Transcription:
Lessons Learned From the Spring of Covid-19

Caitlin Whyte: The COVID-19 public health crisis is far from over. Throughout the spring, as Massachusetts hit its peak, thousands of lives were lost and mourned mostly at a distance. And as the numbers began to slowly improve across the state, Dr. Schoenthaler became a trusted voice of reason. Referring to herself as Dr. Robin Schoenthaler, Boston Cancer Doctor who writes about COVID, her insights and regular musings became popular on her Facebook page and LinkedIn. As people from around the world, engaged and commented, covering topics, as vast as ventilators, vaccines and virtual doctor's visits, to daily walks and signs of hope. Her perspective was what the community needed to help get through the very trying time. We are happy to have Dr. Schoenthaler, Radiation Oncologist at Mass General Cancer Center at Emerson Hospital, with us today. This is Health Works Here. I'm your host, Caitlin Whyte.

Host: Now that we're a few months into, you know, this new reality, what do you think the healthcare community will take away this Spring of COVID?

Dr. Schoenthaler: Life turns on a dime. I think being exposed to the financial impacts of these things has been very eye-opening. I think the fact that there's no, there's such a inadequate public health infrastructure. You know, the fact that we, that masks became monetized, that people were being sent in to hazardous situations and still constantly are being sent into hazardous situations with inadequate PPE. I think people are going to leave healthcare because of the sense of being unprotected. I think some people will be more dedicated to healthcare because this has been really brings into high relief, the relationship between medicine and society and individual patients. I think there's been some really good things in there. Some really bleak things.

Host: How do you see just society growing from this same Spring of COVID? What are some takeaways there?

Dr. Schoenthaler: I don't know if it's predictable. I really don't. I mean, one would like to think that we'll also slow down and be less ambitious and spend more time with our families and take the kids fishing more often, all that. But you know, so many people have been devastated economically that, you know, I think only the precious few are going to be able to really alter their lives now to go back to that kind of more, I don't know, organic way of living. I read a lot about the pandemic of 1918, 1919, and at which was influenza, which was much worse than this. I mean it was much worse, it targeted young, young people. It was, you could die in 12 hours. It was a bleak death. They didn't have no. Well, yeah, they didn't have nearly the medical care that we have to carry you along through the crisis. You know, when you look at newspapers in 1922 were magazine articles, people barely mentioned it.

So I don't know, I don't know how much big change they'll be. Now, what happens after most big pandemics that are of this kind of Epic crisis magnitude is that you have changes in system. Like almost always the public health system gets augmented in some way. And then over the next ensuing years or decades, it gets chipped away and we've seen that over and over. So that might happen. You know, there'll be a resurgence of interest in virus, viral research, that'd be a resurgence in funding our public health infrastructure and systems can change. Medical education changed after 1918, you know, things change, but how much people's lives will, I don't know

Host: Now taking what we learned in the spring and looking into the fall, of course, school is on the forefront of everyone's minds with school and the flu season.

Dr. Schoenthaler: Absolutely no idea.

Host: Absolutely no idea?

Dr. Schoenthaler: Yeah, absolutely no idea. And I've stayed away from that question completely. It's so complex. It's much easier for a family to decide the third, get on a plane or go, you know, rent an Airbnb or, you know, go to castle Island or whatever. Then it is to decide what level of risk they're willing to accept it at school or with the schools are willing to accept. And it's such a complex psychosocial economic criminal system. I mean, it just covers every aspect. I have absolutely no idea. And I'm glad that smart people are thinking about it. I also, I also don't know what's going to happen with public transportation. I mean, you know, the young people in my family are biking, you know, but you know, most of us can't bike in February, to our diehard generation X's. So those two things, I really, I just have absolutely no idea, but one of the things that I've learned from the interactions that I've had with people as a result of this is and development of this is how incredibly differently people perceive risks. And it just above and beyond the politicization of mapping and all that other stuff.

But above and beyond that, just inherently people look at risk totally differently, depending on, I don't know, maybe their childhoods or something or, you know, some people have one bad thing happened to them. And then they think everything bad is going to happen to them. It, some people think only bad things only happen to other people. And, you know, I learned this, I wrote about it. And one of the methods I learned this very clearly as a cancer doctor, that if I say to a patient, you have a one in eight chance that this will come back, that sends some people into an absolute panic, that it means it's inevitable. And if I say there's the one in eight chance that it'll come back to somebody, that cancer will come back to somebody else. They're like, oh boy, those are the best odds ever. And it's the same thing with this only magnified in everybody's experience, you know, the way that people see if I walk down the bike path and somebody walks by M without a mask, now that means my elderly mother's going to die. Right?

It's like, wait, wait, you missed a couple of steps. There was that person infected? How long were you near that? You know? And so that part of it. It's just people's inherent mindsets or how they deal with risk. And then another thing that I think has been really impactful is it's some people like me are very much comforted by numbers. I like statistics. I can think about them. And they comfort me when there's the right statistics. Many, many, many people in my circles are completely swayed by anecdotes. And if they hear an anecdote about, you know, somebody walked down the bike path and the next day her mother died, you know, that that's locked into their head, and they can't get it out. And no matter how many times they say the statistics or the rationale behind why that's not necessarily stuck, they can't, they can't get away from it.

And that's where I think the news, the 24 hour news cycle the relentlessness of clickbait, every Facebook talking about, you know, the beach that they were at, where, you know, somebody coughed on them, we have so many anecdotes now. Our lives are completely ablaze with anecdotes. And maybe that's another reason why my misses work for some people or a lot of people is because it's not, it is, they're almost always an overview and sometimes statistical, but a lot of times it's just an overview of how the physiology works or an overview of what we know. I'm not looking at every mask study ever done that involves Earth. I'm looking at we know of course, wear a mask. It's common sense. And if you put a bag to catch your thousand viral particles in front of your face, you're going to disburse fewer of them. So anyway, that's been a really interesting thing.

It's just, why are people so consumed by anecdotes? And so suede? I think a lot of it is, is because that the news now is more about Anecdotes. I mean, the news has always been about anecdotes. And I, you know, if you look at the news articles from yellow fever in new Orleans or, or the pen, you know, or 1918, or even swine flu, you know, it's full of anecdotes, but I think it's worse now. I think it's, you know, we just are bombarded with anecdotes now.

Host: I mean, besides masks, what are some main ways you believe for people to stay healthy and prevent the spread of the virus, especially in the summertime with people kind of itching to get out?

Dr. Schoenthaler: Yeah. Well, I think the number one thing is staying home when you're sick period, you know, then you won't spread it, which is, you know, super hard to do if you're a working girl, but you know, that's probably the number one thing you can do to not give it to anybody. Don't be around anybody when you're sick and physical distancing, without any question, you know, being 12 feet away or six feet away, or maybe three feet away from somebody is better than being, you know, kissing them. Right. And I'm not, you know, I won't get into arguments about three feet or six feet or whatever. It's just, it's not worth it. The idea is stay out of their space, you know, out of the reach of most droplets. And that's the other thing is I, you know, in the misses, I just don't get caught up in the minutia almost ever. Okay. Occasionally I probably have, but most of the time I just, big picture.

 

And then of course hand-washing, which is super powerful. I mean, you can pick up all the cruddy mail in the world or grocery a can of beans from the grocery that the kid actually coughed on, and you can put it away in your cupboard. And then if you go wash your hands, you're fine. So those would certainly, I'm sure there's other things I'm not thinking of, but those would certainly be the main thing is being physically separated from people being masked, being good with your hand hygiene, which is incredibly tedious and hard to do, but it's been super effective and staying home when you yourself are sick. Also not being around people for a really long period of time. And then, and this is all, I'm all talking summertime. I mean, in winter, I, you know, I think people that are at super high risk in the winter should be just home. People that are really highly vulnerable and at risk of getting severe disease should just absolutely not go back to not hardly leaving the house because all of this is about being outside.

Host: Now, when it comes back to your writing, what can followers look forward to in terms of continued updates from you?

Dr. Schoenthaler: I'm going to keep doing it as long as there's something happening, and intolerably repeating myself. And, you know, as long as I keep getting, you know, really nice feedback about it, you know, I can see that, you know, maybe I'll go down to it. It does take a lot out of me. I think about it all the time now, you know, it's definitely become a thing. You know, it's like being a columnist, you know, once a week columnist. So I'm not saying woe is me, but it is, you know, it is a bigger thing than sitting around with a glass of wine, talking to my friends, right. In fact, I, you know, I'll read something and I'll be like, Oh, okay. I think this is going to go in next week. I need to remember, you know, I started keeping notes, you know, but anyway, so I can see, you know, maybe later in the summer is, is things calmed down. I think it'll be according to current events, you know, things stay calm down. They're wonderful in Massachusetts right now, you know, minus the 900 people that are still in the ICU.

But, you know, as opposed to 4,000, you know, things are better way better. And you know, that's been the other thing just as a side is that I really learned that the difference we have to be very careful in our definitions. You know, that, you know, most people would regard 900 people in an ICU as a catastrophe. And it is for those people and their families. I realized a while back that my definition of catastrophe is that the hospitals are getting close to overcapacity. That's my definition of catastrophe. Everything else is problems to solve and issues to deal with. But catastrophe is when we're past we're past capacity. We have to think about rationing, which was the scariest thing about Italy. But fortunately we didn't even get close here. We did great. But that was by, you know, heroic pre-planning and deploying of, you know, non ICU doctors and nurses to ICU. And I hope some prayers is that it doesn't get back to anywhere near that in the winter.

Host: That was Dr. Schoenthaler, radiation oncologist at Mass General Cancer Center at Emerson Hospital, Becky. Please visit Emersonhospital.org for information or Emersondocs.com to find a physician, and find all of Robin's musings on her Facebook page by searching her name. Thank you for listening to the Health Works Here Podcast, subscribe to this podcast on your favorite podcast source, including Apple podcasts, Google Play Music and Spotify. I'm your host, Caitlin Whyte. We'll see you next time.