“For a moment, think of the United States as a
human body. Full of heart and mind. Bile and blood. Muscle and fat. Like any
body, it has its strengths and weaknesses, and must consistently work to
prevent disease and optimize function. It needs to nourish itself, exercise,
and take care of its physical and mental health. And if the country, like the
human body, were to get sick or infected, it should seek the best medical
guidance and follow it, as hard as that might be.
“Around the world,
there are more than 4.6 million people confirmed to have been infected with the
novel coronavirus. Roughly a third of them are in this country alone. Just as
the coronavirus uses its spike protein to enter and infect human cells, so did
planes with passengers enter and infect the United States. Even for the most
diligent and hygienic among us, living on this planet means we will
continuously come in contact with pathogens, most of them harmless. In fact, as
much as we don't like to think about it, we humans are happily functioning made
up of more germs than human cells. But every now and then, a new or novel one
finds a home in our bodies, takes root and starts to replicate.
“The same can happen
to a country. In both cases, we have been forced to become host to a guest we
never invited and would like to leave. These novel viruses don't
announce themselves, ring the doorbell or call ahead. They just show up, using
close friends and family members as Trojan horses. So tiny -- just 20 to 400
nanometers in diameter. A billion of them could fit on the head of a pin. They
come in different colors and shapes -- rods, circles and icosahedrons. They can
look like Hydra of Greek legend, with nine heads or just as many tails. This
new virus is a regal one in appearance, a king or queen of viruses, complete
with a crown of spikes, which is where the coronavirus got its name.
“It
is hard to believe something so tiny could so profoundly change the world, as
this virus has done. Of course, we want it to die. We want to kill it. Render
it lifeless. But that is impossible. Why? Because this virus is not even alive.
It is just a string of RNA in a fatty envelope. They are the zombies of the
microbe world. Without us -- the hosts -- the virus is nothing, lacking any
ability to grow, thrive or reproduce. It cannot even be cultured in a petri
dish for scientific research. It can only grow in living cells, like the ones
our bodies provide in abundance.
“The
truth is this: Viruses are exquisite and crafty hijackers. Once they enter a
perfectly innocent human body and use its cells to replicate over and over
again, the virus begins a steady march onward, catching a ride in your blood,
your lymph nodes and your secretions. It likes to travel, and fast, with no
consideration to the path of destruction it leaves behind. The body mounts a
defense, sending out armed guards, throwing up roadblocks and trying to starve
the virus of precious nutrition. The body will even muster great energy to boil
the blood in an attempt to make the environment as inhospitable as possible.
“There
is collateral damage, and healthy bystanders will often be damaged and
destroyed. Such is the nature of a battle with a virus, our most formidable
foe. Often times it works, but sometimes it doesn't. And in those cases, we
need help. The best would be creating an extraordinary defense system that
recognizes the virus immediately and has a shoot-to-kill order. It is an Iron
Dome, Patriot missile system and an army of assassins standing by for any
possible future invasion. Within the body, all of these defense systems would
be trained under the auspices of a vaccine. That takes time, however, and
inaction is not in the nature of a human or the country those humans inhabit.
“If
the country were my patient right now, we would be having a conversation that
would be important, tough, forward-planning and goal-oriented. Since I
graduated from medical school nearly 30 years ago, I've had to have those
conversations many times.
“Every
now and then, the patient is so sick that there is no hope of recovery. Those,
of course, are the toughest conversations of all. But that is not the case
here. The conversation we are now having is a challenging one, no doubt. But I
am also quite confident that not only can we restore the patient to good
health; we may even make the patient stronger than before. More prepared, and
ready to deal with this infection in the future. Both doctor and patient have
to be willing participants here. I have to keep up my end of the deal, and the
patient has to keep up their end of the deal as well.
“Whether
it is the body or the country, people want to heal and recover as quickly as
possible. And, they want to do it with minimally invasive techniques and as
little treatment as possible. It's the same things doctors want for their patients,
but the most effective treatments often take time and diligence. No short cuts
allowed.
“I
have yet to meet a patient who relished their treatment and looked forward to
it. So, as a neurosurgeon, I have to take time to explain what I am
recommending, why it should work and the perils of abandoning the treatment too
early, whether it is a newly diagnosed brain tumor or an infection ravaging
their body.
“For
example, I often tell my patients that stopping an antibiotic too early for a
bacterial infection could be worse than not taking one at all. That is because
those infections have a heterogeneous population of bacteria. Some of the
bacteria are more susceptible to treatment, while others are tougher and will
only succumb after a full course of the medication is delivered. While an
antibiotic may quickly wipe out the easier-to-kill bacteria, stopping too early
means only the toughest bacteria are left behind, the lone survivors -- and
they quickly begin to replicate. The result: a resistant infection. One that
makes my patient even worse off than when they started.
“That
is why I'm worried about my patient right now. In this case, the United States
of America. We have been infected, and we are only part way through the
miserable therapy. If we stop now, however, it may not just be back to square
1. We may be worse off than we started. The metaphorical resistant bacteria may
be unleashed.
“Getting
through this together means listening to the recommendations from health
experts, understanding the rationale, being thorough about the treatment, and
not giving up part way through. It also means providing constant reminders that
this isn't the patient's fault, or the country's for that matter. Just as I
don't know why patients develop a crippling brain tumor, we don't know for
certain why the world became infected at this time in our history.
“In
my experience, placing blame in this context serves no purpose. I cast my eyes
to the future and not to the past. It will not change how I treat the patient
or how the patient will respond. I
often spend a lot of time with patients showing them the studies that provide
some proof the treatment I advocate can work. Patients want that, and they
deserve that. I even keep lists of patients who have already recovered and
thrived, and I introduce my new patients to them. The same is true here. There
is proof the treatment being proposed for the country can work, and we should
consistently remind each other of that. And we should also learn from other
countries that have already started to slowly recover and more safely reopen.
“People
often ask me if it is hard to have those conversations with my patients. That's
not how I would describe it. I describe it as an opportunity to heal someone,
body and mind. To get them better. To make them whole in a way that they didn't
think was possible. That can happen here as well, if we stay the course. The
country and the world are facing a serious illness, but it is treatable. It is
fixable. Let's do this together” (Dr. Sanjay Gupta: If the United States were my patient, CNN).
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