used for COVID screening.
And we’re trying to make sure we’ve got everybody arrayed as best we can to help. If you work in the emergency department, if you work in the ICU, if you’re a pulmonologist, you’ve got your work cut out for you. But there are others whose medical expertise you wouldn’t necessarily think would bring them immediately to the front, and they may be called on. We need to think seriously about just how deep a bench we have and how to make sure we are keeping enough providers prepared to do their jobs—and not necessarily the jobs they would otherwise be doing day to day.
So a lot comes into play thinking about this huge additional demand. There are a lot of moving parts. Already, under normal circumstances, we see 114,000 patients a year in our emergency department. And we're suddenly facing a large unknown in addition—maybe two or three times that, just in people who've got COVID.
Some predictions have said the United States is about 10 days behind Italy in the progression of the outbreak. When do you expect to see patients start flooding into MGH?
It's not completely clear. Looking at the charts I've seen, the next week or two are going to be telling. And I think if we’ve failed to flatten the curve, we’ll know pretty quickly. If we’ve done some things right, it may be slower to pinpoint. But I think that in 10 to 20 days, we’ll get the first real signal on how many sick people we're going to have.
I think one thing I'm taking solace from in all this is just how, when we recognize the seriousness of a threat to human health, we are able to mount an extraordinary response. Think about the business communities and individuals upending their lives the way so many have. Ten days ago, you would have said no way that could happen. It was unthinkable.
You mean schools and businesses suspending operations and people staying home to slow the spread of the disease?
Yeah. You know, this crisis is not out of the blue. History teaches us we had every reason to expect a pandemic would be coming our way, whether something viral like an especially virulent influenza or a more novel coronavirus like MERS/SARS, or the increasing prevalence of untreatable diseases related to multidrug-resistant bacteria. Or the direct health impact of climate change on humans. Human health depends on a healthy environment. So much of “modern” medicine is dependent on access to effective antibiotics, and despite clear signals that multidrug resistance is increasingly a problem, we continue to dump antibiotics into human-animal food chains. We have massive evidence for the direct impact of climate change on human health that makes our current viral disaster pale in comparison and yet we’re too often unconcerned about making policy changes that would protect human health by protecting its source—a healthy biosphere.
But the last two weeks have given me reason for hope. It’s heartening to see that we actually can make pretty radical changes when we understand that human health on a large scale is directly threatened. We have shown we can act decisively to help protect ourselves. These lessons will inform future changes. I have hope.
Think about the business communities and individuals upending their lives the way so many have. Ten days ago, you would have said no way that could happen. It was unthinkable.
Any advice that you think people may not have heard already?
No, I just think it is key that people truly value their contribution in isolating themselves from others right now and in washing their hands. That’s doing a tremendous amount. These things may seem simple, but they are hugely meaningful.