June 24, 2020
Dear Members of the Baylor College of Medicine Community:
What follows is a very long caveat, followed by very short message; it seems to me the caveat is actually more important.
Two weeks ago, I talked about where we were. As difficult as things are now, some things are better than in April (e.g. patients seem to be somewhat younger and less critically ill, we have some emerging treatments). There is a little glimmer of hope.
Last week, I talked about where we are: the fact that our only real weapons against the viral invader are scrupulous attention to physical distancing, masking and staying away from others if you develop symptoms. Please re-read that message and broadly share with others. I still see the occasional mask-less person in the hallway and hear of someone who “didn’t feel well” for a few days at work, and turned out to test positive. I think these exceptions are few, but we need to all push for universal compliance. Mask, distance, don’t come to work sick.
As we are now in an environment where the community presence of the disease is on the rise, the natural question for this week is, “Where are we going?” What’s next?
The most honest answer – and the one that makes this whole situation so difficult – is no one knows.
It is about 6:30 Wednesday morning, and pouring down rain. I look at my weather app and see a large cloud settled over Houston. I am very confident it will be raining in half an hour. It is less clear what will happen this afternoon. I would like to spend some time outdoors on Saturday, and don’t have a clue as to whether it will rain or not.
To me, that is what the COVID-19 pandemic feels like. We can only see what is just around the corner. Everything else is opaque. Will it spontaneously fade like SARS? Become an endemic pathogen, waxing and waning for months or years to come? Mount a major recurrence during flu season? Will a safe and effective vaccine be available this year? Next?
No one knows. Dr. Fauci doesn’t know, nor do the politicians, nor do the media pundits. We have guesses – often well-educated ones – but still guesses.
We use the hurricane analogy a lot, but increasingly it is a poor fit to this situation. In Houston, we are really good at hurricane response. We know when one has the potential to hit. We have context and experience from prior storms to know how bad it might be. It makes landfall, does its damage and passes. Houston can then do what it does best – pick itself up and recover.
This is not a hurricane, though I struggle to find an accurate comparison. Comparisons all seem either trite or overblown. It is like an innocent civilian population caught between warring powers. It is like dealing with the complex physical, emotional and cognitive needs of an aging relative with dementia. It is like losing a job in a down economy and struggling to care for your family. You know it will end, but you do not know when. Part of you knows you have the resilience to get through it, and that you will find strength in a difficult situation. However, in the moment, the uncertainty is the hardest part.
So, with that caveat (nobody knows), here is my view of what to expect in the next couple of weeks:
- The viral numbers in Houston (total new cases, TMC hospital admissions, ICU census) will continue to rise.
- TMC hospitals capacity will begin to be stressed, and hospitals will activate plans for sustainable surge capacity. This will involve adjusting staffing patterns for physicians, nurses and other providers and opening additional ICU beds. The hospitals can function at this level for an extended period of time. As viral numbers continue to climb, there will be increasing planning around emergency surge capacity. It is hoped the more disruptive emergency changes in the delivery system will not be needed, and even in worse case projections right now are at least three weeks off.
- We will all know someone who develops the COVID-19 illness – a family member, friends, neighbors, co-workers. It is inevitable as the virus spreads in the community. Most of the disease in our Baylor community will be imported from the outside. Our internal testing and contact tracing processes will effectively limit the spread of the virus at work.
- The increased viral numbers and associated media focus will get the attention of the citizens of Houston and surrounding communities. For those who have not taken this seriously up to now, we will see virus avoidance behaviors start to improve. More masks, less congregation in crowded bars and beaches. The July 4th holiday weekend will still present challenges, but will be materially better managed by the public at large than Memorial Day.
- State and local officials have already started to stake out a more aggressive posture on virus control. In Harris County, masking is now required in all businesses. Officials will continue to explore effective means of limiting viral spread (through education, regulation and enforcement), while attempting to avoid the economic impact of a broader business “lockdown.”
- Improvements in masking and heightened public awareness will slow the viral spread to a degree. The success of these efforts is a major variable in predicting our peak. My current guess is that our peak will occur in late July. Remember the caveat – I don’t know if it will rain on Saturday.
My most important prediction: Our Baylor community will be stressed by the disease burden in our community, but will continue to work together effectively to meet our organizational mission. We will continue in challenging circumstances to take care of a population that needs quality healthcare more than ever, pursue new discoveries and educate future providers and scientists. Most importantly, we will keep each other safe. Thank you all.
James McDeavitt, M.D.
Incident Command Center