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The Crisis of Our Time

The President’s Paragraph from the May/June 2020 issue of the Tarrant County Physician.

by Tilden L. Childs III, MD, TCMS President

At the beginning of this year, I was asked by several people what my goals were for the Tarrant County Medical Society during my presidency. What projects was I planning to work on? At the time, I half-jokingly responded that I did not really have anything particular in mind (although I did), but that I was sure something would come along.  Well, as we all know now, something big and important and scary came along: COVID-19, the disease caused by the novel coronavirus now known as SARS-COV-2. The disease has caused an unprecedented disruption in the world. This was succinctly documented by The Economist magazine with a cover illustration of the world labeled with a “Closed” sign. As this is a rapidly evolving medical crisis with drastic implications for all walks of life and for our future, anything specific that I share with you at the time of writing this article may likely be out of date at the time of publication. However, here are some of my thoughts today.

First of all, I would like to share with you my unwavering appreciation and my awe at the overwhelming response of our medical communities at the local, county, state, and national levels. At the local and county levels, the TCMS leadership is working with and coordinating with the Tarrant County Public Health Department and with our city and county representatives and governmental agencies through our representation by Dr. Veer Vithalani, Acting Medical Director of Medstar EMS. The Tarrant Medical Operations Center (TMOC) has been activated by Dr. Vithalani to help coordinate the medical response in the community. We are also working with the local healthcare systems through our TCMS COVID-19 Task Force. TCMS is helping to facilitate the transfer of information to our local physicians as well as to provide a valuable resource to the media and the public. Additional TCMS projects include assembling a list of medical volunteers, helping to recruit and distribute personal protection equipment (PPE) obtained from community and public resources to local physicians’ offices, and monitoring the availability and progress of COVID-19 testing in Tarrant County. 

Also, TCMS is working with the Dallas County Medical Society to review the recommendations previously developed in the North Texas Mass Critical Care Guidelines document. Additionally, TCMS is working closely and integrally with the Texas Medical Association (TMA). The TMA has marshaled many resources together, has implemented a COVID-19 Task Force, and conducts daily telephone conference calls through the TMA Incident Command Center. The TMA daily morning telephone calls have approximately 100 participants. The TMA gives excellent daily updates of all of the activities being performed by the TMA as well as working closely with the members on the various concerns that have arisen during the course of the medical response to COVID-19.  The American Medical Association (AMA) has been working at the federal level as well. Of course, numerous resources are available online. TCMS provides information and updates on our blog. Additional information is available and is updated daily on the TMA and AMA websites. 

In times such as now, we all need courage- the courage to persevere, to serve, and to honor our commitment to our patients and our profession.

What I have observed at this point in time is that containment has given way to mitigation, which has given way to suppression, with increasingly severe restrictions on our daily life. This includes “shelter in place” restrictions and the closing of non-essential businesses. Of course, the goal of all of this is to “flatten the curve” of new infections over time so as to try to keep from overwhelming the healthcare system. Current estimates predict a decline in the curve sometime in mid-April to early May, and this appears to be occurring! 

Suppression strategies may work for a while, but what is the exit strategy? What will the “re-opening” of our society look like? Will it be relaxation of societal restrictions in conjunction with continued surveillance through extensive testing and contact tracing, new or improved treatments/medications, vaccinations, the eventual development of “herd immunity,” or what? The threat and severity of a “second wave” of infections following the relaxation of restrictions remains to be seen. Will COVID-19 become a seasonal disease? Will a vaccine be developed in time to prevent a recurrence of this crisis? This is doubtful, with current estimates of 1-5 years to develop a vaccine. Possibly the virus will become less virulent over time. Perhaps the “new normal” will represent a significant modification of our daily routines and practices as we learn to cope with this virus. Will tele-medicine/telehealth become entrenched in our practices? As always, time will tell.

For our healthcare system and particularly the members of the healthcare team, this has been and continues to be a time of great challenge and sacrifice. The uncertainty of the current situation and of the future is scary and anxiety provoking. We want clarity of the threat and the knowledge upon which we can trust and then to act accordingly to care for our patients and society as a whole. As this crisis has evolved, it has become painfully clear that expectations of a strong and swift federal government response were unfulfilled. However, I do believe this is not due to the lack of leadership by the medical profession at the highest levels of government. 

The ongoing critical lack of PPE and the slow ramp up of testing has been incredibly stressful and indeed threatening, if not outright harmful, to the health and welfare of our medical personnel on the front lines. This in turn threatens our ability to provide the necessary care for future patients. The impending surge (at the time of this writing) also threatens our patients with a lack of ventilators for the ICUs. Fortunately, American ingenuity and a “can do” attitude is rising to the challenge. 

In times such as now, we all need courage—the courage to persevere, to serve, and to honor our commitment to our patients and our profession. Although the winds and waves of the world are bashing against us, take heart. Have an anchor. Social distancing does not mean spiritual distancing. Be strong and keep the faith. I look forward to seeing you all, each and every one of you, again soon!

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