A Covid report from the front lines
Howard Zucker MD PhD
Howard Zucker was the former New York State Commissioner of Health during the Covid crisis. He is a pediatrician, anesthesiologist, pediatric anesthesiologist, and pediatric cardiologist. Oh, in his spare time he went to law school too. He recently wrote this piece detailing his experiences and because it is relatively short I am reposting it in its entirety with his permission Myron Yaster MD
https://medium.com/@hazucker/what-i-saw-as-the-hot-zones-health-commissioner-the-pandemic-public-policy-and-the-way-forward-134b01cf4077
Perhaps if Charles Dickens was writing the story of this pandemic he would begin with the words — it was the best of people, it was the worst of people. Through this historic public health crisis we witnessed how human nature and biology came to be at odds and how a battle for the body of each person and the soul of a nation was waged simultaneously.
Two years ago this past week, as New York State health commissioner, I flew to the hot zone on the Governor’s helicopter when the first confirmed cases were identified in Westchester County. We sat, maskless, across from religious leaders and shared what we knew about this novel virus. We promised statewide support. I wished I had more to offer but specific information was scarce. We knew very little about this new emerging virus. Our focus was on closing schools to try and protect students and teachers and the community. I left wondering when and how will this end.
The perplexed faces across the table that day were the first of thousands I would see over the years that followed. Fear of pending mortality created anxiety. I saw the diverse New York populous uncomfortable with a lack of assuredness about how things would unfold. As a physician I am ‘comfortable’ with the concept of invisible viruses wreaking havoc on our bodies, but such feelings are atypical for the lay person. The public prefers certainty or at least predictability. But as infections, hospitalizations and deaths skyrocketed, the models suggesting a collapse of the health system seemed like a realistic possibility. I knew from the beginning that without adequate testing, a vaccine and/or antivirals, none of which were available or even on the immediate horizon, we were only left with basic public health practices of masking, distancing and hand hygiene, in the hope we could flatten the curve that might prevent a health system implosion.
The fear of dying was prevalent in all of us. Throughout those harrowing early months as I spent endless days and nights at work, I too wondered what cost this may have on me. With one child ten months old and another only just past two years, the fear of leaving them without a father, or worse yet, orphaned, left me with the same apprehension that permeated the hearts and minds of millions. In one of those rarest of free moments, I found myself pondering my will.
And though others found that this jolt to the never-ending motion of our lives forced them to consciously pause and reflect on priorities, I was never in the position to put my life foremost as twenty million New Yorkers expected government to be at its finest hour. It was my job.
Whether learned or innate, my knack for multitasking and compartmentalizing, honed through years of running a pediatric intensive care unit, and caring for the sickest children, in many ways prepared me for endless unexpected issues. However, each unknown uncovered more queries and were met with ceaseless inquiries from the public, politicians and the press, eclipsing anything that challenging moments in medicine had ever heaved upon me.
I often thought about the pandemic’s bigger picture. When Covid-19 reached our shore it caused a tsunami of conflicting challenges for populations, policies, and public health that washed away any chance for a coordinated national response. We learned that as people literally put masks on, their figurative masks came off. We saw idiosyncrasies about our neighbors and colleagues. People morphed, much like the virus mutated, in efforts to adapt to change. While human behavior typically evolves independently from different stimuli — financial insecurity, family disruption, professional success — in a catastrophic public health crisis the entire globe evolved from the same historic stimulus — a virus on an unknown journey, traveling fast as a stowaway in the bodies of millions. With the seasons of Covid twice coming full circle many became desensitized to the titanic amount of information while others succumbed to a flood of misinformation; either way, a perfect storm for drowning out voices of reason was created.
Despite gathering data at unprecedented speed, we were unable to predict, on a microscopic level, viral mutations and on a macroscopic level, human nature’s response. The latter was the true unknown variable, that shaped how the pandemic played out globally. From very early on I wondered what silver-lining existed. Though I see opportunities for delivery system changes, I think a paradigm shift in philosophy may be as important as innovative spin-offs. For society to move forward we need to make bold changes.
Firstly, a firewall between public health and politics must exist. It is imperative that those dedicating their career to public service should be allowed to follow science and offer the best advice, options and input, free from constraints of elected leaders and partisan politics. Whether this involves term limits, appointment by a board or contract with protections, all options should be considered. All efforts must be made to assure that public health officials are not targets of threats. They should not feel their lives and livelihood are ever at risk by speaking up. We owe it to our citizenry to do nothing less.
Similarly, and secondly, the public must trust our experts. The scientific model, grounded in analysis and theory, has been tested by practical experience over centuries. John Snow’s ‘germ theory’ as the cause of cholera in 19th Century London and the World Health Organization’s smallpox eradication in the 20th Century are just two examples of how public health specialists use scientific processes to stop disease spread. Even though science evolves with new information, we cannot survive as a social order if we do not respect and value the specialists who unravel unknowns. What we need is new emphasis not just on science in our schools, but a better understanding of how science works and the principles of public health as we are surely going to have another pandemic in our future. Spreading misinformation via social media is metaphorically defamatory to the human condition as much as spreading falsehoods about people impugn individual reputations. Misinformation replicates faster than viruses.
Thirdly, when it comes to issues that can destroy the fabric of a nation, social responsibility must be paramount. Despite a TikTok culture, great benefits to our ‘neighbor’ must outweigh personal inconveniences. Our country has risen to this challenge before with the public sector, private enterprise and labor working together during World War II. Rationing programs from fuel to food, collection drives for recycling and purchasing of war bonds reflected community spirit. Paying people to get a vaccine to save their life and likely the lives of others is not emblematic of President Kennedy’s famous ”ask not…” quote. When fighting a pandemic, individualism and social responsibility can become competing forces. The person who condones maskless behavior may very well be the parent of an allergic child, who condemns acceptance of peanuts in a classroom. Though hypocrisy has always existed it may be more evident with societal restrictions.
My pandemic experience makes me believe it is a conflict between nature and knowledge, between variants and a vaccine. Even the best generals confront unforeseen foes, adapting, offensive and defensive tactics. Though often encountering criticisms, public health experts have accomplished much for humankind. We owe it to ourselves to bestow on each other some benevolence, for as Philo of Alexandria said during the first century, “be kind, for everyone you meet is fighting a great battle.”