| Dear Colleagues,
What were you doing on January 21, 2020 ~ just four months ago? • REMEMBER IMPEACHMENT HEARINGS? They now seem like a million years ago. Then we were allowed to go outside, get on airplanes, and we actually went out to eat IN restaurants. • The world's oldest asteroid impact, 2.2 billion years old, was found in Yarrabubba. • A man returning from Wuhan to Washington state had SARS-CoV2 infection confirmed. Then, our lives changed dramatically. We recently received good news in my state, Maryland, with hospitalized numbers across the state down to 1460, our lowest numbers in three weeks. We have begun to slowly open our ambulatory surgery centers, but at 20-25% normal volumes. Elective inpatient surgeries, procedures and outpatient visits will ramp up VERY slowly over a period of weeks based on safety concerns and PPE availability. Our epidemiologists have modelled the strong probability of a summer/fall surge, depending on how quickly social restrictions are relaxed. The worst-case scenario predicts a steep upward curve into fall, with over 4,000 beds needed for COVID-19 across the state. This would actually be 1,000 more beds than were required during our May peak. If this occurs, the progress that we have made in opening back up our clinical activities will again be curtailed. Obviously the situation will differ for each of our academic medical centers depending on local and regional differences, but the same general trends are likely to pertain. One critical element of our response to COVID-19 that neurology will have to continue to use in the months and years ahead is telemedicine. Unfortunately, efforts to create a national licensure that would permit remote visits “across state lines” have been thwarted because of concerns about individual states maintaining control. If this is not allowed to continue as a billable activity then it is almost certain that telemedicine will shrivel back to its nascent state. At Johns Hopkins and many other institutions research activities are planning to resume for lab-based research next month with social distancing, mandatory cloth masks, and reduced densities for staff and post-docs, with a minimum of 400 sq.ft. required per person. This will take significant planning and organization, and we do not expect lab productivity to get back to baseline levels for months, if at all. Clinical research activities will ramp up much more slowly, except for COVID-19 related research and high-priority activities. The use of virtual approaches to conducting clinical research is being actively explored (as discussed in my editorial in Annals 5.8.2020), but for many types of neurological research-- biomarkers and imaging--this will simply be impossible raising the possibility that some research may be terminated. Finally, educational and training activities remain largely conducted by the ubiquitous ZOOM™ platform. Educators and learners alike have shown remarkable creativity and flexibility in adapting to this style of learning. It remains to be seen how medical students and residents can effectively be integrated back into bedside teaching in hospital settings where there are large numbers of people with COVID-19. Finally, many of us may have seen the very moving virtual national graduation ceremony on May 16, at which President Obama spoke eloquently. “If the world’s going to get better, it’s going to be up to you. With everything suddenly feeling like it’s up for grabs, this is your time to seize the initiative. Nobody can tell you anymore that you should be waiting your turn. Nobody can tell you anymore, ‘This is how it’s always been done.” ~Barack Obama
Stay safe, Justin C. McArthur, MBBS, MPH |