“Yeah, I’m not sure why everyone is losing their minds. There aren’t even that many cases,” I wrote. Like much of the rest of the country, I was being naive and avoiding reality.
Now we know where things stand. In the calm before the looming storm, everyone is concerned for the safety of their loved ones. We’re scared about the grocery stores running out of beans, the pharmacies failing to restock prescription medicines and the nationwide shortage of toilet paper.
But the health-care workers I know are suffering from a unique brand of psychological distress. I won’t call it anxiety, which the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes as “excessive worry,” because there’s nothing excessive about it. I would describe what we’re suffering from as pre-traumatic stress disorder. Trauma is defined as a deeply disturbing experience. With post-traumatic stress disorder, after suffering a trauma, a person experiences intrusive negative thoughts and psychological distress. Doctors and nurses see news from our colleagues in China, South Korea and Italy, letting us know in no uncertain terms what is coming. The result is that we are all feeling the psychological ramifications of the trauma. We just haven’t experienced the trauma yet.
Because the battle we’re waiting for is already being waged somewhere else, we’re expecting systems overwhelmed with sick patients who will line the hallways of our emergency rooms and hospital wards. We know doctors and nurses will get sick and have to self-quarantine for 14 days, leaving the health-care workforce decimated. Physicians unknowingly exposed to the coronavirus will spread the disease to our most vulnerable populations. We will run out of beds and ventilators in intensive care units, and we will have to make harrowing, traumatic decisions about who lives and who dies based on nothing more than utilitarian guesses about remaining “life years.”
We know that we will get infected, and we hope that we will be fine after 14 days of quarantine. But we will almost definitely infect our children. And they, in turn, will infect their caregivers — in many cases, our aging parents, because there is nobody else to care for them, because health-care workers cannot telecommute. And then, in the darkest of nightmares, we imagine becoming directly responsible for the deaths of our own parents or other loved ones.
We will watch this all play out with the knowledge that the only action that can possibly slow the exponential growth and explosion of this disease is social distancing, which is happening with woeful inadequacy. We drove down city streets on Saturday, passing by packed bars and restaurants, and pictured clusters of asymptomatic viral loads ricocheting off one another into the night, into homes, into families and communities. Communities that will then become our patients, that we will probably have to treat without adequate personal protective equipment like masks and gloves, because we’re running out of those, too. And the cycle continues.
The only other potential means of stemming the tsunami, widely available testing, is also nowhere to be found. We can’t stop the spread of the disease if we don’t know who has it, and at this time, there are hospitalized patients and exposed health-care workers all over the country who can’t get tested because of a lack of supplies, equipment and foresight.
As I put my young children to bed tonight and answer their questions about the coronavirus, I tell them it will be fine. But I know it won’t be. I’m not anxious; I’m pre-traumatized. And with good reason. We’re all in for the fight of our lives.