August 5, 2020, New York City

My hopes for no new COVID-related admissions are shattered today when the night intern presents a patient, a taxi driver, with a classic pathology.


As hospitalists in a large academic institution in New York City, my colleagues and I first saw cases of COVID-19 as early as mid-March, worked through waves in April and May, and then had almost no COVID-19 admissions through June and July. By August, we have returned to our usual variety of medical admissions and wish for secret herd immunity in NYC residents, despite testing indicating that only 12% of the city's population carries neutralizing antibodies.

My hopes for no new COVID-related admissions are shattered today when the night intern presents a patient, a taxi driver, with a classic pathology. Fevers, cough, bilateral infiltrates on CXR, elevated inflammatory markers, increasing demands for supplemental oxygen. I feel my heart rate increase. Pulsation in my temples become more notable and a wave of nausea comes and goes as I calmly speak about existing evidence for COVID-19-related illness with my team of new interns. We discuss the Henry Ford and RECOVERY studies, as well as our own institutional study on the efficacy of steroids and ponder the appropriate dosing. We inquire if the patient is a candidate for remdesivir and convalescent plasma therapy. We counsel the patient on the benefits of assuming a prone position when lying in bed and ask nursing staff for continuous oxygen monitoring.

Preparing for tomorrow's intern report on COVID-19 inpatient management does not ease my anxiety about what is to come once the city welcomes back its remote workers and schools open to greet their students in person. It is not easy managing my fully informed anxiety. I can only imagine how nonmedical residents of the city will feel when reports of active COVID-19 cases pop up with increased frequency once people come in closer contact with each other.

The reopening of our public schools is at the eye of the storm. How long will it take for one or a few of thousands of teachers traveling by poorly aerated public transportation to poorly ventilated school buildings to become sick with COVID-19, to be admitted to the hospital, to the ICU? How long can I, a doctor and a mother of three school-age children, live in the state of unknown?

Not knowing the risk of contracting SARS-CoV-2, getting sick from it, potentially dying. Not knowing how effective various masks are in different settings. Not knowing when my kids will be able to go to school and be appropriately stimulated when I am at work (so many days in a week). Many of my colleagues are reporting increased anxiety and emotional lability. Living in the state of unknown is known to do that.

A rapid response is announced overhead. For a few seconds, my heart rate spikes, higher than it ever did in pre-COVID days, only to return to normal. The call is not on my inpatient unit.